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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of David G. Shively
also known as
COUNTY, PENNSYLVANIA
File Number 21-10 -- 05'1
,Deceased Social Security Number
Rebecca L. Bailey and Jeffrey L. Bailey
Petitioner(s), who Is/are 18 years of age or older, apply(les) for:
(COMPLETE `A' or `8' BELOW.)
® A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the named in the
last Will of the Decedent, dated 09/25/2A08 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:
^ B. Grant of Letters of Administration
app Ica e, en er: c..a.; .n.c..a.; en e i e; uran e a sen ~a; uran a m~non a e
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the followiLlg spouse (if ~r) and heirs:, (If
Administration, c. t. a. or d. b. n. c. t. a., enter date of ill in Section A above and complete list of heirs.) CC TT -~--
Name Relationship Residence i~:'~~ c7 --< c - > ,~ -~~;
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(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
702 Henry Street, Mechanicsburg, Cumberland, PA 17055
(L~st street address, town/city, township, county, state, zip code)
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Decedent, then ~~ years of age, died on 05/19/2010 at Country Meadows Nursing Home, Mechanicsburg, PA 17055
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 500.000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 75.000.00
situated as follows: 83 Hawthorne Avenue, Mechanicsburg, Upper Allen Township, Cumberland County, Pennsylvania 17055
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:
Signature Typed or printed name and residence
Rebecca L. Bailey 702 Henry Street
~ Mechanicsburg, PA 17055
717-697-0908
Jeffrey L. Bailey
717-697-0908
702 Henry Street
Mechanicsburg, PA 17055
Form RW-02 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2
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$ 23.50
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
Oath of Personal Representative
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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 this ~ day of
~~
~~
For the Register
Signature of Personal
File Number: 21-10-' Q ~'`'~
Estate of David G. Shively ,Deceased
Social Security Number: Date of Death: 05/19/2010
AND NOW, d , in consideration of the foregoing Petition, satisfactory proof
having been presented be r me, IT IS DECREED that Letters Testamentary
are hereby granted to Rebecca L. Bailev and Jeffr _i i Railoy
in the above estate
and that the instrument(s) dated 09/25/2008
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent
FEES
Letters .......................................... $ 460.On
Short Certificate(s) ....................... $ 24.00
Renunciation(s) ............................ $
Aut~matinn $ 5_ M
JCS $ 23.50
V~ i 11 $ 15.00
$
$
$
$
$
$
TOTAL ................................... $ 527.50
Form RW-02 Rev. ~o-13-zoos
A
Je~'rey L. Bailey
Signature of Personal Representative
Supreme Court I.D. No.: 15893
Address: 124 W. Harrisburg Street
P. O. Box 310
becca L. Bailey
Dillsburg, PA 17019-0310
Telephone: 717-432-9733
E-Mail: Schracklaw@comcast.net
Copyright (c) 2006 form software only The Lackner Group, Inc.
Page 2 of 2
Attorney Name: Wm. D, Schrack III
CLIENTS~.SHIVELY, DavidWavid -Will
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DAVID G. SHIVELY w~7
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BE IT REMEMBERED, that I, DAVID G. SHIVELY, of 873 Hawthorn Avenue,
Mechanicsburg, Upper Allen Township, Cumberland County, Pennsylvania, being of sound
mind, memory, and understanding, do make, publish, and declare this as and for my Last Will
and Testament, hereby revoking and making null and void any and all Wills and Testaments and
writings in the nature thereof by me at any time heretofore made.
ITEM 1: I direct that my hereinafter named Executors pay all my just debts, my
funeral expenses, and the expenses of the administration of my estate. With this direction, I
authorize and empower my Executors to expend for my funeral expenses and interment such
amounts as may be considered necessary and proper, without regard to any limit that may be
prescribed by a court of law.
ITEM 2: I direct my Executors to pay all inheritance, estate, succession, and legacy
taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing
hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes
against my residuary estate, it being my intention that none of the aforesaid taxes, either federal
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or state, on any property required to be included in my gross estate, under the provisions of any
state or federal law now in force or hereafter enacted, shall be prorated among the persons
interested in my estate to whom such property is or may be transferred or to whom any benefit
accrues.
ITEM 3: In the event my spouse survives me, I give and bequeath unto my
daughter, REBECCA L. BAILEY, INTRUST, NEVERTHELESS, all of my undivided interest in
our marital premises known and municipally numbered as 873 Hawthorn Avenue,
Mechanicsburg, Pennsylvania, including the contents thereof. My Trustee shall maintain the
premises for the use of my spouse until such time as my spouse moves from the family residence,
and expresses an intent to not return.
Upon my spouse's relinquishment of the right to occupy our marital home, I direct that
my Trustee arrange for the appropriate marketing of the premises, with the proceeds generated
thereby to be added to the corpus of my existing Funded Revocable Trust.
ITEM 4: All the rest, residue, and remainder of my estate, of whatsoever nature and
wheresoever situate, whether it be real, personal or mixed, including property over which I have
a power of appointment, I give, devise, and bequeath unto my daughters, REBECCA L. BAILEY
and CHRISTINA M. POULIN, in equal shares, per stirpes.
ITEM 5: I appoint my daughter, REBECCA L. BAILEY, and her husband,
JEFFREY L. BAILEY, as Executors of this my Last Will and Testament, directing that they shall
Page -2-
not be required to give bond for the faithful performance of duties in this or any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set m hand and seal this ~~ da of
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DAVID G. SHIVELY
The preceding instrument, consisting of this and two (2) other typewritten pages, was
on the day and date thereof signed, sealed, published, and declared by the Testator herein
named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his
presence and in the presence of each other, have subscribed our names as witnesses hereto.
OF
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Page -3-
COMMONWEALTH OF PENNSYLVANIA.
SS.
COUNTY OF YORK
~-
We, DAVID G, SHIVELY,
and
the Testator a~i~ the witnesses,
ively, whose names are signed to the attached or foregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the Testator signed and executed the
instrument as his Last Will and Testament, and that he signed willingly, and that he executed
it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses,
in the presence and hearing of the Testator signed the Will as witnesses, and that to the best of
their knowledge, the Testator was at the time eighteen (18) years of age or older, of sound mind,
and under no constraint or undue influence.
DAVI G. LY
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SWORN TO AND SUBSCRIBED
BEFORE ME THIS ~~~ DAY
e{~•~YI~/.f1~J , 2008.
NC~ P BLIC
COMMONWE LTH F PENNSYLVANIA
Nota al Seal
Janet S. Gore, Notary Public
Dillsburg 13oro, vork Courtty
My Commission E~ir~es Oct. 25, 2010
Member, Pennsylvania Association of Notaries