HomeMy WebLinkAbout06-22-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of ELMA K. SHEAFFER
also known as
Deceased
COUNTY, PENNSYLVANIA
File Number ~ ~ " ~ V - ~~.Q [31"~
Social Security Number 162-54-0423
Petitioner(s), who is/are 18 years 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 /are the CO-EXECUTORS
last Will of the Decedent dated APRIL 23, 1997 and codicil(s) dated
named in the
(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
(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. ord. b. n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
Decedent, then 87 years of age, died on JiJNE 13, 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) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
Form RW-02 rev. 10.13.06 Page 1 of 2
98,000.00
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(COMPLETE INALL CASES:) Attach addUional sheets if necessary. ~^? ~ ~ ~ i "~ 4 ~. ''
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal_~si~nce at N : ` ~~ ; -r-~
3 TODD CIRCLE. APT. E, CARLISLE BOROUGH, CUMBERLAND COUNTY PENNSYLVANIA 17013 0 ~• ~`~ ~--,
(List street address, town city, township, county, state, zip code) --- "~ ~
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:
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 to or affirmed and subscribed
before me the a a day of
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For the Re ter
Signature of Personal Representative
File Number: o~ ~' ~U ' 0 ~.Q y`-7
Estate of ELMA K. SHEAFFER ,Deceased
Social Security Number: 162-54-0423 Date of Death: 06/13/2010
AND NOW, ~ O~ ~` ~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters TESTAMENTARY
are hereby granted to C. EDGAR SHEAFFER AND KENNETH H. SHEAFFER
and that the instrument(s) dated APRIL 23, 1997
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of
FEES
Letters ............... $ 210.00
Short Certificate(s) ........ $ 12.00
Renunciation(s) .......... $
JCP ... $ 23.50
AUTOMATION FEE $ 5.00
WILL ... $ 15.00
... $
... $
... $
... $
... $
... $
TOTAL .............. $ 265.50
in the above estate
Register of Wills ~ r'
Attorney Signature:
Attorney Name: ROGER B. I IN, ESQUIRE
Supreme Court I.D. No.: 6282
Address: 60 WEST POMFRET STREET
CARLISLE, PA 17013
Telephone: 7172492353
Form RW-02 rev. 10.13.06 Page 2 of 2
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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 1653424
Certification Number
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.
Local Registrar Date Issued
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H1t>5.143 REV 1112008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TfPE /PRINT w
BUIC~NK CERTIFICATE OF DEATH
(See instructions and examples on reverse)
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1. Noma a Decedent (Fast, midde, last, suffix)
Elora K. Shaeffer 2. Sex
Female 3. Social Sewriry NtxMrsr - ~ - -- •-.•'
162-54~J423 4. Date a Death (Month, day, year)
_ June 13, 2010
5. Age (Last Blrttxby) Under 1 ar lkrder 1 6. Dab of Blrar Mamh, da , 7. Bi and stare or toter 8a. Place a Dealer Check one
87 "~^'~ D'n "°'" "'"""` Oct. 12, 1922 Carlisle, PA Hospital: Other;
YB. Impatient ^ ER / Ot~eHent ^ DOA ^ Nursing Hama ^ Reslderae ^ Otlbr • Spedly:
8b. County d DeaM
Cumberland Bc. Ciy, Boro, Twp, of Death
S. Middleton Twp. 8d. FacMNy Name (If rat katlWtlon, Pv street and number)
Carlisle Regional Medical Center 9. Was Decedent a Hleperricc Ongb? ®No ^ Yes
o'r••, eP•~r t:awn, 10. Race: Amedcan Indian, Black, Wfrke, etc.
(sue
Mexican, Ptarto R'aen, etc.) White
11. Deaderd'e Usual tbn Kind a wok done moll d Ike. Do not state re 12. Was Decedent ever in the 13. Decederd's Educetbn (Specky oMy higtbat grade corrp bted) 14
Menbl Status: Married
Never Married 15
S
kd
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if
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Kind d Work
Homemaker
Kinds Btreiass/Industry
Own Home
U.S. Amred Forces?
^ Yea ~] Na
Elementary / Secardery (0-12)
8
Gokege (1.4 a St) .
,
,
Widowed, Divorced (Sioedyy)
Widowed .
urv
rg
pouse (
w
ve ma
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en name)
16. Deaderd's Makkng Address (Street, tilt' I town, state, rip code) DecedenYa Did Decedent
3 Todd Circle , Apt E Actual Residence 17a. Stab PA Live let a 17c. ^ vas, Decedent Lived in Twp,
Carlisle, PA 17013 ,~.~rty Cumberland Township? 17d.~No,DecedemUvedwifnin
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a
ActualLimltsa CaY
0 City/Bore
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18. Father's Name (Pleat, middle, last, stAllx) 19. Mothets Name (First midde, maiden surname)
Harvey Shughart Armada Wickard
ZOa. Inlornrenrs Name (Type /Prim)
Kenneth Shaeffer 20b. Informenfs Making Adttress (Street, dry /tam, slab, zIp Dods)
120 Alters Rd., Carlisle, PA 17015
21 a. Method a Disposkion i ^ D„,~ti,,, ^ ~~
~I Bair ^ Removal from stab r wa cnmMlon or tbnatlo
A
th
i
d 21b. Dab d Diapoekbn (Momh, day, year)
J
19
201 21c. I'ba a Dltpaltlon (Name a cxirrbEary, creme or other pba
Westminster Memorial Gardens 21d. Loatbn (C / awn, ebb, zip cod.
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^ r Izy wtaor ExtttMrrer/cararbr? ^ Yea^ Na une
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uner~ ucene•• ( ) 22b. Lkxmea Ntxnber 22c. Name and Address a Faciliy Hof fman-Roth Funeral Home & Crematory, Inc .
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23at only when certllying
pfrysicien h na avaibble at Hrne a deetlr to . To the best a my , death otxxxred at the time, date and place stated. (Sigrrelure and title) 23b. Lkbnse Ntxnber 23c. Deb
signed (Month, day, year)
tx•rtly terse a death.
Ibrrw 24-28 must be completed by person
who pranances deelh. 24. Tore a Death
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ro
raptsa~ed Dead (MOnt`h~, day, year) 26. Was Case R b Medical Examiner / Cororrer tar a Reason Otlrer then Crematron a Donation?
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CAUSE OF DEATH (See Instructlona and examples) r Approximab inbrval:
Ibm 27. Pan 1: Enter the l~Bp,pl,~p,g -diseases, krjuries, a corrrpkcetlorrs .that drectly caused tlb death. DO NOT enter temenal events such as ardac arrest, r
Onset M Death
rea
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tib
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but not restarting in the urdenying cause given in Pan I.
28. Did Tobacco Use Contribute to Deeth7
^ Yes
p
re
ory arres
, or ven
cu
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rl
ation witfrad showing the aEobgy. Vat any one cause on eazir line. , ^
IYYrd71ATE CAUSE (F'mal disease a
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a. n ~ _ . ~~ ~ ~ ~ a,
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condlion ratdtlng in b) _~ ~ Y ~ y y'/
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29. If Female:
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leaf mldltlons, k any, b. L! r~-'~ ~.C. 10~-+-7 ' 6 ~G~~ t~~
b cause bled on wre e.
;
fL'~~5 o~i ~ c~y? y" s,~~ Na pregnant wltnln peat year
^ Pregnam at fkne a death
Enzx UNDERLYNIC CAUSE Due to (a as a tbrreagrasrra oQ: r ^ Na nL but
pregnam within a2 days
(dieean a inJtxy mat lrrltlated the
evenb reaultirrg m death) LAST. c. ~
r or deem
^
Due to (a as a ansegtaarxx of): r Na pregnant, but pregnant 43 days to 1 year
d. i
r ~'~ death
^ Urrkraown If pregnant wkMn dre pest year
30a. Wes an Autopsy
Pedomaed? 306. Were Autopsy Fardings
Available Prig b Campbtion 37. Manner a Deeth 32a Deb d I
njtary (Month, day, year)
32b. Dearxlbe Flow Inury Oaxxred
32c. Place a Injury: Home, Farm, Street. Factory,
Office Buildin
eld
(S
dl
a Cause of DeeM1
~ ~brel ^ Homidde g,
.
Pe
y)
^ Yes
~Jo ^ Yes ^ No ^ A0~°nt ^ Perrdkg Inveatlgadon 32d. Time of Injury 32e. Injury et Work? 32f. k Transponation Inury (SpecylyJ 32g. Loation of injury (Street, dry /form, state)
„ ^ Sukrde ^ Caald Not be Debmrkbd M ^ Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestrian
Otlrer • S~ped/y
33e. Certiker (dads any one) 33b. aaro of
' CeKHyln9 physldan (Physicbn cenkykrg cause d death vAbn arather phyeidarr has proratxrad death and txxrpbbd kern 23)
TotMMStotmygrowbdge,deathoxtanddwbtheaws(s)andmsnnarsashbd---------------- ----------------- ^ .
Pronoundnp and txzrtkyfng physklsn (Phyaiclan batlr prtxatarrdng tbatlr and axnkykg b ease a death)
Todb beat a my larowbdpa, drn, aoaxred at the thrre, dNa, .rid plea, and due b dr. oase(s) end manner as abbd_
• Ys~cslExamNbr/coron.r
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ 33c.
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V / J Signed (Montlr, day, year)
33d. Date ^7
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On the bent W axamhraBon and / a Imaatlgatlon, In tm oplnbn, drtlr occurred at dre flora, deb. and pba, and duo to Ura cauas(s) and manner u abterL ^ 34. and Addrer a Peracn Who Cortpbted Cetme a Death (kern 27)Type / PrMt
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Disposition Permft No. ' ~~ ~:{0(0~~. ~a y .
LAST WILL AND TESTAMENT
I, ELMA K. SHEAFFER, of West Pennsboro Township, 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 executors 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 executors to sell any realty owned by me at my death, 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 iron bed to Vonnie K. Sheaffer,
(b) My grandmothers clock to Bonnie M. Sheaffer,
(c) The sum of $2,000.00 to each of my grandchildren; Amy, Clark, Kenneth, Jr.;
Kaci and Scot, and
(d) All the rest, residue and remainder to my two sons, C. Edgar Sheaffer and
Kenneth H. Sheaffer, share and share alike, the child or children of any deceased son taking the
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share their parent would have if living.
4. I nominate and appoint C. Edgar Sheaffer and Kenneth H. Sheaffer, to be the
executors of this my Last Will and Testament, they are to serve as such without bond.
5. I hereby suggest that my personal representative retain the services of Irwin,
McKnight & Hughes as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 23RD day of
April 1997.
(~ ~ Q ~I; ~6 ~aK,KX-I (SEAL)
ELMA K. SHEAF ~ R
Signed, sealed, published and declared by ELMA K. SHEAFFER, the testatrix above
named, 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 subscribed our names as witnesses hereto.
2
ACKNOWLEDGMENT AND AFFIDA VIT
WE, ELMA K. SHEAFFER, CHERYL L. CLELAND and MARTHA L. NOEL, the
testatrix and 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 purpose herein expressed, and that each of the witnesses,
in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of
their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and
under no constraint or undue influence.
ELMA K. SHEAFF + R
T PIER L L. CLELAND
MARTHA .NOEL
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
Subscribed, sworn to and acknowledged before me by, ELMA K. SHEAFFER, the
testatrix herein and subscribed and sworn to before me by CHERYL L. CLELAND and
MARTHA L. NOEL, witnesses, this 23RD day of April, 1997.
~ ~,- ~ . C~
~ Notary Public
Notarial Seal
Rogper B. Irwin, Notary Public
Carlisre Boro> Cumberland County
My Commission Expires Oct. 3, 2000
Member. Pannsyivania Asaaalatton of Notaries