HomeMy WebLinkAbout05-07-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Adaline E. Jenkins
also known as
Deceased
Petitioner(s), who is/aze 18 yeazs of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
0 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / aze the Alternate Executor
last Will of the Decedent dated January 4, 2007 and codicil(s) dated none
named in the
(State relevant circu»sstances, 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:
B. Grant of Letters of Administration
(If 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.)
Decedent, then 95 years of age, died on May 1, 2010 at Carlisle Regional Medical Center
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ <~ Gti`X'~ ~ d'b
(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:
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 panted name and residence
Charles P. Scott, III '7 ~
COUNTY, PENNSYLVANIA
File Number ~ ~ - ` Q - ~ ~ 1
Social Security Number 560-70-3998
Form RW-OZ rev. 10.13.06 Page 1 of 2
((,'UMPLETE INALL CASES:) Attach additional sheets if necessary. ~ ~ ~R ~ ` ; • ~-
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principa~e~dence at fV r~' z- }
Church of God Home 801 North Hanover Street Carlisle PA 17013 ~ ~ ~ ,~,: ~ ~
(List street address, town/city, township, county, state, zip code) L"-"-~
Oath of Personal representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF Cumberland
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 tc~ ~r affirmed and subscribed
refore me the 1 ~ day of
~,
Signature of Personal Representative
~ ~."~
Signature of Personal Representative ~ ~~ C7 ,,.,,~ ~-..:,,.' _
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For the Registe~ Signature of Personal Representative ;-~-_~ ~ C~ -~ Z,,y` -"~
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File Number: o~ ~ ~ U - ~~~
Estate of Adaline E. Jenkins ,Deceased
Social Security Number: 560-70-3998 Date of Death: May 1, 2010
AND NOW, w~l~(.~ ~ ~ in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Charles P. Scott, III
in the above estate
and that the instrument(s) dated January 4, 2007
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES f ld ~ ~"` -
Letters ............... $ ~~~~ . ~~ Register of
Short Certificate(s) ........ $ G • CS Attorney Signature: -
Renunciation(s) .......... $ ~~ U (~ ~ - ..
t ~ ~-~ I $ ' ~ ~ Attorney Name: Tay P. Andrews, Esequire
`C S • • • $ ~~ ~ ~ '~ U Supreme Court LD. No.: 15641
l~s~.... $ v ~ (~
Address: 78 West Pomfret Street
... $
• • • $ Carlisle, PA 17013
... $
... $
' $ Telephone: 717-243-0123
... $
TOTAL .............. $o~U 3 • `~ ~`
Form RW-02 rev. 10.13.06 Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ Fee for this certificate, $6.00
P 163561~~
Certification Number
HtOSl43 REV 11!2008
TYPE /PRIM IN
PERMANENT
BLACK INK
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This is to certify than 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.
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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 reversal __ - __
1. Noma d Decedent (First, riddle, teal, au1Poc)
JAL %ll,r~ C • ~ ENkr tir 2. Sex
r 3. Soda) Security Number
560 - 70 - 3998 4. Deb of deem (Monet, daY, Y~r)
05 -C/ l - 2C~ l U
5. Aga (Leal Birthday) Under 1 UrdM 1 8. Dare d Birth Month, de , 7. end state a f count 8a. Place d Death Check one
~S "'°~"' °ej" "°'"' '"~"°`
Se
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2 7
1914 Garden Gro a
~ O Hwpnat: peter
Yrs. p
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, wa ®Inpatbnt ^ ER / outpetlenl ^ DOA ^ Nurekg Hone ^ Residence ^ otna -Specify:
8b. County d Death
• 8e. City, Baa, Twp. of Death 8d. Fedlity Nerve (K rat iretlMbn, give street and number) 9. Was Deeedanl d 1Nepanie Origh? [~ No ^ Yes 10. Raw: Amedean Irxliian, Blade, White, etc.
Cumberland
S . Middleton Twp .
Carlisle Regional Medical Center (K Yea. ePed1Y Cuban,
Mexican, Puerro Rican, ero.)
( White
• 11. t)e~wlerife lh,wl Kkd d work d one moat d We. Do not state 12. Wes DeoedeM ever in the 13. Decedenrs Education (Seedy only highest grade cortp bted) 14
Mental Stetw: Married
Never Married
15
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if
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Work
Home I~a~Cer
Kind Rxikrsss/Industry
n ~
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o
U.S. Armed Forwa?
Elemenbry /Secondary (0.12) Cd (1.4 a 5+)
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Wroo~' Dfvaced (SP•~N) .
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pouse (
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e, g
ve ma
den name)
w
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e ^ Y~ ®,~ widowed
• 18. Decedents MaiYrq Address (Street, dry! town, state, zq coda)
}}>~r~h o f God ome
ano
~ Decedents °id Decade"t N . Mi rid 1 e t Un
Actual Resideice na. stare PA Live In a 17c. ®Yes, Decedent Lived in Twp,
Township?
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arlis a
~13 17b. County ('.1 t m hc~ r-1 a n (~ 17d. ^ No, Decadent Lived within
ActuelumKsdf city/~
18. Fat1~s Nerve (Fist, middle, lest, suffix)
William Peter Herweh 19. Momer'e Name (First, middle, maiden saneme)
Sadie Edith Roberts
20a. Inforrtiants Name (Type /Print)
Charles Scott 20b. Inlorrtrents Meilkig Address (street, ' /town, ebb, zip pods)
1436 Zimmerman~td. , Carlisle, PA 17015
• 21 a. Memod d Dispwidon ~ ^ Cremation ^ Donatbn
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i
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t 21 b. Date d DispwHkn (Month, day, year) 21c. Plow d Dispoaitbn (Name of wmetery, crematory w other plow) 21 d. I.awtlon (City /town, sbb, zip code)
ur
a
• ^
ertaval
ramsbe ~ ~ ExrMncoro ^ Yee^ ~ May 5, 2010 Riverside National Cemetery Riverside, CA
22a dr-rser~eL pa'g°" aesua') rm.'~er'e°""'~er z2°."a"~e °n°'wdre6adFaany Hoffman-Roth Funeral Home & Crematory, Inc.
- 013144E 219 N. Hanover St. Carlisle PA 17013
Hems 23ec only when wrtly(rg
is rat avatlade e1 nme d seem ro 23a. To the beat d my knoa4edge, deem occttrted et the tlme, date end plow stated. (Signature and title) 23b. Lkerue Numher 23c. Date S
~ (Monet, day, year)
wrtlry woes d death.
tlems 24-28 moat be wrrVl•t•d by person
• who proraaiwa seam. 24. Time d Deam
~~; I ~ ~' jH, 25. Date Praaixaed Dead (Monts, day, year)
G7 - - L/ I '~ '~' c.1(!~ 26. Was Case Referted t Medical Examiner I Coroner fa a Reason Omer men Cremedon a Daxatbn?
^ Yea Q t~Jo
CAUSE OF DEATH (See Instructlone and examples) i Approximate interval:
Hem 27. Pan 1: Enter the drain devents - diseaeea, ktjudae, a cantp9catkxre - that direly cawed tlN death. DO NOT enter bmihsl events such es cardiac arrest, r Onset ro oeem
ree
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tlh Pert II: Enter peter
but rat ssutl(rg In the undedyirtg cause M Part L
9iv^ 28. Did Tobacco Use Contnlwte ro Death?
^ Y
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, a ven
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atlon w
aut ahowirq the etlology. Lint only one caws on each tlne. ~
IAMIIEDIATE CAUSE IFinel dreease a /
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^ Unknowm
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~/~ j ~y1 ~ ~1 j~ / -~:~ ;J ~ /~y
candtlon resultlng in death) ~ a. ~IIn~G / ~-r t~ R ?J /~SL/„([ // ! G`1- /l ~ 1(~ Ll~ I~~
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29. K Female:
^
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Duero (a as a canaegirenw oQ:
r 1;; 17 L~i ~~i r - Not pregnant withkt past year
ra;<c«duons, it r
arty, b. '
b cause Ywd an line a.
a/.rE~`.~ (7~ ^ Pregnant at Ume d death
Enter UNDERLYIIKi CAII$E Duero (a as a consequence of): ~
(disease a tlutt initlabd the - ^ Nd pregnant, but pregnant wdNn 42 days
of deem
evems resuldrgin deem) LAST. °~ ~ ^
Due to (a as a consequence of): i - Not pregnen6 but pregnant 43 days to 1 year
• d. i
i ^ UMcnorm~K pregnant within the pest year
30a. Was en Aulopey
Performed? 30b. Were Autopsy Fkidirigs
AvaibDle Prior to Completion 31. Manner d Deem
r~~ 32a. Dale o1 I
ryury (Monet, day, year)
3~. Describe How Injury Occurred
32c. Place of In' Homo, Farm, Street, Fa
OIRw BulkF~n
ro
N
~~
S
of Cause of Deem? ~ N•rorel ^ Homidde g, e
. (
pec
yJ
^ Yee
^ Yes ^ No ^ Accident ^ P Irwes' tlon
endk~g ~ ~• Txne d Injury 32e. Injury et Work? 321. If Transportation Injury (SpecityJ 32g. Location d in'
Wry (Street, dty /town, state)
^ Suidde ^ Could Nd be Determkred M ^ Yes ^ No ^ DrNer/Opereta ^ Passenger ^ PedasMen
Omer - Speciy.•
33a. CaNfier (dredc a,y one)
• GnH
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altian IPh
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wd 33b. signature end Title of CertlBer
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ng woes d deem when stems physkien has praiaxaad deem and completed Item 23)
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• Pronounefng and wrtxying Phr•ki•n (~ ~h W~undng deem and wrtflyirg ro woes d deem)
To the bad d my krarrladgs, deem occurred at the time
dab
and
plow
andduebthsauee(a)andmenneru
bbd 33c. License Number
.
33d. Date Spned (Harm. Y, Y~r)
,
,
,
s
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• MadcN Examiner/Caoner
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e bola of sxamfnetlon end / or invaatlgetlon, In my oplnlon, deem oaurred N the time, date, and pleas, and Mrs to the cause(s) and manner as sated_ ^ 34. Name and Address of Person Who
Completed Ceusa d Deem (Item 27) Type /Print
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.
35. Regisuer's and District N
- ~l Tai t io i 36. Dero Filed (Monet, ley, year)
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Dispaadion Permit No. ~ . 0 ~.
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND
COUNTY, PENNSYLVANIA
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Estate of ADALINE E. JENKINS ,Deceased
I, GENE L. SCOTT , in my capacity/relationship as
(Print Name)
EXECUTRIX
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
CHARLES P. SCOTT, III
.s-~~
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
,-~ ' --~C~----
(Signature)
1436 Zimmerman Road
(Street Address)
Carlisle, PA 17015
(City, State, Zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this ~ day
n f ~ ~ Cu.., ,-, .~ 01 ~
Notary Public
My Commission
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
C4MMONWEALTH_OF PENNSYLVANIA
Form RW-06 rev. 10.13.06
NOTARIAL SEAL
SHELLY SEXTON, Nob~y Public
Carlisle eoro, Cumberland County
My Commission 'r+~ 'I 26, 2011
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r~~.^t t.r'~.~ 6+!1'~.~iS t<`V/i t~.f'~ ,~ILIL..7 :7!'~~~~l ~.~r
33e'` fit' i ,'1
LAST WILL AND TESTAMENT
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ADALINE E. JENKINS ' ~~ x.. - '~~ -~
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I, ADALINE E. JENKINS, of Carlisle Borough, Cumberland County, Pennsyl~ia, decl~ -~~-= ~,
N '~
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this to be my i.,ast ~J~'ili a~~d ~CStameni and revoke any and ail wills and codicils Heretofore made by }
me.
ITEM I: My personal representative shall pay from the residue of my estate the
expenses ofmy last illness, funeral and burial debts duly allowed against my estate, and all death
taxes (Pennsylvania inheritance tax and federal estate tax) occasioned by my death and incurred with
respect to all property taxed to my estate regardless of whether such property passes by this Will or
passes outside of this Will.
ITEM II: I bequeath my personal effects, household goods, and other tangible
personal property of like nature (not including cash or securities), together with any existing
insurance thereon, a.~ sPt firth it ~ separate r:~.e:norardu.Y: -;~l~ich I shall place witi~ ~~~y ~J.iii to the
persons therein designated. If I shall leave no separate memorandum, or with regard to my personal
effects, household goods, and other tangible personal property of like nature (not including cash or
securities) not referenced by such memorandum, I bequeath such property to my Son, CHARLES P.
SCOTT III, or to his wife if he shall not survive me.
ITEM III: I devise and bequeath the residue of my estate, of every nature and
wherever situate, as follows:
25% to my son, CHARLES P. SCOTT III, of Monroe Township, Cumberland County,
Pennsylvania;
25% to my daughter JANICE BEDNORZ, of Apache Junction, Arizona;
25% to my daughter, JOYCE MATTOS, of Maricopa, Arizona;
12.5% to my niece, DIANA WISE, of Boron, California;
12.5% to my grand-niece, MICHELE BOREN, of Lucerne, California; and
ITEM IV: I appoint my Daughter-in-law, GENE L. SCOTT, Executrix of this
my Last Will and Testament. Should she fail to qualify or cease to act as Executrix, I appoint
CHARLES P. SCOTT III as Executor of my estate.
ITEM V: I direct that my Executrix and her successors shall not be required to
give bond for the faithful performance of her duties in this or any other jurisdiction.
IN WITNESS WHEREOF, I, ADALINE E. JENKINS, have hereunto set my hand and
seal to this my Last Will and Testament, consisting of three (3) printed pages, each of which hears
my signature, this 4th day of January 2007.
~~
~-e~ ~ (SEAL)
ADALINE E. JEN S, Testatrix
Signed, sealed, published and declared by the above-named Testatrix, ADALINE E.
JENKINS, 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 t and presence of each other, have hereunto subscribed our names
as witnesses.
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND 1
WE, ADALINE E. JENKINS, TAYLOR P. ANDREWS, and
l~s ~,~'~ ,the Testatrix and vv~tnesses, respectively, whose names are signed
to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned
authority that the Testatrix signed and executed the instrument as and for her Last Will and
Testament 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 and that to the best of their knowledge the Testatrix was at the
time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence.
,T
P. Andrews, Witness
Witness
Subscribed, sworn to and acknowledged before me by ADALINE E. JENKINS, the
Te tatrix, and sub c~ d t and sworn or affirmed to b~9xe me by TAYLOR P. ANDREWS and
~~~-- ~ G o~ wrtnesses this Y'Fh
lay •f January 2007.
NOTARIAL SEAL ~~
SHELLY SEXTON, Notary I'ub=i=~ ~ (SEAL)
Carlisle Boro, Cuc~bertand :~~ ~~ ?'v 7 Nota Public
My Commission Expires Ap~~7i '2E~Y Gv ''~ G ~'