HomeMy WebLinkAbout08-29-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of S. Ray Clem ,Deceased ESTATE N0: 21- a01~ -Oq, 11
., n, i,..
.S.S N O :_ 177-16- 44
Petitioner(s) who is/are 1 S yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND ~`C" as
applicable:
~ A. Probate and G rant of Letters Testamentary or pAdministration e.t.a., or d.b.n.c.t.a. (complete Part C also)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters Testamentary under
the last Will of the above-named Decedent, dated May 29, 2003 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
instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person, and was not a
party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as defined in
23 Pa. C.S.A. § 3323(8):.
^ B. G rant of Letters of Administration
(If applicable, enter d.b.n., pendent Ilte, durante absentia, durante minoritate)
C. 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 e.t.a. or d.b.n.c.t.a., enter date of Will in Section A and complete list of
heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party t0 a pending divorce
proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(8), except as follows:
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THIS SECTION MUST BE COMPLETED: ~" ~- `"~?,
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence
At 61 Longwood Drive, Mechanicsburg, Silver Spring Township, Cumberland County, PA 17050
(Street address with Post Office and Zip Code, Municipality; Township, Borough, City)
Decedent, then ~~ years of age, died March 27, 2009 at East Pennsboro Township, PA
(Month, Day, Year of death) (City and State where death occurred)
Estimated value of decedent's property at death:
_If domiciled in PA All personal property $ A6t n~
_If not domiciled in PA Personal property in Pennsylvania $
_If not domiciled in PA Personal property in County $
_Value of Real Estate in Pennsylvania $
Total Estimated Value $ ~
Location of Real Estate in Pennsylvania: (Provide full address if possible.) 61 Longwood Drive, Mechanicsburg, PA 17050
Signature(s)
Namalsl R Mailinn Gddroce/nel
artha Ann CIem,61 Longwood Dr., Mechanicsburg, PA 17050
Interim Form RW-02 revised 1226 10 by cnmMrland ~`.,.,.,n, ..o..a:.....,,..:,._ ~.. .t_ ~___
,.,...,.,..6 w....,,, .,y ~,~~ ~ uun Page 1 of 2
OATH OF PERSONAL REPRESENTATIVE
Commonwealth of Pennsylvania ~ SS
County of Cumberland
The Petitioner(s) herein named swear or affirm 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.
byye~~f~~ore me this day of
t-Tl~ ~icl~' ~
a X~ n D 1.~,~0 ~P,f1a,1,l~hY~1
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For the Register
C7 a
DECREE OF PROBATE AND GRANT OF LETTER ~ h-
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Estate of S Rav CiPm ,Deceased File Number: 21-~~__-
AND NOW, this ~_ day of ~~~~~ ~l ~ , in consideration of the Petition on
the reverse side hereon, satisfactory proof havif~g been presented before me, IT IS DECREED that Letters
Testamentary - of Administration are hereby granted to:
(If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.)
Martha Ann Clem in
the above estate and that instruments(s) dated May z9, zoo3 described in the petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.
~ ,~ {~ A ~~~ ~~rx~h Y.JC,j Nil
Glenda Farner Strasb ua gh, ~ ~ ~J~a~~S
Register of Wills
Sworn to or affirmed and subscribed
1
~~
FEES:
Letters ....................$ __ ~~fs1--~SZ~
Will ........................ f~'~ t>t~
Codicil(s) ...............
(~ Short Certificates ~~T
( )Renunciations.......
Bond .........................
Other ........................
.................................
Automation FEE......... 5.00
JCS FEE ................... 23.50
TOTAL ................$ ~I , 5~
Signature of Counsel Requires to tnte~~p~ance
Atty's Signature
PRINTED Name: Andrew C Sheely
Supreme Court ID No.:62469
Address: 127 South Market St., P.O. Box 95
Mechanicsburg PA 17055
Phone: 717-697-7050
Fax: 717-697-7065
Page 2 of 2
~ Interim Forth RW-02 revised 12.26.10 by Cumberland County pending action by the Court
NIOS.SUS REV (01/07)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 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 tq the State Vital
Records Offiee for permanent filing.
P 15216937
Certificaeton Number ~Oi~~,pi 3~ ~n 0'f
Local Registrar ~/ Date Issued
"~"1~ "EY "~ COMMONWEALTH OF PENNSYI.YANIA • OEpkRl'YENT OF MEAiTM• VITAL RECOpDS
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I+AST HILL
I, 8. Ray Clsm, of 414 Orr's Bridge Road, Camp Hill,
Cumberland County, Pennsylvania
declare thi
t
,
s
o be my Last
Will, hereby revoking all prior Wills and Codicils.
FIRST: I direct that the expenses of my last illness and
funeral be paid out of
my estate as soon after my death as is
convenient and expeditious fn the judgment of
my Executrix,
hereinafter named.
SECOND: I give, devise and bequeath my entire estate to
my beloved wife, Martha Ann Clem
id
, prov
ed she survive me by a
period of thirty days.
THIRD: Should my wife, Martha Ann Clem, predecease me or
die on or before the thirtieth da
f
ll
i
y
o
ow
ng my death, then
and in that event, I give, devise and bequeath my entire
estate to my son, Ray Eugene Clem.
FOURTH: I have made no provision in this my Last Will
for my natural born daughter, Patricia E. Fike
as I d
,
o not
wish her to receive any share of my estate.
FIFTH: I have made no provision in this my Last Will for
my two adopted daughters
Ste
hanie L
i
,
p
. F
sher and Kimberly A.
Clem a/k/a Kimberly A. Dworchak, as I do not wish them to
receive any share of my estate.
SIXTH: I have made no provision in this my Last Will for
my two step-daughters
Beli
d
L
,
n
a
. Dellinger and Rebecca A.
Hench, as I do not wish them to receiv
e any share of my
estate.
wife,SMartha•Ann ClembyExecutri
~
o
t
e
p1
1n
x
of
this
n-y
Last W
1
Should
my wife, Martha Ann Clem, be unable to s
o serve for any reason
whatsoever, then and in that event, I nominate
constit
t
,
u
e and
appoint my son, Ray Eugene Clem, Executor of this my Last
Will. I further di
t t
rec
hat they shall not be required to
post any bond to secure the faithful performance of th
i
e
r
duties in the Commonwealth of Pennsylvania or in any other
jurisdiction.
R. SCOT'i CRAMER ,-
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Y
5A 3 Market St "'
x~c~ ~ r'' i i~'
P.O. Box 159 ~ ,r~ rL= C:, S r? C
Duncannon, PA 17020 ? '~ ~ ~.>
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IN WITNESS WHEREOF, I have hereunto set my hand and seal
to this my Last Will which coyn~ sts of two (2) sheets of
paper, dated this ~`~'~day of /v`~
2003.
~ (SEAL)
. Ra lem
R. SCOTT CRAMER
Altorr~ey at Law
5 S. MaOcet St.
P.O. Box 159
Duncanran, PA 77020
The writing contained on this and the one preceding page was
signed and sealed by 8. Ray Clem, and by him published and
declared as his Last Will, in the presence of us, who have
hereunto subscribed our names as witnesses at his request, in
his presence, and in the presence of each other..
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of S. RAY CLEM ,Deceased
L inn Brown , (each) a subscribing witness to
(Print Name/sJ
the ~ Will ~ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she / he /they was were present and saw the above Testator /Testatrix sign the same
and that she / he /they
the Testator estatrix
signed the same and that .she he /they signed as a witness at the request of
in her presence and in the presence of each other.
C.~•
(Signs reJ
LgL l ~~ s G~,o ~
(Street Address)
~C~ruSvrr~e P~ 17053
(City, Stat , ZipJ
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
of
day
Deputy for Register of Willp~gnwe>~tl~dPen ~0
NOTE:
NtYTAR]AI-SEAL
]UDY M. HENNINGERr Nota»Y ~~
Duncanrwn Boro,~ CC~Z X15
My Comml>~lon Expl MaY
(Signature) (~' .,-
T~
O
~ ~i ~.~
(Street Address) ~ ~ lV
~
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(City, State, ZipJ _
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Y- ~~ G
f, , n
Executed uut of Register's office
Sworn to or affirmed an~ubscribed
befo a this day
of ~ >~
y Cornmission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
To be taken by Officer authonzed to administer oaths. Please have present the original or copy of instrument(s) a[ time of notarization.
Form RW-03 rev. 10.13.06
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of S. RAY CLEM ,Deceased
Wavne Los'ue , {each) a subscribing witness to
(Print name/s)
the ~$ Will ®Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she /~/ they ~/ were present and saw the above estato /Testatrix sign the same
and that she ~ they signed the same and that she he they signed as a witness at the request of
the Testato Testatrix in her his presence and in the presence of each other.
(Srgnoture
iZo Lff D,e/~..c
(Street Address)
~g~~~ l>'(~ ~-~ / 2a~~
(City, State, ZipJ
Executed in Register's lOffice
Sworn to or affirmed and subscribed
before me this
of
Deputy for Register of Wills
NOTE: To be taken by Officer
day
Cgnmonwealt>h of PenrrsyNanls
NOTARIAL SEAL
JUDY M. HENNINGER, Notary Public
Duncannon Bono, Perry Caunty
t'iy Commission Ex!~irc3s May ~5, 26x15
_,. _..__
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(SignamreJ ~ ~ ~ _ ~
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trD - ~'
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(Street Address) ~? C-y
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(City, State, ZrpJ :D --r-t
t\:r
I~,xecuted vut of Register's Off ce
Sworn to or affirmed and su scribed
before this ~ day
of ~ ~~ .
N
mmission Expires:
and Seal of Notary or other official qualified to
oaths. Show date of expiration of Notary's Commission.)
present the original or copy of instrument(s) at time of notarization.
Form RW-03 rev. 10.13.06