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Home My WebLink About06-03-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA .~ ~, r7 e ,, J ., Estate of Gladys M. Clapsadle File Number ~*'- ~ ~ 1 ~ ~~~' ~"'"~ ~_,~ also known as ,Deceased Social Security Number 179-30-4225 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 EX@CUtOr _ named in the last Will of the Decedent dated 5/4/2005 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, was never adjudicated incapacitated, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as provided in 23 PA C.S. section 3323 (g): NONE ^ B. Grant of Letters of Administration (If applicable, enter: c. t. a.; d. b. n. c. t. a.; pendente liter durance absentia; durante.mir~oritateJ 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. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) Name R elatinnchin n,.,.: a.._ __ 11 Carpenter Lane ~? r r"1 < I I may, ,;~'- ~ >f . __ ,: ~ _.-, (COMPLETE INALL CASES:) Attach additional sheets if necessary.~'~~'''''yy C~ ~r~i ?'"' ~ ~ ~=~r Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principa~s'?i~rice at _1~~1 ~-:. Walnut Bottom Road Shippensburg PA 17257 Shippensburg Twp ~•~ (Lrst street address, town/crty, townshrp, county, state, zip code) - ~..~ Decedent, then 72 years of age, died on 10/15/2009 at Shippensburg, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ _ 5.000.00 (If not domiciled in PA) Personal property in Pennsylvania $ _ (If not domiciled in PA) Personal property in County $ _ Value of real estate in Pennsylvania $ _ 0.00 None situated as follows: 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 '~ Mary Grace Gardner 11 Carpenter Lane r 2~=~-c~ Newbur _ PA 17240 Form RW-02 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, Petitioner(s) will well and truly administer the estate according to law. Sworn to ~r affirmed and subscribed before me the .. `~'~ day of ~,, - \ 2011 / ~~r ~~ r or the Register ~~%~~ . Signature of rsonal Representative Signature of Personal Representative Signature of Personal Representative File Number: 0 ~ C - I ~ - ~- ~ ~ ~- tea: ~ ~ ~ C ~ ' ' '7 : .... ~ t ~ _ z:~ t ~: t•_ t ~r~ ti -~ t13 , i~r ~i Estate of Gladvs M. Clapsadle ,Deceased Social Security Number: 179-30-4225 Date of Death: 10/15/2009 :- - AND NOW, ~ L- ~~ i ~ ~ , 2011 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary _ are hereby granted to Marv Grace Gardner _ in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ............................. $ - -' ( ~~t ,` Short Certificate(s) ............ -~ ,._..~ $ ~, Renunciation(s) •• .............. $ Bond .,.. $ Other ..., $ .... $ .... $ .... $ .... $ Automation FEE ..., $ 5.00 JCS FEE ..., $ 23.50 TOTAL ............................. $ ..2$-~9 _~ Attorney Signature: ~~ 1 .fit -(..~_,~;?'~I ~ ,, • , _ ; Re ister o Wills %~ - Attorney Name: H. Anthony Adams _ Supreme Court I.D. No.: 25502 _ Address Telephone: 49 West Orange Street Suite 3 Shiapensburg _ PA _ 17257 7175323270 _ Form RW-02 rev. 10.13.06 Page 2 of 2 )AL REGISTRAR'S +~ERTI~'IATI~~IV CAF t~EA"~'~-I 'UV'~~FilNlf~~: It is illegal to duplicate tt~i~:~ ~.ca)z~'~/ i;°F phot~alt;:~~t a#' photograpf~, .. ,s ;. fi~~ tii~, r>:~rtrE)~atti. `~r,.O1) ,.ar „~„ :° ~ r~ )~ tt~ ;_, f-ti(~. '}, st ~+,9~~ ~(1F(>rmation here given is r ,,,,''~,~. - ~~1~:.-, (~t:~<~s ~~. R '_'f~)~~;1 ~~ 11 ~ ~_I,) c~ri~~i)ial C'~~rtil~ic~(tE~ (~f Iae~~th ,,,`,,~'~; -~~ i~_~Y, Irfct! ~.z t!) s:~' .t-, ~ x_,I.~ 6Ze~i~trar. The ctri~inal ~~ ~ `'~~-,i ~, 2ivl~~a.(~~~{{ r1! i ~• %I~~~ar~1cE1 t(,~~thc State 'Vital • ~ .. Y. .~Y '. f1~S S,•t Jl l~l ~ l~ )~,, III, ~ t()~~/11S l)I())L.. .~. , . , ,,; .* ,` ~ r~~~ ---- , firs C~rtitic.~aiic~r~ '`v(,(~~I)i,t r. ;,ra, ~:, - _~Ii 1°,.,,9~11`:I1~ Dale ~~SLI;~C~ ~... 4. c;n ~ tai s" .)` ~ _---~ • ~.J (-7 ICS >~ `=_ ~ 't ---~ Hit]5-t43 REV 11/2008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ -~ .• •~ TYPE I PRINT IN .....~ ~ ~ ---- Ste) PERMANENT CERTIFICATE OF DEATH ~ BLACK INK (See Instructions and examples on reverse) CTATL LII C .,~ ~.. ~ ""- ~~ Q w J a w w 0 0 w Q Z 1. Name of Decedent (Fxst, middle, lest, suffix) 2. Sez 3. Sodal Security Number 4. Date d Death (Month, day, year) Gladys M. Clapsadle Female 179 - 30 - 4225 Octolber 15, 2009 5. Age (foal Birttxlay) Under 1 r Under 1 da 8. Date of Bbth Month, de , r 7. Birth ce end state or ta e' n count 8a. Place of Death Check ce one Mol1Ms Days Hours Mmules Ou amp On Wp. Hospital: _ Other: 72 Yrs. 7/21 /37 ranklin Ct . , PA ^ IrryetieM ^ ER / Otrryatlent ^ DOA ®Nursing Hane ^ Residerxa ^ Other • Speary 8b. County of Death Bc. City, Boro, Twp, of Death Bd. Fadlity Name (h not ktsthution, give street and number) 9. Was Decedent of Hispanic Ckigin? No ^ Yes 10. Race: ricen Indian, Black, White, etc. Cumberland Shippensburg Twp. hippensburg Health Care Center (~~,~'n, ~~~,erc.) ( White t t. Decedent's Usual tion Klod of work d one du ' most of wo Yfe. Do rat stale retire 12. Was Decedent ever h the 13. Decedent's Education (Specify only highest grade comp leted) 14. Marital Status: Herded, Never Married, 15. Surviving Spo use (If wile, give maiden name) Kind of Work KindoiBusiness/Industry Assembler G S Electric U.S. Armed Forces? Elementary I Secondary (D-12) College (1.4 or 5+) Wed' Divorced (~ . . ^y~ ~ ~ 9 Never Married - 1s.Decederd'aMagingAddress(Street chY/town stala'Z'y~ode) 121 Walnut BOt~Om I~OaCt D~cadeM's Penns lvania Did Decedent S11i ensbur y Liveine ActuelResiden 17 St t pp g ~ • Shippensburg, PA 17257 ce a. e e 17c. Yes,DecedentLivedin__ Twp. 1m~~n,y Cumberland Townanip? 17d.^No,DecedenlLivedwhhin Actual Lk111iS of City / Bono 18. Father's Name (First, middle, lest, suifbc) 19. Mother's Name (First, middle, maiden surname) - Fred Clapsadle Sara Grace Mackey 20a. InlonneM's Name (Type / Pdnt) 20b. InlomneM's Mahing Address (Street, coy /town, slate, zip code) - Linda Williamson 427 Bradshaw Avenue, Haddonfield, NJ 08033 21 e. Method of Disposition r ^ Cremation ^ Donation - 21 b. Date of Dispcei8an (Month, day, year) 21c. Place of Disposition (Name d cemetery, crematory a other place) 21d. Location (City /town, state, zip code) ® Burial ^ Removal from Slate i WasCremtlionorponationAuthodzed ^ Diner • ' by Medical Examiner/Coroner? ^ Yes^ No 10/20/09 St I natius Cemeter g y ranklin Twpp. dams CT • , PA 17222 z2a. ~ ur Funerels sae rson south) 2zn.l-i~,aeNumber 22o.NamaandAddraaaofFadliry Fogelsanger-Bricker Funeral Home, Inc. . ~ FD-011776-L P.O. Box 336, Shi pensburg, PA '17257 Complete items 23ac onry when cer8lying ph en is not available at lime o1 death to 23a. To the best of my knowledge, death aawrred at the ' ,date end place stated. (Signature end Ulle) 23b. License Number / / / 23c. Date Signnnpppd (Month day, year) / r ~ ce cause of death. ~ ~ ,J~ ~ ~ ~ ~ ~ ~ (p (p L / ~ ~ / CJ / / / - Hems 24-26 muss be completed by parson rorauraes death - who 24. Trme of Death ~i ~4 s 25. Date Pronounced Dead (Month, day, year)[ (~ ~ 28. Was Case Referred to 'rat Examiner / CAronel• for a Reason Other than Crematbn a DonaOon? ^ p . o ; ~ O n M. Cir ~ J; ~o o % Q~ ~v Yea CAUSE OF DEATH (See Instructions end examples) ~ Approximate interval: Pad II: Eller other a10MfitaM condhions contdbutino to d@~, 28. Did Tobacco Use Conldbule to Death? hem 27. Pad I: Enter the chain of events -diseases, iryudes, or complications -that tiredly caused the death. DO NOT enter terminal events such es cardiac arrest, ~ Onset to Death but not resuhing fn the undedying cause given in Pad I. ^ Yes ^ Probably respketory crest, or ventricular fibd0ation whhoul showing the etiobgy. list onry one cause on each line, r r ' I ^ No ^ Unknown IMMEDIATE CAUSE (Final disease or _ condition resuhing in death) ~~. ~~ (~~ ~ ~ r 29. if Female: ~ '~ ~, i _ v ~- a. o R ~-`"~.J ' ^ ~ Due to (or a~uerxre of): , r Not pregnant wdhin past year ^ P nant at tim f d th e Sepduaegn0all list conditions, tl any, b, ~ r e o ea 9 ^ Enter dre UNDEtiLY NG CAUSE a Dua to (or as a uence ol): i preg pregnant whhin 42 da Not nant, but ys (disease a injury that inihated the ~ r events resulting in death) LAST. c' ~ d death ^ Due to (or as a consequence r Not pregnant, but pregnant 43 days to 1 year ' • d. ' r before death ^ Unknown h pregnant wAMn the past yeas 30a. Was en Autopsy 30b. Were Autopsy Findings 31. Ma r of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory, Pedormed? Available Prior fo Completion Natural ^ Ho i id Olfke Building, eta (Speci/y) of Cause of Death? m c e ^ Yes No ^ Yes ^ No ^ Acddent ^ Pending Investigation 32d. Time of Injury 32e. Injury et Work? 321. 11 Transpodation Injury (SpecltyJ 32g. Location of injury (Street, city I town, state) ^ Suicide ^ Could Nol be Determined ^ Yes ^ No ^ Driver/Operelor ^ Passenger ^ Pedestdan M. ^ Other -Specify: 33a. Cedhier (check onry one) 336. S ture and Title of Cedilier • Certhying physician (Physician cedilying cause of death when another physician has pronounced death and completed Item 23) ~ To the best of my knowledge, death occurred due to the cause(s) and manner ae stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - J(~~~ ~~ `!~ • Pronouncing and ceRNying physklen (Physican both pronamcing death end codifying to cause of death) To the best of my knowledge, death occured at the time, date, snd place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ _ 33c. License Number ~ 33d. Date Signed (Month, day, year) _ ,-,-, ~ ~ S q 3 ®~ ~ L ~ a - /S ~ ~ • Medical Exsminer/Coroner On the basis of examtnstbn r Investigation, in my ion, de occurred el the time, date, and place, and due to the cause(s) and manner as stated_ ^ _ 34. Name and Address of Pe plated Cause of Death (Hem ,,2" Typr~ // /Print ~ / ~ ~ / C ~~~~ 7 ~ ~~ Registrar's Signature end Dis rct N r 38 (Mo y, year) % s/ ~' / 7 ~ ~ l l ~ r ~ ~ `' " ~ i- ~ I I Z~ ~I ' Disposition PemnB No. __ S.l LO~ ! d ~ ~ ~ ~ ~~ ~~ - ~ ~~~ W = =~~ .~ ~~ Q ~ ~ . C_..~ Gast ZViCCancf7estament of GCadys ~l~l. C~apsacfCe I, GLADYS M. CLAPSADLE, of Southampton Township, Franklin County, Pennsylvania, being of sound mind and memory declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all my just debts and funeral expenses, including my gravema~rker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: If my nephew, GREGORY CLAPSADLE, is living with me at the time of my death then I give devise, and bequeath to GREGORY CLAPSADLE, his choice of furniture where we are both living. If my nephew is not residing with me at the time of my death then this provision is null and void. ITEM III: I give, devise and bequeath all of the rest, residue, and remainder of my estate of every nature and wheresoever situate to my sister, MARY GRACE GARDNER, her heirs and assigns, livin, on the thirty-first day following my death, in shares of equal value, share and share alike. ITEM IV: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the exper.~se~s of the administration of my estate. ITEM V: I appoint MARY GRACE GARDNER, Executrix of this, my Last Will and Testament. Should she fail to qualify or cease to act then I nominate and appoint LYNNE ALWINE, Executrix of this my Last Will and Testament. ITEM VI: I direct that my Executors or their successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on ~ sheets of paper, dated this ~ day of May, 2005. a~ ~ ~? EAL) GLADY M. CLAPSA E The preceding instrument, consisting of this and other typewritten page(s), each identified by the signature of the testatrix, GLADYS M. CLAPSADLE, was on the day and date thereof signed, published and declared by GLADYS M. CLAPSADLE, the testatrix herein named, as and for her Last Wiill, 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. ' ing at ~ ~ ~ I ~~ residing 2 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND , We, GLADYS M. CLAPSADLE, the testatrix in, and the undersigned witnesses to, the will, the attached or foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed the instrument as my will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the testatrix sign and execute the instrument as her will, that she signed it willingly and 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 a witness and that to the best of our knowledge the testatrix was at that time 18 or more ;years of age, of sound mind and under no constraint or undue influence. ,j GLADY M. CLAPSA E ~~v iy~ness // ~/ Witness Subscribed to and subscribed or affirmed and acknowledged before me by GLADYS M. CLAPSADLE, the testatrix and th witnesses whose names are signed above this day of May, 2005. Notary Pu is NOTARIAL SEAL SALLYI. WINDER, NOTARY PU8L1C NORTH NEWTON TWP., CUMBERLAND COUNTY MY COMMISSION EXPIRES MARCH 6 2007 3