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PETITION FOR PROBATE AND GRANT OF LETTE~tS
REGISTER OF WILLS OF COUNTY, PENNSYLVANIA
Estate of File Number ~ 1- ~~ _ ~~p5~
also known as
Deceased Social Security Ntunber O~ '
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
A. Probate and Grant of Letters estamentary and aver that Petitioner(s) is /are the
last Will of the Decedent dated ~rtd 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
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^ B. Grant of Letters of
(Ifapplicable, enter: c.t.a.; db.n.c.t.a.; perutente life; durance absentia; dur
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
(COMPLETE INALL CASES:) Attach additional heels ' nec ssary.
Decedent w domi filed at ath 'n un
(List street ,taw crty, t ns ip, county, state/zip code
Decedent, then years of age, died on ~ at
named in the
trument s~ offered -L-~
(,7. c,
r-- ~ -
t"~,7
ode) ~":.,
--_ __-
any) an~teirs: 1'~ =T-
..i _
at~0~'
ucceueni a~ aeam ownea property wtm esnmarea values as rottows:
(If domiciled in PA) All personal property
$
J ~ ~
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ C
situated as follows: O~ 0 ~ ~ pf 7~
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petitio~and the grant of Letters
the undersigned: n the appropriate form to
Si tore T ed or rinted name and residence
i
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA .
SS
COUNTY OF ~ u~ b e T~ a n d ,
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) wi~l well and truly
administer the estate according to law. ~--~ t ~,
Sworn tc or affirmed and subscribed
before me the _~_ day of
e =~4
~ ~ r
~ / /
For the Register
Signature of Personal Representative
Signature ofPersoxal Representative
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File Number: ~ (' I 1
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Estate of ~P ~ ~/ T, ~ r~ d ~+~ ~`D /'I ,Decease
Social Security Num'',~b~ernn: ~ 7 N - Z D - ~3.7 7 Z Date of Death: ~ Z.' ~ J ' f
AND NOW, ` ~.~~ ] r~~ ~ 1 ~~ ~ 1 Petition, (satisfactory proof
having been presented bef a rte T IS D REE that Letters ~'
are hereby granted to r= ~_
V I ~ in the above estate
and that the instrument(s) dated -_ J ~k rites 2 (`~~`~ q
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters ............... $ CJ` ~ U . (~-~
Short Certificate(s) ..~..... $ . O QG
Renunciation(s) .......... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~.
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
of Wills
Form RW-02 rev. 10.13.06 Page 2 of 2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 i ms )s to cert~ty m~l> me )nrormauu)i ucrc ~lvc9, ,~
correctly copied fror{~ an original Certificate of Death
duly filled with me ~s Local Registrar. The original
certificate will be i forwarded to the State Vital
Records Office for ermanent filing.
P 18037689 _ _~ ~~ ~. 1~ ~~
Certification Number Local Registrar ~ Date ]sued
H106-113 REV 112006
TYPE / PRIM IN
PERMANENT
BLACK INK
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
1. Nrm d DecedrK (Fret, midda, krt. sulfa) 2. Sex 3. Sodel SecurAy Number 4. Date of eam (Mmm, day. Year)
Betty Jean Anderson female 174 - 20 - 3772 bar 15, 2011
5. Ape Ilad 1lidndaYl Under 1 year Urtdr 1 MY 6. Dar d BiM (Month. tley, Year) 7. BNhpuce ICiry sM MMe a laldgi merry) 6e. Place d Oeam (CMG ody ate)
89 NMhe ~"` K-.a true. April 9, 1922 Mechanicsburg, PA HOeP~ aMr
Yrs. ^Inpatlent ^ER/Oulpelient ^DOA ^NunergH Residence ^Omer-SPedN.
b. County d Death 6c Ciy. Barn. Twp. d Deem wb. Facitiry Name In m ngduli0n, pve meal and rexrleerl 9. Was Drxtlard d Hispanic Onpin? ®No ^ es 10. Race: American Indian. &eca, W/ute, etc.
Qmlberland Mechanicsburg
203 N. Market Street IK Y.a. Doran,
Mexican, PuaM flkan, etc.) whi to
it. Decedent's UsW lion IKind d wM d ors - mat d tits. Do m suu reared 12. Was Decedent ever n Kx t3. OeceOeds Education (Spedfy ally IIry11al grade cmp ktetl) t e. Marital Srale: Married, Never Mernetl. 5. Surviving Spa iae. (II wqe give maiden Hamel
Kidd d Wm Kintl d Busxuss f tMuaay U.S. Amted Facer
Elenrnury / SecoMary (0.121
Cdlage (t d or 5+) Witlowetl. Divorced (SP¢nNi
owner/ ator store ^~ ~ 6 widowed
- 16. Decederd's Mdlrg Address (Strad. col' /town. mde, tip ede) DecWenl's Did D redeM
sate PA u.e at a 17c. ^ va
Dec¢tlenl tined n
Acbld Residence t7a
rwp.
203 North Market Street .
.
(1~[[I}~rlarKi rownrxp? nd.$ ~ da~,al
to c
d Mechanicsburg
Mechanicsburg, PA 17055 d~
r c~,,eam
1& Patera Nme (Pint middle. last. surf) 19. MdMr's Name (Rrd, diddle, riWdan sarumej
Oscar Charles Mayberry "T~ll.i~ °~3snche Burkholder
20a. InbmrN'S Name (TYpe /Print) 2m. InMmnl'a Mdig Address IStreeC CITY /tam, star. +W rode)
Richard J. Mayberry 5 West green street, Mechanicsburg PA 17055
21a. Mdhotl d Dspodtim ^ Creratbn ^ Daraaon 21b. Date al Dispodtim (Moen. day. year) 21 c. Place d DKpaitiat (Name d emrery~ aeautory a amr gaeV 25 d. L lion (Cfry l bwn. sate, nP Codei
Band ^ Removr hom Sate ;' Was cr«adwn esDarbdt AumorlaW
- 20
2011
t.~E'C Rolling Green Cemetery Hill
PA
^ Odur - Spply' by MMkN ExeMmr / CaoneR ^Ves ^ No ,
.. ,
22a. sigamn d Fmrd sanica Ueraae les perm acting a sum) 7A. dame farnber 22c. Name and Addeas d FetlFy g Market Q],3Za Way
- - FD 011667 L Mal zzi Viral Home
Dbrtarle Kern 23ec cerahYS 23a. ro du bed d my WatNedge. seam omxretl al the Ina, den end PNe slated. (Sigmdae arN tAle) 23b. Licerue Number 23c. Date Sgatl (MOmh, day. rear)
plyaorr s m aaeeabr t:m d tlum t0
altiy sae d dam.
Krm 2426 mW be mnpkud M person 21. Tare d Dean 26. Drs PresquKed Datl (MOdK. day, yeazl 26. Was Case Rdarre0 b Medical Examiner! Co r to a Reason Omer man Cremaem a Dautan?
wMpnx,Pmcesdedd Approx 3:00 PM M. December 15, 2011 ®ra ^~
CAUSE OF DEATH (See tltartlCdtOrID arM exempba) I ApPrainrMe intarvd: Part II: Eder timer ' 28. DN Tobacco Use Camnbde Ic Deem?
Item 27. Port I: Enur 0u duKl d evruc -6easa.'mjunes, a Compicseau -Rat dredll' creed Kr loam. DO NOT mar tertninr evmu slKh as cardiac arrest. Onset b Deam bd not resttlxlg N me undsdyin9 Huse given in Pa I. ^ Ya ^ Probably
rapimtesY 8de91, a vmdcdar fibrilaeon wAhw Shar'sg me eliobgy. Lir say one was m ad1 fee. ~ ~ No ^ UnWawn
YYEDIATE CAUSE (Frul6max a ~s~ ~ ~~~ i
celuitim rewpngn nl -~ ///YO lA4 iAt.~ L a~
a
~ Lr/fJI^1
29. u~~FlIemaq~.
dh
t
Due to (a as a ~nsequerra dry. n Pes
Year
CJ Nd pregruM w
^ Preguat d time d deem
Sequedialy bt cerltlition6. p any. p,
Iae~rlo m tlu cruse asud m Kra a. Due to (es es a con dry.
Edx 91e WIDERLYMIG CAUSE m9m'~
^ Nd prepwa. do prequn xahn o2 days
losses a ~ ' Kul I~pe~Otl me i
c
event revJtl deem) USL I of loam
-
Due to (m a8 a conseQuerra oQ: I ^ Nd prepmm, hd preguM d3 days r 1 yet
bdcre death
d. ^ ularloam n pregnad aaNn the Pmt tar
30a. Was an AdWry 30b. Were Autopsy RMxgs 31. Manner d Dam 32a Dale d Injury (MpM. day Year) 310. Describe Hon Injury OmudeO 72c. Place d Iryyry: Home. Frm. stet Frnory,
Pedomad? Ava9a0h Pror to Cadgbtion
of came d Deem? ~ MWat ^ Ho~itle OAice Building. etC. /SpedtyJ
^ Ves g] No Q Ves Q No ^ ant ^ Pendng Inverigeaon 32tl. Tam d eyury 32e. KM^Y at Wak? 32f. X Trarx@metim Iryury (SPeaN7 32g. Locaam d Nqury ISae d. M I Town. state)
^ SuicUe ^ Could Nd De Dderrlirled M ^Ves ^ No ^ Dover! Operates ^ Passengr ^Pedatnan
goer- SPecAy.'
33a CeNfur (mxa onA' ale) 33b. Sig Tpu d Cer(ifier
' CerlityFg phyek'a (Pnyddan edifying euSe of deem amen anotrror phydoan has prartouncb tladh an0 mnpleletl Kam 23)
~ ~~~ ~~
To Wald my knorhdge, deem oautrW m»1ofM eues(s)and memraatNed___ ______________________________ ^
• Proflomcirtg erttl ceMMnp DKYskian IPMddan Dom PraglnCin9 dam end edlhM9 m cease d dednl
d
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l
tl
^ 33c. Lce umber 33tl. Da Siryted lMmm, daY. Year)
_ _ _ _ _ _
eem oeeurtad et ma time. dsm, and p
ea. anti tlue to t
u cause(s) al
mamer a aWed_ _ _ _' _ _ _ _ _ _ _
To ttr beet d my krweMdpa.
• MtliWExeminer/CAromr /~~ O / Q qy/ f
GJ
/ ~6-dpi/
On lM bola d exemWtbn and 1 es invea0gdion, in my opinion, dam occurred d the time, date, end place, and due M tM teasels) and manner as sule[L ^ 3a Name eritl Address d Parson W
~o
C~nW t Y d Dealn
fK 27)
~ ~ Tye / Prir,!
36. Ragas a S' atur0 an0 Disc ~)
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Disposrticn Pemn No. V~-+! J ~~? ~ I
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THE LAW OFFIC7
of:
JAMES M. B.
Attorney At-La
w
352 S. Sporting Hill Road
Mechanicsburg, PA 17050
737-2033
LAST WILL AND TESTAMENT
FOR
': C:
~'
.~,_~
.._... -~_- :-ri
~. .'~
i = :;r.
BETTYJ. ANDERSON
..
Last Will And Testament Of
BETTY T. ANDERSON
I, BETTY J. ANDERSON, of the
being in good bodily health and of sound and disposing mind and mer}iory, and not
acting under duress, menace, fraud, or undue influence of any person ~'I whomsoever,
merely calling to mind the frailty of human life, and being desirous of disposing my
worldly goods while I have the strength and capacity so to do, I do mak ,publish and
declare this my LAST WILL AND TESTAMENT. I hereby revoke, ca cel and annul
all my former Wills and Testaments, including codicils thereto, by me at a~y time made,
and declare this alone to be my LAST WILL AND TESTAMENT.
AS TO SUCH ESTATE IT HAS PLEASED GOD TO ENTRUST M~E WITH IN
THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ:j
ITEM 1. I direct that m Executor hereinafter named a and disch r e all of m
Y SPY g Y
just debts, funeral and testamentary expenses.
ITEM 2. I order and direct that my bodily remains be place f Ir permanent
INTERMENT in the mausoleum at the Rolling Green Ce etery, Camp
Hill, PA.
ITEM 3.
ITEM 3.
ITEM 4.
I give, devise, and bequeath my Real Estate known and nu4mbered as 6
and 12 West Green Street, Mechanicsburg, Pennsylvania 17055 to
RICHARD J. MAYBERRY, per stirpes.
All the rest, residue and remainder of my entire estate, wheresoever
situate, and whatsoever it may consist of, I give, devise and b@queath,
absolutely, and in fee, to RICHARD J. MAYBERRY, per s~irpes.
I nominate and appoint RICHARD J. MAYBERRY, as I~Executor of
this my Last Will and Testament.
ETTY J. ANDERSON
6/5/09
1
ITEM 5. I order and direct that my Personal Reperesentative(s) name herein use
the legal services of JAMES M. BACH, as Attorney for my Estate.
ITEM 6. I direct that my personal representatives, as well as their suc essors shall
not be required to give bond for the faithful performance ofd their duties
in any jurisdiction.
ITEM 7. I direct that all estate, succession, legacy, inheritance or other transfer
taxes, however designated that shall become payable by reason of my
death in respect of all property comprising my gross estate fc~r tax
purposes, whether or not such property passes under this LAj.ST WILL,
shall be paid by my Executor out of my residuary estate. ~',
ITEM 8. I grant to my personal representatives herein named, in addi on to, but
not in limitation of those powers vested by law, to be exercis~d without
prior application to or approval of any court, the power and ~uthority to
retain indefinitely any property, to invest and reinvest any assts or the
proceeds derived from the sale of assets, although said investments may
II
not be of the character prescribed by law, to sell, convey, assi~n, transfer
and encumber any property, to pay, settle or compromise all Maims, to
make distribution or divisions in cash or in kind, and in gener~l to exercise
~~
all powers in the management of any property hereunder whi~h any
individual could exercise I the management of similar property owned in
her own right, and to execute and deliver any and all instrume~its and to
do all acts, which maybe deemed necessary and proper. I~,
BE J. ANDER ON
6/5/2009
--------------------------------------------------END------------------------------------1-----
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
I, BETTY J. ANDERSON, the TESTATRIX, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby a owledge that
I signed and executed the instrument as my LAST WILL; that I signed it gly; and that I
signed it as my free and voluntary act for the purpose therein expressed.
Sworn to or affirmed and acknowledged before me, by: the TESTATRIX this ~ day of une
2009.
TTY J. ANDERSON
NOTARIA SEgL
JAMES M. EACH, Notary Pubilo
Hampden T~~;~., Cumbertan~l C~utfty
My Commission >=xpirea M~ i:3, X09 ~
J ~H, H5Q1`JI~
NO Y PUBLIC
Me anicsburg, PA 17050
My Commission Expires: 05j,13J2011
The preceding instrument consisting of this and two (2) other typewritten ages,
identified by the signature of the TESTATRIX, was on the date thereof signed, p bushed and
declared by BETTY J. ANDERSON, the TESTATRIX therein named as an for her
LAST WILL AND TESTAMENT.
~'~'"'w` ~~ Residing at
CHAEL L. BEISSEL
/~~- ``~ 4~~ Residing at
THOMAS W. FLECKENSTEIN
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
We, RACHAEL L. BEISSEL and THOMAS W. FLECKENSTEIN, a witnesses
whose names are signed to the attached or foregoing instrument, being duly qualified accordin
g
to law, do depose and say that we were present and saw the TESTATRIX sign an~ execute the
instrument as her LAST WILL; that the TESTATRIX signed it willingly and that ,she executed
it as her free and voluntary act for the purpose therein expressed; that each witness i;n the hearing
and sight of the TESTATRIX signed the WILL as witnesses; and that, to the, best of our
knowledge, the TESTATRIX was, at the time, 18 or more years of age, of sound mind and
under no constraint or undue influence.
Sworn to or affirmed and acknowledged before
THOMAS W. FLECKENSTEIN, witnesses, this ;
CHAEL L. BEISSEL TF
NQTARIAL SEAL
JAMES M. EACH, Notary Public
Hampden Twp., Cumberland County
My Commission Expires May 13, 2011
My
me, by: RACHAEL L. BEISSEL and
h d~of une 2009.
W.
PUBLIC
burg, PA 17050 I'
fission Expires: 05/13 j2011