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HomeMy WebLinkAbout01-10-12PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF C~i'M6SrC~AN`~ COUNTY, PENNSYLVANIA ~J7~L~ ~ ~GI° ~y File Number ~ - I ~ ~(~~ ~ 1 Estate of also known as f ~ ~ C ~ 8 ~~ '~ ,Deceased Social Security Number 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 Testamentary and aver that Petitioner(s) is /are the ~ f-G t~'fOZ named in the last Will of the Decedent dated /W~ 1 q~~ 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 bom 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: 0 B. Grant of Letters of Administration (Ifapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante at~sentia; durante minoritate) 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.) (COMPLETE IN ALL CASES:) Attach /additional sheets if necessary. De a ent was domiciled at death in C. ~M d ~ ~ ~~~ County, Pennsylvania with his /her last principal residence at $2.~~ ~,/+e.S®,l LR~~ lq~lAt.1t~5 /RH- Loulsrtt uuf,t/ rw-' WM6~(Ct-ANA' PA t7~55 (List street address, town/city, township, county, state, zip code) Decedent, then 9 ~ years of age, died on IAttIJRR~I 13 Zo r 1 at D~ ;~/ PM Decedent at death owned property with estimated values as follows: ~~ // ~,j (If domiciled in PA) All personal property $ `'r g~ ~ ~' (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ p 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 undersi d: n ~ t ~t '` ° T d or rinted name and residence !`1G 1 S,M~'rid~0 a$~z-~ ~ A~ 3~ u~i;~v~~~r A?tz. ~:t~'q+~rlS~dR~- ii (~ l 7~Sv ~, • C t• ~~ Page 1 of 2 Form RW-02 rev. 10.106 ~, , '1 -j' - ~ ~ j~j Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~C Jl'M~'1Q,YrG.y~C'1 SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the the knowledge and belief of Petitioner(s) and that, as personal pre native(s) administer the estate according to law. ~ ,~' s~ fr ~~' r~ .. Sworn to or affirmed and subscribed bef re me the / Q day of ! ~f C~ ~i For the Register of Personal Representative Signature of Personal Representative Signature of Personal Representative File Number:s~ I l ~ ^ Estate of ~ ~ L LL ~ ~~ ~~ / ,Deceased Social Security Number: ~ ~`I ~~ ~~~7 Date of Death:~~°~A~Y 13r Z_Or ~ AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters are hereby granted to and that the instrument(s) dated described in the Petition be admitted to probate and filed of FEES Letters ............... $ Short Certificate(s) ........ $ Renunciation(s) .......... $ ~ ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ •. `~-b6' ~~. '~ Form RW-02 rev. 10.13.06 in the above estate as the last Attorney Signature: Attorney Name: Petition are true and correct to the best of Petitioner(s) will well and truly Codicil(s)) of Register Supreme Court I.D. No.: "' © ta, x y ,'-. Address: ~-:.~ '-- m ,~,^ _._ ~i - C~ ~~ Telephone: "' ~ N ~- ' '-' ~" rte` `.~ ~r~ L. Page 2 of 2 ~'~ LOCAL REGISTRAR'S CERTIFICATION ~~F DEATH WARNING: It is illegal to duplicate this copy by photostat or~ photograph. Fee for this certificate. $6.00 P 17046789_ Certification Number a3 REV 1112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS E f PRINT IN ~1AC11C~INIM( CERTIFICATE OF DEATH (See Instructions and examples on reversal 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 to the State Vital Records Office for permanent filing. o"J JA 1 8 011 Local Registrar Date Issued Tom; -,-- y ` : C7 ~ ,. I `- i ~'. Cl7 ~ ~ _. _. i i i 7 L7 -~ --+ r - _~...1 C..~• 1. Name d OeatleM (First, natlde, Yet sdlM) 2. Sex 3. SocYl secudy Number 1. Date d Death (Month, day, year) Adele M. MacKay Female 134 - 03,--8467 January 13, 2011 6. Ape (last &rdlday) lHrder 1 Under 1 6, DeY d BiM Month 7. Bi G end eYb ar oou Y. PYce d DeaN Check one 91 Yre, • MrxM Data Hour MMea August 7, 1919 Batavia, NY Hospital: ^ Inpatient ^ ER I Oulpadant ^ DOA Other; ®Nureing Home ^ Reaitlence ^ Other ~ Speciry~. 6h. Cwlty d DeeN 8c. CMy, Born, T d Death wP 6tl. Fadl Name M rid irlseNtlon, MY ( 9Ne street and rasnber) 9. Wes Decadent of NnFenit Ongin7 ®No ^ Yes 10. Race: American Indian, BIacN, White, etc. Cumberland Lower Allen lisp. (0 yee''PeC"''`~be1' IspeGr» Bethany Village Mexkan,PuertaRian eW.) White 11. DeatbnYa Ueuel ICnd d welt done ngel d file. Do rid aYY re' 12. Wm Decedent ever M Ne 13. Decedre'e Educetbn (Speclly only highest V•d• cgnPYladl 11. MerMel SYNe: Mertied, Never Mame4 15. SurvNilg Spouse (II wile, give maiden name) KkW d Wad lands Bueelese/lndrtry U.S. Amled Porten? EYmenlery I Secondary (P12) College (td or sa) WroONed' Divorced (SpealyJ Executive Secretor Electronics Mf ^vee ®kW 12 ldidowed 16. DeatlenYS McYirg Address (Sired, ary I tavn, state, zp code) Oatadanre Penns lV an i a °id DeC~B"' y Y 5225 Wilson Lane r ~ ActuM Residence 17a. SYre uwYa 17c. Ll Yes, Decatlanl Lived in Lower Allen rwp Mechanicsbur PA 17055 g Township? t7b.cgmty Cumberland nd.^Np,DetedemLiYedwmm~ Adual Limits d Cary I Boro 16. FaNq's Name (First mitlde, Yst aura) 19. MdheYS Name (Firs, middy, maiden eumeme) Elwood Myers Edna Helwig 20a. IMOnnanYS Noma (Type I PnM) 20b. Inlormanfs Maaag Address (Street aY I Wen, sYY, dP code) Robert S. MacKay 456 Woodcrest Drive;, Mechanicsburg, PA 17050 21a. Melhotl d DYposlaon I ^ Cremelicn ^ Donebm 13urid ^ RemovMhanStal ~ 21b. DMe d DYpaitlon (Monty, day, year) 21c. Place d OYposMlon (Name d cemetery, crematory or oMar plea) 21tl. Location (City I town, state, zip coos) ~ ^ ~ e ~M.de.IEnMnerlD AWar1eW^Y~^~ January 17, 2011 Rollin Green Cemeter g Y Lower Allen Tw p.>PA 17011 22e. d Service ' (or person sedrg ss such) 22h. Lkenee NgMer 22c. Noma end Address d Facifily ~ FS 012 849 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 ConpYY Mama aNy wlwl certlly:lg pNaden Y rid m sure d deeN W 23e. To beet d my oaurred at the tlme, dab plea elated. (Sipsetue end tltb) 23D. License Numdm 23c. Date s' 5~ (Monty, aY• Year) ~ °M"~°U°ed ~, // ? aJAItiL7Aa2y !.3 :.~4G';/ Mrns 2426 man be carlpYYd bl parts wlq pronoutae deeN 21. Time d Death ~ 'G ; 2S. Day Pronamce0 peed (Month, day, year) ` 28. Wes Ceee Reteared Metllal Examiar I Coroner for a Reason Other than Cremation q Donation? . . M. G~ t ~.3 ^ Yea CAUSE OF pEATH (Sw Inatruetlone and eaampke) I Approximate kttervd: IYm 27. Pen is EnYr the dreYl d avenrs - diaeeass, kyud•s, q coniDlicadorw ~ Nat drectly auead Ne deaN. DO NOT enter tartnYd event such ss artliec enest. ~ Ores b Death I i Pan II: Enter other gimikxM mial~g W -th but not reeulfi ro IM rg undedyklp cause gNan n Pen 1 26. Dip Tdlacco Use Canlnhute to Deem? ^ Yes ^ Probabty resp rebry aural, q venaktAer fibrNena widnd staweg IM etiology. LYt qtly one taus an each Ikle. ; IMMEdAiE CAUSE FM dnssss q R 4 w (LJ2, ~.~,~ ^ No ^ Unknown /? CMdifiM reaMkg Y ~eeNl -~ e. _ I N ~C r V ~ T I O I v r ~ ~~ U ~ '7 , S 1 29. II FBmele~. Duero (q a caneeRUarlce oQ: ^ .__ ~ carldlidw. M ~, b ~ ~ t ~ ~ ~'f~ ~ ~ ~ I W narue YeYd m ~ a ~ ~~ O w aQ / ~ Not pregnant wimin past year ^ Pregrent at tlme d deeN NOERLYtNG CAU6E Da W (or ss e consequence oQ: i E ^ Not pregnant, but pregnant wimin 12 days (sasses q Mpary Net edtleYd the I event resuakq n deeN) LAST. t. I Ny fe2..i ~ r I ~ v~ o1 aam ^ Due to (q ss a Opnsepaerla oQ: Nq pregnant, but Pregnant 43 days l0 1 year d. r stare daN ^ Unknown it pregnant wbNn dw peal year 30e. Was en Adapsy Perlonned? 30b. Were Auropsy F'ardirgs beilede Pna to Completbn 31. Manner lketh 32a. DeY d Inury (Monty. deY~ Year) 32b. Desaiba How Injury Ocaned 32c. PYce of I u Home, Farm, Street, Facro M ry~ ry~ d Cause d DeaM7 aka& ^ ~~ Olkce Buil dn etc S 9, ! PeaNl ^ Yes ^ Yes ^ No ^ Accitlem ^ Pending Investlgeaon ~~ TMne d rotary 32e. I et Work? May 321 6 Tren njury (Spealy) eporYtian I 32 . Leeson of i 9 Mury (Street city I town, slate) ^ Suicia ^ Could Nd a Delarmined ^ Yes ^ No ^ Dmer10peretor ^ Passenger ^ PedealMm M ONq ~ SpeNy: 33e. Certifier (cMck ony one) 33b. sqn and Title d CeNIYr • c.rllMMg pryekYn (PhyakYn amlying sues a deeN wan aratMr plryeicYn ha8 pranaunced deeN and competed IYm z3) ? ~Yw, Tothebatd my larowMdge,dxlh oaurnd drw to tM eause(e)arM mratarrahbd_________________________________^ • Ptorgwldng and arUlying phyaklan (PhyalGan Ddh prongxlckg deeN ant ardlyllg b ease d r1NN) 33a LManss l mbar 33tl. DeY Signed ( Ih, day, year) `'«~°°~de.Naaarred.Lla.Lyle,d.Y,.rdpYa,endda.WN.aa..(a,andmenne,..~.l.d------------------^ T ~ ~ ~ _ 3.3 ~~~~ l I • M al d l O ' ' On thebrY daaamNetbn eMlal mMdgtbn, In my opinion, death octanes M the Ura, MY, and psa, and due to the auae(q antl manner n ataYd_ ^ 3y,(vemgend otof P/ajrv~an WM ~Cd(nz~,Ae/Y`d Ce d Oeet~h/(1Ymyyy T / P~nnl/~ ~q~ ~ er\~~ fl ~ ~ I ~ 35. Ragislrefs Signs DYtrirl N 1 / r V Tr y y 1 z • 1 ~-1 ~ 1 a.) Y ~ - Oiapaafien Pemrit No. C~'t 2 339 ~ ~ I ~ 1 ~ ~~, -~ LAST Y9lILL AND T~ST~IVIKNT . ®~ ~ o .. -,-, cx~ -~, -_ n ~D~LK ~I~~K~Y ,~'~~ ~: ~~. -r~~ ~w ;~,~ -~ --; ~,.s, ;", I tiLLLL 1viA ~ `r Y ^,._-__., ~T~i2 r• 1~~ i v: L~1ii1 i.1ii, i,IiiTberland Count P" ~..t.,.._... k~c ,..c ~ .. C. _ sound and disposing mind, memory, and understanding, do hereby make, publish, and declare this to be my Last Will and Testament and hereby revoke all other Wills and Codicils, that I have made, including the will dated February 18, 1985. FIRST: All of my Estate, of whatever nature and wherever situate, I give, devise, and bequeath, in equal shares, to those of my children who survive me by thirty (30) days: my son, EDWARD R. MACKAY, of Durham, New Hampshire; my son, ROBERT S. MACKAY, of Mechanicsburg, Pennsylvania; and my daughter, JANET E. MACKAY, of Tunkhannock, Pennsylvania. Should any of my children fail to survive me by thirty (30) days, but be represented by children then living, these children shall take, der stir~es, the share to which my child would have been entitled if then living. SECOND: If any portion of my Estate shall be payable to a beneficiary who is less than eighteen (18} years of age, my Executor may pay such share to the beneficiary's parent or guardian, as custodian for said minor, who shall deposit such share in the minor's name in a Uniform Gift to Minors' Act account in a savings institution of the Executor's choosing, payable to the minor at majority. THIRD: All interests of any beneficiary in the income or principal of this Estate, while undistributed and in the possession of my Executor, even though vested and distributable, shall not be subject to attachment, execution or sequestration for any debt, contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to pledge, assignment, conveyance, or anticipation. FOURTH: All inheritance, estate, and succession taxes (including interest and any penalties thereon) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. FIFTH: I nominate, constitute, and appoint my son, ROBERT S. MACKAY, as Executor of this, my Last Will and Testament. In the event of the renunciation, death, resignation, or inability of ROBERT S. MACKAY to act for whatever reason in this capacity, then I nominate, constitute, and appoint my son, EDWARD R. MACKAY, as Executor of this, my Last Will and Testament. I direct that no representative named above shall be required to post security for the faithful performance of his duties in any jurisdiction insofar as I am able by law to relieve him of such obligation. Any of my representatives shall be entitled to reasonable compensation for the performance of the duties set forth here. sr IN WITNESS WHEREOF, I have hereunto set my hand and seal this 1 day of 3~ , 1998, on this, the second of two typewritten pages. I :have also signed the left-hand margin of the first page for purposes of identification only. Q~ ~ ADELE MACKAY SIGNED, PUBLISHED, and DECLARED by the Testatrix, ADELE MACKAY, as 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 hereunto subscribed our names as witnesses. Sn4 !}i~~~J+ ~...~ ~2. Nat-,'~lsk~~a ra , ~~ I ~ 1 9 U ACKNOWLEDGMENT Commonwealth of Pennsylvania County of Cumberland I, ADELE MACKAY, Testatrix, whose name is signed to the attached 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. ~~ oc.~'o ~~ ADELE MACKAY Sworn or affirmed to and subscribed before me by ADELE MACKAY, the Testatrix, ~- this ~ S day of , 1998. Po N Public Notarial Seal Jennifer L. Garner. Notary Public Camp Hill Boro. Cumberland County My Commission Expires Aug. 27 2001 AFFIDAVIT Commonwealth of Pennsylvania County of Cumberland We, Debra K. Wallet and ~(l,.r,~~ ~ ~C ilP,~ the witnesses whose names are signed to the attached instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament; 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; and that, to the best of our knowledge, the Testatrix was at that time 18 years of age or older, of sound mind, and under no constraint or undue influence. ~.bl1~ll,.a.,'k t~a~,.t' -rte= r7'i .s'r Sworn or affirmed to and subscribed to before me by~~ ~' ~ ~ u _L_/~~ and S~ ,witnesses, this ~ day of ~ ~ , 1998. o Public Notarial Seal Jennifer L. Garner, Notary Public Camp Hill Boro, Cumberland County My Commission Expires Aug. 27 2001