HomeMy WebLinkAbout06-16-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Mary Elizabeth Sheaffer
also known as
Deceased
Social Security Number 192-14-5705
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 Executrix
last Will of the Decedent dated July 5, 2007 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
COUNTY, PENNSYLVANIA
File Number (7~~ ~ ~ ~ O" ~~ V
(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
Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
tv
any) aieirs: (If ~~-~,
. .~.,-~
Name Relationshi Residetic
~` t:l7
X3'1 - -
~..::,':' _.~,7
t,~ ~,
~::~
--- ~ :te
- -
~ ---t
~ .
a
~ r :.t:.:t
.
COMPLETE INALL CASES:) Attach additional sheets if necessary. ~ ~ ~ ,~ ` ~~
( aD
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
15 Cedarhurst Lane Camp Hill Lower Allen Township Cumberland County Pennsylvania 17011
(List street address, town/city, township, county, state, zip code)
Decedent, then 91
years of age, died on June 9, 2010
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(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:
$ 200,000.00
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:
Signature Typed or printed name and residence
Barbara S. Bourdette, 15 Cedarhurst Lane, Camp Hill, PA 17011
at Holy Spirit Hospital
named in the
Form RW-O2 rev. 10.13.06 Page 1 of 2
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, Petitioners} will well and truly
administer the estate according to law.
,r
Sworn to or affirmed and subscribed ~~~
Signature of Personal Representative
' before me.the day of rya
' ' ~:z ~,
~-
~~ ~L , ~~~ Signature of Personal Representative K„~" ~ ';
For the Regi er Signature of Personal Representative ' t: fj ~ ~ =~? '~_~.1
":~~ ~~ ~ c_ ..
,..
. _ .....,
,.
File Number: 1 ~ ~, ~ -' ~ r. Q
Estate of Mary Elizabeth Sheaffer ,Deceased
Social Security Number: 192-14-5705 Date of Death: June 9, 2010
AND NOW, ~ U ~ ~ ~ ~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters _~;~ ~ Y1~ ~-1'~'~ Y\_/
are hereby granted to ~Glr hOlr~ S ~ ULlr ~-~' Q
in the above estate
and that the instrument(s) dated ~ ' t~ ' ~ w~
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of D cwent.
FEES ~-
Register o ills ~ 'i~ L!, ~ ~~
Letters ............... $ ~ ,~-"
Short Certificate(s) ........ $ D~' U • ~1U Attorney Signature: _ _._,~.:
Renunciation(s) .......... $ James W. Kollas
~ ~' $ ~ ~ ~~ Attorney Name: _ _
~~ C~ ... $ ~ Supreme Court I.D. No.: $1959
_~1-c j~ c~ ty~. cc-t~i do ... $ .~ . (Std
Address: Kollas and Kennedy
... $
. _ $ 1104 Fernwood Avenue, Ste. 104
$ Camp Hill, PA 17011
... $
• • • $ Telephone: 717-731-1600
... $
TOTAL .............. $~ • ~.00
Form RW-02 rev. 10.13.06 Page 2 of 2
105.R05 REV (01/071
LOCAL REGISTRAR'S CERTIFICATION OF DEA-TH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
r ~6~a6~o~
Certification Number
"phis is to certify that the il~formation here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be for~~~arded Co the State Vital
JZecords Office for trmanent filing.
JUN 1 0 Z 10
LGr~ ~~~ /
_____ __L___
Local Registrar Date Issued
C7 ~-'
"^~,. ~ ~ r~' t ''Yy
r~ ~ C ,-..
V m
'
1~
~ 4
+4. ^ ~ ~
i
f
t
~ ....
3 REV ttl2aDe COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
I PRINT IN
K CERTIFICATE OF DEATH
(See Instructions and examples on reverse) STATE FILE NUMBER
1. Naar d Decedent (Fleet, middle, be4 eufAx) 2. Sex 3. Sodel SecaAy Num~u 4. Deb d DeaM (Momh, day, Year)
Mar E. Shaeffer female 192-14 5705 une ~9, 2010
5. Ape (Lea Bklhdey) lkrder 1 Under 1 6. Deb d Birth Mordh 7, end elate a t 8e. Pleoe d Dart Check one
91 °"' '~"' "`~`° Dec. 23, 1918 Harrisburg, PA Hospital: Other:
Yte. ®Inpatbnt ^ ER / Outpatient ^ DOA ^ Nursing Horne ^ Residence ^ Odrr - Specfy:
8b. Corsdy d Death 8c. Ciry, Boro, Twp. d Death Bd. FexdAly Name (K rat krdWtlon, ghre area arW number) 9. Wee Decedera d Hipartb Orgln7 ~ No ^ Yee 10. Race: American Irxtlen, ltledc, White, etc.
Cumberland E. Pennsboro Holy Spirit Hosp. (,;,,, ~,,~.) ('
hits
11. Decedents Usual d work d er moot d Ale. Do not ebb 12. Wee Decetbnt ever h Mr 13. Decederd'e EduceBon (Specify any hiplret grads carrp bterl) 14. Media Stahre: Marred, Never Married, 15. Survlvkrg Spo use (8 wile, give mekbn nurr)
Khtd d work land d Bwkree / Induary U.S. Artad F«cee? Elementary f Secondary (a12) CoAsge (1-4 a 5+) WaON~' Ohorcad ()
Retail Sales ^Yes LTNo 11 idowed
18. Decedents Mdlhrg Address (Street, criy i town, ebb, zip Dods)
15 Cedarhurst Ln. Decedents Dld Deoederd
AciudRasMuae,7a.smb~A u~e~a nc.~Yea,DecedentUvedinLower Allen T,~
Camp Hill, PA 17011 tm.cortray Cumberland Tipa 17d~^~lD ~'t~'"'"~" cny/Boro
18. FaBrfe Name (Flra, middle, lea, eu1Poc) 19. MotMte Nmr ( eraronre)
'
Warren Eichelberger art
Mary o
20a. kdonnara'a Name (type / Prkrt) 20b. Inbrrrbrd'e Maekq Addrae (Strap, dry / bvm, state, zip code)
Barbara S. Bourdette 15 Cedarhurst Ln. Camp Hi11,PA 17011
21a. Mahod d Dhpoatlon t ^ Cremetlon ^ Danatlon 21b. Dee d Dlepoeitlar (Month, day, year) 21c. Place d Dlepcaltlon (Name d smeary, cronxtlay a other place) 21d. Location (Gry/town, state, zip code)
^ Remavaltransbb ~ wa «UoMIonAWrorlsad June 1 2 2010 Rollin Green .Mum. Park
g amt Hill PA
~ y
^ Darr- ' by ICororraR ^ Yee^ No e
7ta. Signattw d Santos atAnp eudr
~« 22b. Lirxnea Nunber 22c Name end Address d FedAly
- 011248E Musselman FH&CS Inc. 324 Hummel Ave,Le.moyne,PA
CarpNb hems 23ec oMy when arfNykg 23e. T the d a the tln>s, dent place paled. (Sigrrhas tlAe) 23b. lkenee Number 23c. Date Signed (Month, day, year)
plryekierr a nd avafl~le a 8me d dsaM b
certlly cause d dash.
Ibnre 24.28 mua be oonplebd a/ person 24. Tmr d 25. Pronaeaed tkad (Month, ,year) 28. Wes Case Rehnad b Medkxl Exemkrr / Corone+ a Reason OMer tlon a Donedon?
who proraumrs death. ~ M. ^ Yes ~ No
CAU3E OFD T11 (9se instruct) and esrmples) r Approzkneb interval: Pert II: Enbr otlrr ' 28. Did Tobeoco Use ContrAxrte to Deah9
bum 27. Pert I: Erdu the ctbrn d events - , Ir>kxlN, a compNcetione -the dkee8y caused 8r death. DO NOT enter bmdna everts such m carder amp, ~ Orret ro Death but rat reeultlng In the underlying cause given in Pert I. ^ Yes ^ Probably
reephetory amp, or ventricular AbrAeBon wAtarA elawirq the etlobgy. Ust only one cause on each Mrr. ~
i
^ No ^ Unknown
~Rn~ p
lhj ~
I
d
J TE
G
E ~
~
~ A' ~
; 29. It Femrb:
on
a
n
ea
.
f~
A
-
L U~~ ^ Nd
re
nant wNhin
ast
ear
Due b (ar a a carequarae oQ: i p
g
p
y
^ Pregnant at drtr d death
M Ace candtlona, A arty, b. CO ItE-G. U CA /p~Tly Y ' ^
~1>NDEAt.YMq CAUSE
(deaae. « 8rt IrYllabd dry c. ~ r P F~%/ 1 ~ oral ~
r
h
LAST Not pregnant, but prepnent wllhin 42 days
d daatn
^
events realArh deat
)
. Due b (« u a coneequerw:e of): ~ ~ d~ but Pregnant 43 days b 1 year
d• i ^ Unknown A
re
nant wAMn the pas
ea
p
g
y
30a. Wee an Autcpey 30b. Were AuMpey Flndnpe 31. Mux>er d Oeeth 32a Dab d tray (AlorMh, day, year) 32b. DeecAbe How occurred 32c. Place d In(rasy: Home, Farm, 9aeat, Factory,
Perforrrredl
Averlebb Prbr b Completbn
a cage. d I~atA9 ~,,~~1
`P~"~~"~ ^ Homidde 08ice BuNdng, etc. (Spedly)
^ Y
~ N ^ Y
^ N ^ Aoddent ^ Pendhrg Inveetlpatbn 32d. Time d Mjury 32s. krJuy a WaAft 32f. 8 TrerteporMion Injury (Spselry) 32g. Loeatbn d ~ (Street, city / bwn, state)
o
ee o
ee ^ Suidde ^ CoWd Nd be Debrmined ^ Yes ^ No ^ DrNsr/ Opsratw ^ Paeeerrger ^ Pedeetrtan
M Odrr-~7
33a. CsrBAu (drdc oMy one) 39b. Sipne end TAIe d G
• CeRMyNW phyaloen (Plrysidan artAykq cave d dash when arroAbr ptryeicen hoe pranaxaed dmCr end completed Item 23)
To the tart of my loroerbdga, dash oecrsnd due to tlr awe(s) and manrrr a stabd _ _ _ _ _ _ _ _ _ ^
- - - - - - - - - - - - - - - - - - - - - - - - ^~--- _ !_'
• pkq eras b+g t>M~ ( body Pig deahr and certllyeg bcaw~ ddeath)
^ 33a L es t4rarmer 33d. Date Signed (Month, deY, Year)
To tlra bat d my babMdDe, deatlt occurred a the tbrr, dM, and place, and dw to the ease(s) end mama u stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Medley EsarnYwlCororrar ~'l. iJ ~t 7 5.1 (p O ` j 9 ~ (~
On tM bMe of urunhrdlon and / a Invaatlgation, Mt my opkdon, deaM oaurrad a tM tlma, dab, and plea, and dw to the ease(s) and nwexrr a sfaNd_ ^ 34. Nuns and Address d Perocn Who Conptebd Cause d Death (hem 27) Type /Print
~USNN~A fGAti.f hLK
Regisirara SlgnaWrs and District ~ I ~~' J I 2 I /` I I I
I 38. 1~ ~Y~ `(~1
~°°e ~'O[-Cf b 1
5 ~ Nor~~, 2-s-t. SCI-rue-+ Cu~Pµ~~~r ~ 1701
`'""""- - ~ Dra=g ~~~~
Diepoaitlon PermA No:
Llri u .~~.~~~ ~ O ~'' ii~~ ~$
s
G~ E~rC r'~
..::
~~ ~ ' ' LAST WILL AND TESTAMENT
OF
MARY ("BETTY") ELIZABETH SHEAFFER
I, MARY ELIZABETH SHEAFFER, of 15 Cedarhurst Lane, Camp Hill, Cumberland
County, Pennsylvania, do make and declare this to be my last Will and Testament, hereby
revoking all prior Wills and Codicils.
FIRST: I direct that all my debts and funeral expenses be paid as soon after my
death as may be practicable. I further direct that all estate, inheritance, transfer, legacy or
succession taxes which may be assessed to my estate or any part of my estate as an expense of
administration and without appointment.
SECOND: I give the rest, residue, and remainder of my estate to my daughter,
BARBARA S. BOURDETTE of Camp Hill, Pennsylvania.
THIRD: If my daughter fails to survive me, her portion of my estate shall be
distributed equally (50%/50%) to my granddaughters, LISA B. BOCK ,Camp Hill,
Pennsylvania and LESLIE SANSONE ,Tucson, Arizona.
FOURTH: If my granddaughters fail to survive me, then I give the rest, residue, and
remainder of my estate to their children, my great grandchildren, to be divided equally among
them.
FIFTH: Without limiting the powers conferred by statute by general rules of law,
my Executrix is specifically authorized and empowered:
(a) To invest any funds of my estate in any corporate shares, bonds, notes, or
other securities or property, real or personal, including any common or commingled funds
maintained by my Executrix. This is to reflect my intention to give the broadest powers and
discretion to my Executrix;
(b) To sell or otherwise dispose of any property, real or personal, at any time
forming a part of my estate, for cash or upon credit, in such a way and on such terms as my
Executrix may deem best;
(c) To manage, operate, repair, improve, mortgage, and lease for any term any
real estate at any time held;
(d) To make distribution in cash or in kind upon any division of my estate;
and
(e) In general, to exercise all powers in the management of my estate which
any individual could exercise in the management of similar property in her own right, and to do
all acts which my Executor or Executrix may deem necessary or proper to carry out 1:he purposes
of this Will.
SIXTH: I direct that my daughter, Barbara S. Bourdette of 15 Cedarhurst Lane,
Camp Hill, Pennsylvania, shall be Executrix of this Will. If my daughter, Barbara Bourdette,
predeceases me or otherwise cannot act as Executrix, then I direct my granddaughter, Lisa Bock
of 3 8 Essex Road, Camp Hill, Pennsylvania, shall be Executrix of this Will, If my
granddaughter, Lisa Bock, predeceases me or other wise cannot act as Executrix, then I direct my
granddaughter, Leslie Sansone, 3310 W. Bright Terrace, Tucson, Arizona, shall be Executrix of
this Will. No Executor or Executrix acting hereunder shall be required to post bond or enter
surety in any jurisdiction.
r
IN WITNESS WHEREOF, I hereunto set my hand this ~~ ~--~' day of July, 2007.
,.
MARY ELIZABETH SHEAFFER
SIGNED, PUBLISHED, and DECLARED by the above, MARY ELIZABETH
SHEAFFER, as and for her Last Will and Testament, in the presence of us, who, at her request,
in her presence, and in the presence of each other, have hereunto subscribed our names as
witnesses:
i
f~
,. .~
_.
of
1- ~.r
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
I, MARY ELIZABETH SHEAFFER, Testator, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I have
signed and executed the instrument of my Last Will and Testament; that I signed it willingly;
and that I signed it as my free and voluntary act for the purposes therein expressed.
Sworn to and acknowledged before me by MARY ELIZABETH SHEAFFER, the
Testator, this ~ ~'' day of July, 2007.
(~,ni AnIA QDSL
~ Cz.. L
MARY LI7~ BETH SHEA I~'ER
NOTARIAL SEAL ~`
Notary Public CAROLE A ROSE
Notary Public
TWSP OF LOWER ALIEN
CUMBERLAND COUNTY
My Commission Expires Oct 21, 2007
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
....
_.___
We, , _-=t~ ~'- 4 ~ ; i ~ j {_ and ~ ~ r ~ ~._. ~' ~,. ~, the witnesses
i ...J
whose names are signed to the attached instrument, being duly qualified according to law, do
depose and say that we were present and saw the Testator, MARY ELIZABETH SHEAFFER,
sign and execute the instrument of her Last Will and Testament; that she signed it willingly and
that she executed it as her free and voluntary act for the purposes therein expressed; that each of
us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our
knowledge the Testator was at that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
Sworn to and subscribed to before me by
.; , z ~~._ ~ ,~ ~ .-~ a ~. and
,~
~~
r- ~- -•: ~~, ~-- (~~~ r`~_, witnesses, this ~ ~'' day of July, 2007.
'Witness NNN------ _ --_-~-
otary Public
Sq
~, ... ;
NOTARIAL SEAL .'
CAROLE A ROSE
Notary Public
TWSP OF LOWER ALLEN
CUMBERLANG COUNTY
My Commission Expires Oct 21, 2007