HomeMy WebLinkAbout12-02-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY COUNTY, PENNSYLVANIA
Estate of Shirley D Fisher
also known as Shirley Doris Fisher
File Number 21-10 -
Deceased Social Security Number 192-20-1198
Susan Ann Haverstick
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE `A' or `8' BELOW.)
® A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the EXeCUtriX named in the
last Will of the Decedent, dated 12/17/1992 and codicil(s) dated
Rav P. Fisher .Husband of the De~~~pn± Was Executor named in the Last Will and Testament. Rak P. Fisher
died 9/22/2005. Susan Ann Haverstbck was named as Alternate Executrix
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 rca e, en er c a.; n c..a.; pe en e r e; urante a sen ra; uran a mrnorr a e
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: (/f
Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
Name Relationship Residence ~ ~' _~
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at U'+ `
4837 Trindle Road. Mechanicsburg, Hampden, Cumberland County, PA 17050
(List street address, town/city, township, county, state, zip code)
Decedent, then ~4 years of age, died on 10/23/2010 at Carolyn Croxton Slane Residence, Susquehanna Twp, Harrisburg, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA)
(If not domiciled in PA)
(If not domiciled in PA)
Value of real estate in Pennsylvania
All personal property
Personal property in Pennsylvania
Personal property in County
situated as follows:
39,568.00
0.00
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:
I Sianature Typed or printed name and residence ~
Susan Ann Haverstick 55 Lone Oalk Drive
Marysville, IPA 17053
a_.
Form RW-OZ Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS
couNTY of Cumberland County }
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 «ifirrreif and subsr.,ribed
before me this _ ~-~ _ day cf
~'~'~-- ~ C~--K-'n--
of Personal Representative Susan Ann Haverstick.
Signature of Personal Representative
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For the Register Signature of Personal Representative ~~~ r
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File Number: 21-10 - t l 'J
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Estate of Shirley D Fisher , DeceasE;d -..~
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Social Security Number: 192-20-1198 Date of Death: 10/23/201 O
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AND NOW, ~~ C l 1 ~ 1+4 .~' 1 ~ ~-- ~ ~~ ~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Susan Ann Haverstick
in the above estate
and that the instrument(s) dated 12/17/1992
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent
FEES
Letters .......................................... $ C~ ~` ~ (~ `~
Short Certificate(s) ....................... $ I ~ ~ ~~ ~ ~'
Renunciation(s) ............................ $
TOTAL ................................... $ 1 ~~ - L_~~J
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Attorney Signature: .,s
Attorney Name: EDMUND G. MYEF2S ____
Supreme Court I.D. No.: 20558
JOHNSON DUFFIE
Address: 301 MARKET STREET
PO BOX 109
Lemoyne, PA
Telephone: (717) 761-4540
Form RW-OZ Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2
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Htos-tea REV tu2oos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE /PRIM IN
PERMANENT CERTIFICATE OF DEATH
BLACK INK /See instructions and exam les on reverse
C P ~ STATE FIl F NUMBER
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1. Name of Decedent (First, middle, last suffix) 2. Sax 3. Social Security Number 4. Dale of Desdh (Month, day, year)
Shirle Doris Fisher Female 192 - 20 - 1198 Octoblsr 23, 2010
5. Age (Last Birthday) Under 1 ear Under 1 da 6. Date of Birth Month, da , a 7. Birth ce C' and state «for ei ce fie. Place of Death (Check m one
Months Days Nours Minuras Hospital Other. T•~~,~p
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- 84 Yrs. Au st 27 1926 Hosensaek PA ^ Inpatient ^ ER f Outpatient ^ DOA ^ Nursing Home ^ Residerzxr L4 Othel S
pecity
8b. County of Death &. City, Bono. Twp. of Death 6d. Facility Name (h rat institution, give street and number) 9. Was Decedent of Hispanic Origin? ®No ^Yes t0. Race: American ind'ran, Blade, White, etc.
-
Dauphin
Susquehanna 'ItA7p.
Carolyn Croxton Slane Residence (II yes, specrry ~,
Mexican, Puerto Rican, etc.) (SP~M
White
71. Decedent's Usual Occu lion Kind of w«k tlorte d ud most of Ne. lb not state refired 12. Was Decedent ever in the 73. Decedent's Education (Specify ony hghest grade compl eted) 76. Martial Status: Monied, Never Married, t S.:iurviving Spo use (If wife, gNe maiden reme)
Kkd of Work Kind of Business/Industry U.S. Armed Forces? Elementary /Secondary (412) College (1-4 a 5+) widowed' Divorced (SPeclty)
Secre Sales ^Yes ®No 12 Widowed
16. Decedent's Mailing Address (SVeet city /town, state, zip code)
- Decedent's Did Decedent
Pennsylvania Live in a
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4837 East Trindle Road t 7c.
Yes, Decedent Lned in
wp.
Actual Residence t 7a. State
Township?
t7d. ^ No, Decedent lived within
CUmberlaIld
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?Mechanicsburg, PA 17050 7
'
ounry Actual Limits of CgylBoro
18. Father's Name (First, midde, last, suffix) 19. MotheYs Name (First middle, maiden surname)
Charles Grubb Lillian Keresnerer
20a. InfomtanYS Name (Type / PdnQ 206. Intamant's Marling Address (Street city 1 town, state, zip code)
Susan Haverstick 55 Lone Oak Drive Marysville, PA 17053
21 a. Method of Disposition r ^ Cremation ^ Dana6on 27b. Date of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory «other place) 27d. Loptaxt (Gry/town, state, aP code) I
- ® Buda) ^ Removal Irom Stare ~ Was Crer»Mion « Donation Authorized
^ a,,,r. r ~r rr.dical Examinerrc«onen ^ Yea^ Ne
October 29 2010
Indlantown Ga Nat' 1 C '
-i lQ,.~ PA
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22a. S' d F rat person adirtg as such) 22b. license Number 22c. Nome and Address of Facility 8 Market Plaza Way ,I
- - ~ FD - 014889 Mal zzi Funeral Home Mechanics PA 17 _`i i
to ' whence ' '
is nd avaiable at fime of lea ro 23a. To the t ~ my deathaccurtad data and dap stated. (Signature artd tide)
~ 23b. rue Number
~, ~. 3 ~ ~ 23c. Date S (Month, da ,year)
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certMy cause of death. ~ ~
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hems 24-26 must be completed by person 24 of DeCd~\ 25. Date Pro de y
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who proounces death. ,
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CAUSE OF DEATH (See Inetructbns and examp s) r Approximate interval: Part II: Enter other significant conditi«u c«ttribrxko to death. 26. Did Tobacco Use Comribute to Deathl
Item 27. Pan I: Eller the drain bl evenLS -diseases, injuries, «oontplicatioru -that drectly caused the death. 00 NOT enter terminal events such as cardiac arrest, ~ Onset to Death but not resulting n tits underlying puss given in Pan I. ^Yes ^ Probably
respiratory arrest «ventricuWr fiWillation wahaa s
lowing the etiobgy. List only one pose on each Nne. r ^ No ^ Unknown
IM~M~ ~CAIlSE IF ~ disease « 9 . \;(~ / ,,,1 i
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29 If Female:
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^ Pregnant at time W death
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Enter UNDERLYING CAUSE Due to (or as a coruequertce of/: t Not pregnant but pregnant within 42 days
a learn
(dsease « ktjury that kA6ated ore i
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events resuttirrg rn death) LAST.
Due to (a as a consequence of): r
d. ~ ot pregnant but pregnant 43 days ro 1 year
before death
^ Unknown d pregnant within the past year
30a. Was an Autopsy 30b. Were Autopsy Findings 31 Ma of Death 32a. Date d Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: hlome, Farm, SVeet Facrory,
Perforated?
Available Pri« to Completion
of Cause of DeaM?
Natural ^ Homicide Office Building, etc. (Specfy)
^ Y
N ^
^ ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Irqury at Work? 32t. If Transportation Injury (Specify) 32g. Loptbn of injury (Street city /town, state)
es
o Yes
No
^ Suidde ^ Coub Not be Determined
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^Yes ^ No
^ Dritrerl0perator ^ Passenger ^ Pedestrian
. Other • Specify
33a. Certifier (check only one) 33b. Sig nd Title of Certifier
• Certllying physician (Physician certilyvg pose of death when another physician has pronounced death and completed Item 23)
_ _ _ _
To tM !>W of my knowledge
death occurred due to the cause(s) and manner as stated ~ V
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_ -' _ _ _ _ _ -' _ -' _ _ _ _ _ _ _ _ _
• Pronouncing and euttlying physician (Physician both pronormdng death and certifying to pose o1 death)
To the best of my knowledge, death occurred al the time, date, and place, and due to the pose(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• fdedlcalExamirrerlCoronsr
On lire basis of examinetlon and / or Investigatbn, in my opinion, death occurred al the time, date, and pWce, and due to the cause(s) and rnenner as stated_ ^
33c. Lice e`Nnumnber ` 1 / 33d. Date Signed Month, day, ar)
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Disposition Permit No.
CRW/December 11, 1992/21912
~~~t~t ~Illill xnD (7~ est~tmrnt
OF
SHIRLEY D. FISHER
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I, SHIRLEY D. FISHER, of the Borough of Mechanicsburg, County of Cumberland, and
t~'ommon~~~ealth of Penns,,'v~ria, being of sound and disi o~;lra mi:~d, man;;?ry a.*ld unders±anding, do hereby
make, publish and declare this as and for my Last Will and Testament, hereby .revoking gal other Wills
heretofore made by me.
ARTICLE I
I direct the payment of my legal debts and the expenses of my last illness and disposition of my
remains from my estate as soon after my death as conveniently may be done. All of the forE;going shall be
considered expenses of the administration of my estate.
ARTICLE II
I bequeath all of my tangible personal property (excluding cash or securities), together with any
existing insurance thereon, to my husband, RAY P. FISHER, if he survives me for a period of thirty (30)
days If he does not so survive me. I bequeath said tangible personal property to my daughter, SUSAN
ANN HAVERSTICK. If both my husband and my daughter are not then living, I bequeath said tangible
personal property to my grandson, CHRISTOPHER J. HAVERSTICK.
ARTICLE III
I devise and bequeath all of the residue of my estate to my husband, RAY P. FISHER, if he
survives me by a period of thirty (30) days. If he does not so survive me, I devise and bequeath all of the
residue of my estate in equal shares to my daughter, SUSAN ANN HAVERSTICK. If both my husband
CRW/December 11, 1992/21912
and my daughter are not then living, I bequeath said tangible personal property to my grandson,
CHRISTOPHER J. HAVERSTICK.
ARTICLE IV
I appoint my husband, RAY P. FISHER, Executor of this my last Will. In the event of his inability
or unwillingness to act or continue to act as Executor, I appoint my daughter, SUSAN ANN
HAVERSTICK, Executrix.
ARTICLE V
I direct that my Executor, or his successors, shall not be required to give bond fc-r the faithful
performance of their duties in any jurisdiction in which they may be called upon to act, insofar as I am able
by law to do so.
IN WITNESS WHEREOF, I hereunto set my hand and seal this /~'~ day of December, 1992.
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Shirley D. sher
Signed, sealed, published and declared by the above-named Testatrix 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.
. ~
CRW/December 11, 1992/21912
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA :
ss:
COUNTY OF CUMBERLAND ,
I, Shirley D. Fisher, Testatrix, whose name is signed to the foregoing instrument, having been duly
qualified according to law, do hereby acknowledge that I signed and executed the instrument as. 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. ,
,,~
hirley D. ,' er
Sworn or affirmed to and acknowledged before me, by Shirley D. Fisher, the Testatrix, this ~~ ~~~
day of December, 1992.
Notary Public C:.j ~. ~.
Nt}TAkIAL SEk~. ~.~~_
ptANNE LENIN, N~;TARY ('iJF3i.;~.
EEMDYNE BORq. Ci3M$ERa,A~tt3 ~~„
MY ~'(~lMISSION EX~'IR~Sw~EC„ 21, 7953
CRW/December 11, 1992/21912
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss:
We, ~~ ~ ~~ '~~~.-~..~~..rr~'~ `~ , and ~~~c~._~-~~--~., ~~r~a..i~,~-..~, the witnesses
,~
whose names are signed to the foregoing instrument, being duly qualified according to law, cio depose and
say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will
and Testament; that she signed wiliingiy and t5a± 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 Testatrix signed the Will as
witnesses; and that to the best of our knowledge, the Testatrix was at least 18 years of age, of sound mind
~ and under no constraint or undue influence.
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Sworn to or affirmed to and subscribed to before me by ~~ • ~ ~~~~-.s..,,~ h ,• and
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~...~,--, ~ ~, ,r-~..~~~-~... ,witnesses, this ~ day of December, 1~~2.
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~.E!~OYl~E ~~R~J. ~U~+!SE4~i..~i~~fu i'{l.
MY C~Jb1Mi~~iQR' rXP,R~S C~~C. ~'i, 1~~