HomeMy WebLinkAbout10-25-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WII,LS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of Caroline Rill Simmons , Deceosed ESTATE NO. 21- ~ ~ - `) `t~
a/k/a:
a/k/a:
a/k/a; SS NO: 168-24-4270
Petitioner(s) who is/are I S yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as
applicable:
~ A. Probate and Grant of Letters Testamentary or ^Administration c.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 _ 4/19/1989 and codicil(s) dated _ __
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Except as follows, Decedent did not many, 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. Grant of Letters of Administration
(If applicable, enter d.b.n., pend~t life, dnrante absentia, dnrante misoritate)
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 c.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 to a pending divorce
proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A.. § 3323(8), except asfollows:-
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Name Address tansbi bo ent ~_;
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USE .4DDiTIONAL SHEETS IF NECESSARY ~ ---
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THIS SECTION MUST BE COMPLETED: i; ~.'~ ~~~
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal=~'esidence T'
At 1728 Warren Street New Cumberland 17601 New Cumberland
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then 79 yeazs of age, died 10/16/2001 at New CumbeNand, Pennsylvania
(Month, Day, Year of death) (City and State where death occurred)
Estimated value of decedent's properly at death:
If domiciled in PA All personal property S 18,000.00
_If not domiciled in PA Personal property in Pennsylvania S
_If not domiciled in PA Personal ProP~y ~ Co~tY S
-Value of Real Estate in Pennsylvania ~ 109,000.00
Total Estimated Value $ 127,000.00
Location of Real Estate in Pennsylvania: (Provide full address if possible.) 1728 Warren St., New Cumberland, PA 17601
Signature(s)
Name(s) & Mailing Address(es)
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Interim Form RW-02 revised 12.26.10 by Cumberland County- penning acuon oy me noun
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.
Sworn to or affirmed and subscribed
before me this ~_~ ~ ,day! of
For the Register
~a;~~
DECREE OF PROBATE AND GRANT OF LETTERS
r~ (i
Estate Of ~~Q ~~ ~` ~ I i1 ~ 1~~ ~ ~ n) (m ~1 ~'ii~S ~ Deceased File Number: 21- ~ ~ - i t C~
AND NOW, this ,~ ~ ~ liday of ~~' ~ ~~ ,~-c I ~ , in consideration of the Petition on
the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters
/Testamentary _ of Administration are hereby granted to:
~ (If appttrabie, enter e.t.a., d.b.n., d.D.aata., ett.)
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Signature of Counsel Required to Enter Appearance
in ~~
the above state and that instruments(s) dated __ - 11- ~ described in ~l~ petitiod= ~e
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. r
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Glenda Farner Strasbau ~'~~~?,~Ef ~~;~"L~ ~ ~°~~
Register of Wills J ~ __.., l ~ r
FEES:
-~
Letters ....................$ ,
Will ........................ ~ ~ • L L
Codicil(s)... C'.C~ ?
(~j) Short Certificates
( )Renunciations.......
Bond ............................
Other ............................
.................................
Automation FEE......... 5.00
JCS FEE ................... 23.50_
:~:~3. `~C,~
b?.~8--
TOTAL ................ $
~~
Atty's Signature
PRINTED Name:
Supreme Court ID No.:
Address:
Phone:
Fax:
Interim Form IZW-02 revised 1226.10 try Cumberland Count~~ pending action b~ the Court Pale 2 of 2
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LOCAL REGISTRAR'S CERTIFICATION OF QEATH
WARNING: It is illegal to duplicate this copy by photostat or photogr~sph.
Fete fvr this cerCif~.ra[e. S(~.UO
P 1?7~Q127
C'ertifi~ation Number
13 REV 11RDD8
E I PRINT IN
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LACK INK
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
lSee instructions and examples on reverse) UI IgI0.F0.
Name d Decedent (Flrst, middle, last, suffix) 2. Sex 3. Sadel Securlry Number 4. Dare d Death (Momh, tley, year)
1
.
Caroline R. Simmons Female 168 - 24,- 4270 October 16, 2011
5. Aga (Last Birtlday) Udder 1 r Udder 1 fi. Date of BiM Momh, 7. Bits end dale a f cal Be. Place d Dim Gedc on are
Mims Dgyg Ibas Mk,dgg HogDital: Omer:
79 Yrs December 25, 1931 Harrisburg, PA ^mpanent ^ERIOulpetlent ^DOA ^Nursing Home ®Residence ^Omer-Spgdry:
•
Counry d Deatn ffc. Clry, Boo, Twp. d Deem
8b 8d. Fadfiry Name (If trot instllutlon, give street end number) 9. Wes Decedent d Hispenk Onpin? ®ryo ^ ygg 10. Race: Amgrk:an Inman, Black, White, ek.
.
Cumberland New Cumberland 1728 Warren Street ( PuenoR,eroa ~spgaM White
• 11. Decedents Usual Kmd d wok dare mat d worMn Ina. Do rwl stele red 12. Wes Decedent aver In me 13. Decedents Etlaatlon Inv tidy hlghast grime ~ate4) 14. Marital SIeWS: Mamed, Never Monied, 15. Surviving Spouse (If wile, gNe maiden name)
wMowed, DNOrced /SP~'N)
Kind d Wok KkM d Buenessllndustry U.S. Amred Forces? Elemerdary I Secondary (P72) Cdlege ltd or Sr)
Married LeRoy James Simmons
Su 1 Anal st Federal Government ^ Vea ®rro 12
18. Decedents Meiling Addresg (Street, dry I loom, smte, ziP code) o~adenrg Pennsylvania °Lw~ide mm 17c
lecedent LNed fn T
^ rag
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1728 Warren Street .
,
AcWal Residence 17a. Spate
Cumberland T°"n'~"'D? 17tl.®No, Decedent Uved witmin
New Cumberland
Ne m er an t7b. County ~p~I Lpryly pl
ciryl8ore
t8. Famefs Name (Flret, mldAe, las4 sulnx) 19. Mother's Noma (Flrst, mklde, meltlan surname)
John Shaver Syra Pakradouni
20a. InfomlanCs Name (Type I Pnm) 2W. Informants Mailing Atldees (Sweet, dry I town, stele, zip coda)
LeRoy J. Simmons 1728 Warren Street, New Cumberland, PA 17070
21 a. Metlad d Gspositlon ' ^ Crarnatron ^ Donation 21h. Date d Gepoaitim (Month, day, year) 21 c. Place of Disposition R4eme of cemetery, aemetay a Diner place) 21 d. Location (Gry I rown, state, z$ code)
AnBrar~.d^
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Bunel ^ Remevalfromstate ~ ~~ ~«
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® October 20, 2011 Rolling Green Cemetery Lower Allen Twp. , PA 1701
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22a. SlgnMUre 226. License Number 22c. Name end Address of FacXlry
FD 012 848 L P.O. Box 431, New Cumberland, PA 17070
Inc.
Parthemore FH & CS
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Canplele Hems t a'N w4en ceAMn9 23e. To the beet d my lawvdetlge, deem aauned at the dine, date eM piece slated. (Slgneture arts title) 23b. License Number 23c. Date Signed (Momh, day, Yaerl
ptryeician b trot eveilebk at time d deem ro
dernry cause of death.
Tina d Deem
24 )
25. DeM Pronamced Dead (Monts, day, yea d b Medical Exemirer 1 Caawr rot a Reason Other then Cremeticn a Donation?
rre
28. Wes Cage Refe
Items 24-26 must ba wmDleted by parson
~ who pronounces death. .
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CAUSE OF DEATH (Sea Instnredbns and elrampbs) ~ ApproxMete Marvel:
Pan I: Enter the dletrl d events - dieeeses, mjudee, a carnPlkations -that rarectly caused the death. W NOT enter tenninel evade each es carder enese ' Onset ro Death
Item 27 Pan IL Einar Diner "
bd not resunlrp m the aaLedYin9 cause given in Pgn I. 26. Did Tobacco Use ContnMde ro Death? -
^ Yes ^ Probably
.
raeplretay arrest a veMiadar IbdlMtla wMpd showAng the BtioWgy. List any ale cause an each fine. r ^ No ^ Unkrrown
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a1MED1ATE CAUSE 1Pnal disease a n ^ ~
condtion resunmg n death)
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29. n Femele~.
^ Not Dre9n~t within Dart year
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Duero (a as a axwequence off: i ^ Pregnem at fime d deem
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UNDEHLY9M CAl1SE a Duero (a as a axepquerroe orl: ;
~ preened, bd pregnant within 42 days
that eutiekd the
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' ^ Unkrrown N pregnant wkMn tiw past year
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3Da. Was en Adapsy 30b. Were Auropay Flndinga 31. Harmer d Deem 32a. Date d Inury IM«dn, day, Year) 32b. DescrDe How Injury Ommed 32c. Place d Injury: Hans, Fann, Stree6 Fecrory,
Onke Bundng, etc. ~Spea'yl
Perlannetl? Available Prior ro Canpletlon ^ NaNfel ^ Homldde
d Cause d Deem? ^ AaiOent ^ Perdrg Inveetlgatlon 32d. Tine d Inury 32e. Injury al WMC7 321. n Traneportatlon Irgury (Spedly) 329. Location d irqury (Street dry /town. state)
^ Yes ^ No ^ Vea ^ No ^ Vea ^ No ^ Drlverl0oereror ^ Pageagar ^ PedesMan
^ Sddde ^ Codd Nd he Ddarmined M. Omer- Spedly
33e. Cerdfer (deck tidy one)
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To Ure freldmylarowbdge, deeM atone 33c. license Number 33d. Date Signed (Madh, day, Y ~rl
• Prorquaing arrd cartllyNg phyeklen (Physiden bom gonourxdng deem and ceniy4ng ro cause d deem)
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To the beedmy gwwkdge,dMhoeeuned alts dine,deb, end ghee,aM due to lM auea(e)and manner es atemd---'---"-'-----'- ~- l f ~ t I~ I
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end phc4 and due to the cerae(a) end miner m etarod_ ^
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' Dhponition Pemtit No. ~.LQ.,SO S[ J -1
LAST WILL AND TESTAMENT
OF
CAROLINE R. SIMMONS
I, CAROLINE R. SIMMONS, of the Township of Fairview, County of York,
'' and Commonwealth of Pennsylvania, declare this to be my last will and revoke
'', any will previously made by me.
ITEM I: I devise and bequeath all of my estate of every nature and
wherever situate to my husband, LEROY J. SIMMONS, provided he survives me by
thirty days.
ITEM II: Should my husband, LEROY J. SIMMONS, fail to survive me by
thirty days, I bequeath such of my tangible personal property as is set forth in
'; a separate unsigned memorandum, which I shall place with my will, to the person
therein designated.
ITEM III: Should my husband, LEROY J. SIMMONS, fail to survive me by
thirty days, I devise and bequeath the residue of my estate of every nature and;
wherever situate as follows:
A. One-half thereof to my issue, per stirpes, living on the thirty-
~~~~~ first day following my death. i
B. The remaining one-half thereof to the issue of my husband, LEROY ,
J. SIMMONS, per stirpes, living on the thirty-first day following my death.
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STONE ffi STONE Page 1 OC (~
Attorneys at Law L 1
. i
414 Bridge Street - -~--I
New Cumberland, Pa.
E.
17070
ITEM IV: I appoint my executor and his successors guardian of
', any property which passes either under this will or otherwise, to a minor and
with respect to which I am authorized to appoint a guardian and have not
otherwise specifically done so, provided that this appointment of a guardian
shall not supersede the right of any fiduciary in its discretion to distribute
a share where possible to the minor or to another for the minor"s benefit.
Such guardian shall have the power to use principal as well as income from
time to time for the minor's support and education (including college educa-
tion, both graduate and undergraduate) without regard to his or her parent's
ability to provide for such support and education, or to make payment for
these purposes, without further responsibility, to the minor or to the minor's !.
parent or to any person taking care of the minor.
ITEM V: I appoint my husband, LEROY J. SIMMONS, Executor of this my
last will. Should my husband, LEROY J. SIMMONS, fail to qualify or cease
to act as my Executor, I appoint my son, TERRY L. CLAY, and my husband's
daughter, CONSTANCE J. SIMMONS, Co-Executors of this my last will and testament
ITEM VI: I direct that my Executor or Guardian or their successors
shall not be required to give bond for the faithful performance of their duties.
in any jurisdiction.
IN WITNESS WHEREOF, I, CAROLINE R. SIMMONS, Testatrix, have hereunto
set my hand and seal this )~j 1ti day of ~-p~l ~ 1989.
CAROLINE R. SIMMONS
STONE 8~ STONE
Attorneys at Law
414 Bridge Street
New Cumberland, Pa.
17070
Page 2 of 4
SIGNED, SEALED, PUBLISIiED and DECLARED by CAROLINE R. SIMMONS, the
' Testatrix above named, as and for her Last Will and Testament, and in the pre-
Bence of us, who at her request, in her presence and in the presence of each
other, have subscribed our names as witnesses.
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Address
`~ ~) ~{ .f-mow '~t'.i .2.: ~-Ct~ ~4 s~_/ .
Address ~ I
COMMONWEALTH OF PENNSYLVANIA:
:SS:
COUNTY OF CUMBERLAND
I, CAROLINE R. SIMMONS, the Testatrix 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 this 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 contained.
1`
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C ~.~.~,~, ~_ '.
CAROLINE R. SIMMONS
Sworn to or affirmed to-~}a~nd acknowledged before me by CAROLINE R.
SIMMONS, the Testatrix, this ~`^"' day of 1989.
~ri r~ ^ .
Notary P.iblic
STONE a. STONE DELINDA M.NRITCHIE.SNOTARY PUBLIC
Attorneys at Lew NEW CUMBERLAND BORO, CUMBERLAND CC.
.t~4 Brldge street MY COMMISSION EXPIRES MARCH 29. 1993
New Cumberland, Pa. Page 3 Of ~L ._,_
17070
CONIIyfONWEALTH OF PENNSYLVANIA
:SS:
I' COUNTY OF CUMBERLAND
// ~ ` ` . ''~ I~
We, ~ ii„ ~ and l~(}~.t.,~ -a~.~ - ; ~. ,~~C~~~'~~
the witnesses whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, depose and say that we were present and ',
saw Testatrix sign and execute the instrument as her last will; that Testatrix ".
signed willingly and that 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; that to the best of our knowledge,
the Testatrix was at that time eighteen or more years of age, of sound mind
and under no constraint or undue influence.
Witness
Sworn to or affirmed t'o -and acknowle->dged before me by
~~s~.°'ss~l `.l~.~d~~~U!~--- and ~L9 11j' r~lU~ ~ ~ - A~L.~_~_-~ witnesses,
this day of - 1989.
y ~ ~~ r~~/~~ -X~._,
Notary Public
NOTARIAL: SEAL
DEtINDA M. RITCHiE~ NOjARv PUBLIC
NEW CUMBERLAND BORO. CUMBERLAND CO.
MY COMMISSION ~~'?;^~S M~.RCH Z~, 1493
STONE 8. STONE Page 4 of 4
Attorneys at Law
414 Bridge Street
New Cumberland, Pa.
17070