HomeMy WebLinkAbout08-10-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of JACKSON M. SMITH
also known as JACKSON M. SMITH, SR.
Deceased
COUNTY, PENNSYLVANIA
~~ I - ~C~ - c,~ `~ ~~
File Number
Social Security Number 201-16-5737
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE A' or 'B' BELOW.)
Q A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the EXECUTOR
last Will of the Decedent dated JUNE 29, 2010 and codicil(s) dated
(State relevant circumstances, e.g., re~runciation, 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 I 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.)
-a
Decedent, then 84 years of age, died on 08/08/2010 ~ CARLISLE REGIONAL MEDICAL CENTER,
CARLISLE SOUTH MIDDLETON TOWNSHIP, PA 17015
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
~ 120,000.00
$ 20,000.00
situated as follows: lJ O c-tk, M- c~tQ~Q'~.ov,~+.u n~'~ ~.~.1rJ ec' a..+~ ~'~a ~~
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
ANGELA L. MULLIS, 16 BENTLEY PLACE, CARLISLE, PA 17015
named in the
Form RW-02 rev. 10.13.06 Page 1 of 2
~ -- .
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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 ~resince at _~„~;~,; ' }
2 RUSH DRIVE APT. 307 CARLISLE CUMBERLAND COUNTY PA 17013 '%= r-~ r ti
(List street address, town/city, township, county, state, zip code) ~-'y`
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.
..=' rl -
Sworn to or affirmed and subscribed
11 Signature Pe nal Representative
before me the ~ l.' day of
~~. ~ ,
k ~ Signature of Personal Representative ;_ ~.,_
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For the Regi er Signature of Personal Representative -:: ~ -- ~ ; '~
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File Number: ~ l ~ `~ _ G ~ ~~' ~;' ~.;1 ,--,
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Estate of JACKSON M. SMITH ,Deceased
Social Security Number: 241-16-5737 Date of Death:08/08!2010
AND NOW, '~ ':~'4` ~ L , ~'~ ~ ,' in consideration of the foregoing Petition, satisfactory proof
having been presented befo a me, IT IS DECREED that Letters TESTAMENTARY
are hereby granted to ANGELA L. MULLIS
in the above estate
and that the instrument(s) dated NNE 29, 2010
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil()) of Decedent.
FEES
r ~ / ~
Letters ............... $ ~
Short Certificate(s) ........ $ ~ (;~1.'
Renunciation(s) .......... $
'~'~ $
$
...
$
...
$
...
$
...
... $
TOTAL .............. ~r~~7 .~ ase~
Register
Attorney Signature:
Attorney Name: SUSAN J. HARTM~IV
Supreme Court LD. No.: 65184
Address: 1 IRVINE ROW
CARLISLE, PA 17013
Telephone: 717-249-7780
Form RW-02 rev. 10.13.06 Page 2 of 2
OCAL. REGISTRAR'S CERTIFICATION OF DEA-TH
}lW~,RNING: It is illegal to duplicate this copy by photostat or photograph.
F~z.e' litr thin ct°rlbE~~:atL~. ~;(~.(?~~t
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;;,».;,"„"; I his ~~; tc} c:ertlfa that the Information here g)wen is
t,l~i''`'~'(N DFP ~ ~, -
t ~,P _ -- -,, E,~ ~ t}rre~:tly c(,pied 1-rt+Ir) an orirtinal Certificate of Death
;~`ao; ~~ ,; iiuly filed ~.~)th i~lc' <(~•; I~r}cal Re~;~strar. l'he original
'~,~ ~~~~~°: ~~e)t~ifi.a~c tc~i;! I}L~° I~~}r~warded to t1~Ie State. Vital
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H105-143 REV 1112006
TYPE I PRINr IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFI~.. fE OF DEATH
(See instructions and examples on reverse) C7ETC cu r w unaFa
1. Name of Decedent (First, middle, last, suffix) 2. Sex 3. Sacisl Secudty Number 4. Date of D th (MO ,day, year)
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201 - 16 - 5737 ~
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5. Age (Last Birthday) Under 1 er Under 1 da 6. Date of Binh Month, de , ear 7. Bi ce Ci aM state or torsi urount 6a. Place of Death Chock on one
Montlre Days Hares MinNea ~
_/ Carlisle, PA Hospital: Other:
~ ~~ ~~
C,
a YrS. P] ~}Clnpatient ^ ER / Oulpetient ^ DOA ^ Nursing Home ^ Residence ^ Other - Speciry:
6b. County of Death 6c. Ciry, Boro, Twp. of Death 6d. Facility Name (If not institution, give street and number) 9. Was Decederd of Hispanic Odgin? ®No ^ Yes 10. Race: American Indian, Black, White, etc.
• Dauphin H
i
bur Harrisbur Hos ital (If yes, sperary Cuban, (S black
P
arr
s
g Mexx~n, Pueno Rican, etc.)
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11. Decedents Usual tan Kind of work d one du ' most o(workin life. Do not state reb 12. Was Decadent ever in the 13. Decedent's Education (Specify only highest grade completed) 14. Madtai Sutus: Marred, Never Married, 15. Surviving Spouse (If wife, give maiden name)
Di
d
i
Wid
'
d
S
Kind of Work KMd of Busiress/Industry U.S. Armed Forces? Elementary /Secondary (0.12) College (1.4 or 5+) vorce
(
pec
yJ
e
,
ar
widowed
Athletic Director US Government ®vea ^na
16. Decedents MaNing Address (Street, city /tam, state, zip code) Decedent's Penns 1 Vanla Did Decedent
y Live in a 17c
^ Yes
Decedent lived in
TWD•
2 Rush Drive A t . 307 Carl isle , PA
p _
.
,
Actual Residence 17a. State
Township?
' ran
17d. ^ No, Decedent Lived within
Carlisle
]•
]Q]•3 CitylBoro
17b.Counry Actuallimilsof
16. FetheYS Name (First, middle, last, suffix) 19. Mother's Name (first, middle, maiden surname)
Theodore Smith Mary Furman..
20a. InfonnanYs Name (Ty / Pdntl
Angel Mullis 20b. Informant's Mailin Address (Street, city! town, state, zip code
16 Bentley Place Carlin e, PA 1701.3
21a. Method of Disposition r ®Crematbn ^ Donation 21b. Date of Disposftlon (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21 d. Location (City /town, state, zip code)
^ Burial ^ Removal from State i Wea Cremation or Donatbn Authorized
~ August 12 , 2010 of fman-Roth Funeral Home and Carl isle, PA
Yes^ No
^ Other - r by Medaal Examiner/Coroner?
• 22e. Signatu unerel S rvice naee (or ng es such) 22b. License Number c. and Addre
~oman- ss of Fe 'liry
Roth Funeral Home and Crematory Inc. 219 North Hanover
~ 138504
Complete items 23ac only ' certifying 23a, To the best of my knowle ,death occurred at the dme, date end places . (Signature and title) 23b. License Number y, year)
on
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23c. Deis Signed (
physician is not available a time of death to /~.. j~ ~
~ ry N ~/
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certify cause of death. ~
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Items 2426 must be corpleted by person 24. Time of Death 25. Date Dead Month, day, year) 26. Was Case Referr-re-~d t/o Medkal Examiner /Coroner for a Reason tDtlter than Cremation or Donation?
'
^
~ who pronounces death. ~ C] U ~ M, ~ ~ ` V Yes L
7No
CAUSE OF DEATH (See instructions and examples) r Approximate interval:
t
l
t
h
di
t t
D
th
T
O Part II: Enter other sicnificant conditions contributing to de~tih,
iven in Part I
in the unded
in
cause
t res
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t 26. Did T cco Use Contdbute to Death?
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b
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even
s suc
as car
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enter termina
Item 27. Pert I: Enter the chain of events -diseases, ajuries, a complicatarts • that rtirectiy caused the death. i)D NO
respiratory arrest, or ventricular fibrillation without showing the etioagy. List Dory one cause on each line. r .
g
g
g
y
u
no
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ro
a
es
^ No ^ Unknown
IMMEDIATE CAUSE ((Final disease or ~ ^` ~] ` ~
condition resulting m death) _~ a
y ` `~ r ~ ~ f'~
~ ,J 29. It Female:
re
nant within past year
^ Not
.
Due to (or as a consequence of): ~
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g
^ Pregnant at time of death
SequenltaNy 1is1 condtions, Yf any, b r
-
i
^
leading to the cause listed on line a. Due to (or as a tonne uence o(1: i
Enter Ilse UNDERLYING CAUSE q Not Dregnant, but pregnant w
thin 42 days
of death
(disease a injury that initiated me c i _
ear
but
re
nant 43 da
s to t
t
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nant
^ N
events resulting m death) LAST. r
Due to (or as a consequence oq: , p
y
y
p
eg
,
g
o
before death
d
~ -. ^ Unknown if pregnant within the past year
,
30a. Was an Autopsy 30b. Ware Autopsy Findings 31. Manner of beam 32a- Date of Injury (Month, day, year) 32b. l)ascdbe How Injury Occurred 32c. PWce of Injury: Home, Farm, Street, Factory,
Pedormed? Available Prior m Completan
of Cause of Deam7
aturel ^ Homicide ORce Building, etc. (Specify/
^ ^ Acddent ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. If Transportation Injury (SpecityJ 32g. location of injury (Street, city /town, stale)
^ Yes No Yes No
^
^ Yes ^ No ^ Driver/ rotor Passen er
~ ^ 9 ^ Pedestrian
Could Not be Determined
^ Suicide M. ^ Omer - S ,
Pec•N:
33a. Certifier (check Dory one) 33b. Signature and Titte Certifier
CertNying physician (Physittian certifying cause of deem when another physktian has pronounced deem and completed Item 23)
ted
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_ _ _ _ .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
my knowki
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ea
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o
To the best o Lcense Number 33d. Data Signed (Mon day, y r)
• Prawuncing and certirying physician (Physir~an born pronour»:ing deem and certifying to cause of deem)
To ttro beat of my krrowledge, death occurred at the time, date, and Place, and due to the cause(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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• 11~ A.~ ~'~';2 4
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L
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oroner
Medica
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On the basla of azeminatan end I or Investigation, in my oplMon, death occurred at the time, data, and place, end due to the cause(s) and manner as stated_ ^ 34. Name and Address of Pavan Who Completed Cause of Deam (Item 27) Type / Print
Registrar's ure and District ~urrr~~[. ~
3 I
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36. Date Fled (Month, day, year) h
~ T, e (~ ~ ~ V ~ !' ~U Y s r
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Disposition Permit Nd: ~} -r-} ~ ~ ~ ~) (S~ ~ ~ ~ ' r ~ u
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LAST WILL = -~'
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TESTAMENT ~r ~ ~ 4~"
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I, JACKSON M. SMITH, SR., of 2 Rush Drive, Apt. 307, Carlisle, Cumber-l'~nd Cot~xtty,
Pennsylvania, being of sound and disposing mind, memory and understanding, clb'hereby rrke, ~ ~ `=~-"~
publish and declare this as and for my Last Will and Testament, hereby revoking any and all other
wills and codicils heretofore made by me.
FIRST. I direct that all my lust debts and funeral expenses be paid from my ;estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that I be cremated and my ashes be interred in the same place as my
wife, Geraldine W. Smith, in accord with my expressed wishes.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shall consider necessary and desirable for the purchase,
erection and inscription of a suitable marker for my grave.
FOURTH. I give, devise and bequeath all of my estate of whatever nature, b•° it real,
personal or mixed, and wherever situate unto my children as follows:
A. A Twenty Percent (20%) share unto my son, JACKSON M. SMITH, JR., per
stirpes;
B. A Twenty Percent (20%) share unto my son, MICHAEL W. SMITH, per stirpes;
C. A Twenty Percent (20%) share unto my son, ANTHONY L. SMITH, per stirpes;
and
D. A Twenty Percent (20%) share unto my daughter, ANGELA L. MULLIS, per
stirpes.
E. I give, devise and bequeath the remaining Twenty Percent (20%) of m;y estate of
whatever nature, be it real, personal or mixed, and wherever situate unto my
grandchildren in equal shares, per stirpes, as follows, to: DAWN N. SMITH,
EARL J. CHIVIS, JACKSON M. SMITH, III, DANIELLE A. SMITH,
MICHAEL W. SMITH, JR., JESSICA L. MULLIS, and JOSHUA A. SMITH.
I direct that any other grandchildren that may be born before my death share equally with
my above named grandchildren.
FIFTH. I direct that any and all Inheritance, Estate and Transfer taxes impose-d upon my
~%n~
estate passing under my will or otherwise, shall be paid out of the principal of my residuary
estate.
SIXTH I hereby nominate, constitute and appoint my daughter, ANGELA I~. MULLIS
as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation
or inability to act for any reason whatsoever of my daughter, ANGELA L. MULLIS , I nominate,
constitute and appoint my son, MICHAEL W. SMITH as Executor of this my Last Will and
Testament. I hereby relieve my Executor from the necessity of posting security in connection
with his duties, as such, in any jurisdiction in which he may be called upon to act insofar as I am
able by law to do so. In addition to the powers conferred by law, I authorize my Executor, in his
absolute discretion, to retain in the form received, and to sell either at public or private sale any
real or personal property owned by the at the time of my death.
SEVENTH. If any of the beneficiaries of this, my Last Will and Testament, shall be
under the age of Eighteen (18) at the time of my death, then any portion of my estate in which
they share shall be held in trust for them with my daughter, ANGELA L. MULLIS, as Trustee.
The trusteeship shall end when the child attains the age of eighteen (18) years. The Trustee shall
provide for the care, maintenance and education of said beneficiary and shall from time to time
use either principal or income from the inheritance to provide for these needs. If any beneficiary
by Trust dies prior to attaining the age of eighteen (18) years, the Trust terminates and all such
funds shall be paid over to the beneficiary's legal heirs. The trusteeship shall end when the child
attains the age of eighteen (18) years.
EIGHTH. I have made, or may from time to time make, a written memorandum
expressing my desire to give certain items of personal property to specific persons. I urge my
Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be
stored in conjunction with this Will.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, consisting of three typewritten pages this .~~.~tti day of ~~ , 2010.
J KSON M. SMITH, SR.
Signed, sealed published and declared by the above named Testator JACKSON M. SMITH, SR.
as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and
presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
t
COMMONWEALTH OF PENNS YL VANIA
COUNTY OF CUMBERLAND
SS.
I, JACKSON M. SMITH, SR., Testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my
free and voluntary act for the purposes therein expressed.
Sworn or affirmed to and
acknowledged before me, by
JACKSON M. SMI/T~H~~ this
of v
-~ f _. _
CKSON M. SMITH, SR.
~ 9~ day
2010.
COMMONWEALTH OF PENNSYt_VANBA
NOTARIAL SEAL
JOAN D. ADAMS, Notary Put~lic
Carlisle 6oro., Cumberland County
My Commission Expires March 7, 2011
L~~2e~1/ i ~~~
Notary Publ'
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
:SS.
We ~ t/'~.~ ~ tJi ~ Gl tJ '1'~~ and
Imo/ Ll~G ~~l ~ ~ wJ 1~/l,G%-~ ~
the witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw JACKSON M.
SMITH , SR. sign and execute the instrument as his Last Will; that he signed willingly and that
he executed as his 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 eighteen (18) or more years of age, of sound mind and
under no constraint or undue influence.
Sworn or affirmed to and
subscribed bef~e me by~~~~ ~~ ~ N
~~y,a ~,
1n/! Lt,-~ f~ .ti! .~ . fJ ~~G~ /~ and
,witnesses,
this ~-~`~ay of ~~~~~ , 2010.
~ ,~, L~l
Notary Public
CO~vIMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
JOAN D. ADAMS, Notary Public
Carlisle Boro., Cumberland County
My Commission Expires March 7, 2011