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HomeMy WebLinkAbout01-25-12Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for betters as specified below, and in support thereof aver(s) the following and respectfully request(s) the grant of Letters iri the appropriate form: Decedent's Informatipn Name: MARY G SHIELDS _ ~ r} a/k/a File No: ~ ~ ' ~ a "~ a/k/a: (Assl;gned by Register) a/k/a: Social Security No: 162-22-1242 Date of Death: January 14, 2012 Age at death„ 87 Decedent was domiciled) at death in Cumberland Count principal residence at 5 Vy'est Main Street Y~ Pennsylvania (scare) with his/her last Stre@t address, Post Office and Zip Code Boroueh of Newbure Cumberland City, Township or Borough Count Decedent died at Green Ridt=e Villaee Y Street address, Post Office and Zi Code West Pennsboro Townshtn Cumberland Pennsvlvania p City, Township or Borough Count Estimate of value of decedent's roe Y State p p rty at death: If domiciled in Pennsylvalia ........ . ... . • , • • , • , , , . ,All personal property If not domiciled in Penns)blvania........ $ 275,000 00 If not domiciled in Penns}j[vania. ~ • • • • ' ' ' ' ' • • • • • Personal property in Pennsylvania $ •••••••••~•••••••...... Personal property in County $ Value of real estate in Pennsylvania ............................... . ................. n nn .$ TOTAL ESTIMATED VALUE:.... $_ 275 0 0 00 Real estate in Pennsylvania situiited at: (Attach additional sheets, ifnecessavy.J Street address, Post Office and Zip Code City, Township or Borough County A. Petition for Prob to and Grant of Letters Testamenta Petitioner(s) aver(s) he/she/ hey is/are the Executor(s) named in the last Will of the Decedent, dated February 21, 2009 thereto dated none - and Codicil(s) State relevant circumstances (eg. renunciation, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child born or adopted; and Decedent was peither the victim of a killing nor ever adjudicated an incapacitated person. O NO EXCEPTIONS ~ EXCEPTIONS © B. Petition for Gram of Letters of Administration (Ifapplicable) c.t.a., d.b.n., d. b. n. c. t. a., pendente lite, durante absentia, durante minoritate If Administration, c.t.~Z. or d.b.n.c.t.a., enter date of Will in Section A above and com lete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g) and',was neither the victim of a killing nor ever adjudicated an incapacitated person. © NO EXCEPTIONS ©I EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (ifany) and heirs (attach additional sheets, if necessary): ~~~ b ,~! .. ~~~ ~V^1~~ The Petitioner(s) above-named kwear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as Per$onal Representative(s) of the De edent, the Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before Date ~j ~z me this - ay of , ~~- Date By: Z Date For he Register Date BOND Required: Q YE5 Q NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ...................... $ ( Yj') Short Certificate(s)...... - ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission .................. . Other w, a ....... /S- ........ Automation Fee ............... JCS Fee . .................... ~•~ TOTAL ..................... $ 3~-3 Attorney Signature: ~~~~~ Printed Name: David Patrick Perkins, Esquire Supreme Court ID Number: 34342 Firm Name: Address: 44 Jame.--l~Circg. ~hi» .nsh rrg, PA 17257 717-532-9537 DECREE OF THE REGISTER Estate of MARY G. SHIELDS File No: ~ ~ - 1 p~ "- -/ ~"1 a/k/a: AND NOW, satisfactory proof E~ ~ , t~~, in consideration of the foregoing Petition, ,~I~ented before me, IT IS DECREED that Letters Testamentary are hereby granted to Dale B. Heberlig and JoAnn E Sprecher in the above estate and (if applicable) that the instrument(s) dated ~, February 21, 2009 described in the Petition be~iadmttted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. R gister of 'lls ', ~ n~' ~ . Form RW-02 rev. l0/11/2011 Il,~ Page 2 of 2 Oath of Personal Representative ~ ~~};~~?~~:. t ~ , a~L.% i ~ tiC: COMMONWEALTH OF PENNSYLVANIA } ~~~t'v1,;. F~I.~w } SS: COUNT' OF CUMBER~,AND } `~~~, JJ~~ ~~ ~~~ 9+ ~k tiJU~.805 REV (9/1l) ~ - - - - - - _ _ _ _ _ LOCAL REGISTRAR'S CERTIFICATIOM OF DEATH -x WARNING: It is illegal to duplicate this copy by photostat or photograph. cn c~ ,~ `-~' .-1 vi ~.-. ~r~-.. Fee for ~p,~ ceh~fica~, $(.~ ~ir'+ `'T~ ' .a „. eQ '~ ~ ~~ ~t•• ~~ ~ Certification Number F This is to certify that the information here given i correctly copied from an original Certificate of Deat duly filed with me as Local Registrar. The origins certificate will be forwarded to the State Vita Records Office for r anent filing. ~7 -~L~ ~~ Luca Registrar Date Issued TYPe/Print in Oermanent COMMONWEALTH OF PENNSYLVANIA . DEPgRTMENT OF HEALTH .VITAL RECORDS Black ink CERTIFICATE OF DEATH 1. Decedent's Legal Name (First, Middle, Last, Suffix) Mary Grace Shields 2. Sax 3. Social Security Number5ta Sa. Age-Last Birthday (Vrs) 3. Under 1 Yaar sc. under 1 Da F e m a l e 1 6 2- 2 2 __ 1 2 4 2 Wlonths Days Hours Minutes 6. Date of Birth (MO/DaV/Vesr) (Spell Month) 7a. girth 1 87 Ne Wb VrS Sa. Residence (State or Foreigni. Country) Hb. Resltlence St J U 1 y l $ , ~ 9 2 q 7b. Birthplace (Cc p q ( rest and Number -Include Apt No.) gc. Dld Decedent Live in a Townshlp7 gd. Ream.nce (county) 5 West M i January 14, 202 e or Forcian r-,......... an Cumberland a n Street OYes, dettdent uvea in Be. Resmentt (zip code) X 7 2 5 7 t""p- 9, Ever In Us Armed ForttsT 10. Marital status at Time of Death Mars°• decedent IlVed MrRhin limits of N e W b U T g Ves ~}~ DUnknowt+ Q Divorced 0 Marrlad idow Sl. survivin 5 city/born 12. Father's Name (First, Middl 0 Never Msrrietl ~ Unknow B Pouse'a Name (If wife, give name prior to first marriage) Harvey T - B i t, n e r sq~x) 13. Mother's Nsme Prior fo FI'rst Marriage (First, Middle, Last) 34a. Informant's Name 14b. RelKionshlp to Decedent g M. Darlene Sp~..recher daughter add Nus hei qty G ........................ .......... 11c11000a Th a a e, zip eode71 22 5 7 ~ if Death Occurred in a HospltaL~~••~-"'~- a o Ir n w o o d( R 1~'inpatlent ..............'............:....ceo pensburg, aA o ........yes...... ~_.. ~~.r. en. ............ . . Emer envy Room/OUtpatl nt ~If Death Occurred Somewhere Other Than • Hpspkel: •~~ •• " """""'•• p O Dead on Arrnal •-•••-••--•--...... _ _ iSb. Facility Name (If not institu ion, glue sheet and number; rsi^B Noma/LOn Term Care Faclll LJ Hospice Facility y Decedent's Home ~~ •~ "' '~ Green Ridge V'd 1 1 a g e ISc. qty pr Town, Sbte, and Zip Code Other (Specify) m 16a. Method of Disposition West P e n n s b o r o T o.w n s h i p 1sd. county of De.tn O Removal from State O Burial merlon 16b. Date of Dls Cumber 1 a n d ~ Donation re Position 16c. Place o1 Diaposftlon (Name of Cemetery, crematory, or other place) other (sp Sclfy) l- 7 7- 2 O l 2 i6d. Location of Dlspo ition (City or Town, sbte, and zip) H o l l i n g e r C r e m a t o r i u m 17a. SlBnature of pun rel ervice Licensee or Person In Charge °f Interment 17b. License Number Mt. Holly Spr ngs, Pq '17065 //)~/~ 17c. Nema antl Complete Atldre sot Funeral Facility ~~ Fo elsan er-B i FD-02984-L r$ 18. Decedent's Educatglon - Chec the bo x h t best describes the O 19eDetttlent of Hispan~ Orige Schack th• highest degree Pr level of school~co King Street, Shippensburg, Pq 17257 B~Bth grade or less mpleted at the Hme of death. box that best describes whether the dettdent the tlecetlent consltlered himself or herself to b 20. Oettdent's Race -Check ONE OR MORE races to Indicate what ~ No diploma, 9th - 12th grat) Is Spanish/Hlspanlc/Latino. Check the "NO" ~ High school graduate or GE burr ~ decedent Is not Spanish/Hlspanlc/Latino. ~hlte ~ Korea ~ Some tolls ~ completed (~'ILj not spanlsh/HlspanlULatlno 0 Black or African American O an ge cretliet, but nd degree 0 Yes, Maxlcan, Mexican American, Chicano ~ 'Gmerlean lntlian pr Alaska Native 0 Assodate degree ( .g, AA, Jig) 0 Asian Indian Vietnamese Bachelor's degree (e.g. BA, ~q6, BS) 0 Yes. Puerto Rican Q Other Asian ~ Master's de Q Ycs, Cuban Q Chinese ~ Native Hawaiian gree (e.g. MA, N1S, MEng, MEd, MSW, MBA) ~ Yaa, other spanlsh/HlspaniUlatlno ~ Filipino ~ Guamanian or Chamorro 0 Doctorate (e.g. PhD, Ed D) o)• Professional degree ~ Japanese Q Samoan . MD DDS DVM LLB JD ISpeclfy) ~ Other (Specify) ~ Other Paclflc Islander 21. Dee~~dlent's Single Race Self-D signatlon -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22s. Decedent's Vaval Oceu ~/hite 0 Japanese Q Black or African American Korean 0 Samoan patien -Indicate type of work Q American Indian or Alaska Matlve Q Vletnameae 0 Other Pacific islander done during most of working Ilf DO NOT Q Asian Indian --- - - Q Don't Know/Not Sure VSE RETIRED. p cmneu O Other gslan p Refr,aed W a i t r e s s Q Filipino 0 Native Hawaiian ~ Other (Specfy) 22b. Kind of Business/Industry Q Guamanian or Chamorro ITEMS 23a - 23 MVST BE MP ETED 23a. Data Pronounce Dead Mo Day r Howard J O h n s O n BY PERSON WHO PRONOUNCES R I 23 . signature o Person Pronouncin Deat s Restaurant CERTIFIES DEATH O! / i ( / ~t g ( n y when app Ica eJ 23c License Num e 23d. Date Signed M /Oay/Yr) 24. Ttme of Death T O` / r~ ^ / ro / / / ~~ ~'-'f 25. Wss Medical Examine ~CO ' ~ ~ ~r v ~v ~ ~ ~ J CAUSE OF er Cont-=tt dT ~ Yes No 26. Part 1. Enter the rshf 'nt£-maeaaes, n,J„Hes, or computations--thee etrem DEATH respiratory arresT, or ventrl ular flbHllatlon without showing the etiology. DO NOT ABBREVIATE ,Enter oNOT en er ~ Approximate t [ermira I evenb a ach a ardiac arrest IMMEDIATE CAVSE ___ 1 r. / Y one cause °n Ilne. Add dtlitlonal lines if necessary f Onset to Death (Final disease or condlfipn rt ~ G `-Y~ ~ ~'l ~-( ~ ~ g_ resulting in death) D t ( a consequence of): b. seq~ennauy n:t conditions, if any, ie.aing to the cause Doe tP (pr a.. c awggence ofJ: f listed on line a. Enter the on VNDERLYINO CAVSE (disease or injury that Due to (or sequence of): initiated the events resuting d. as a con In tleath) LAST. Due fo (or as s consequence of): 26. part 11. Enter other 1 nl i c rl h but not rasul2ing in the under) in j Y B cause given In Part 1 27. Wes an autopsy parformedT Yes p 28. Were autopsy flndingsoavallable 29 if~ F ~^ale. to complete the cause f deathT rjI`lot pregnant within past ykar 30. Dld Tobacco Use Contribute to DeathT Yes No ~ Pregnant at time of death ~ Yas 0 Probably 31. Mater er of Death 0 Not pregnant, but pregnant within 42 days of tleath r~N6 ~ Unknown ~turai 0 Homicide ~ No[ pregnant, but pregnant 43 days to 1 year before death 0 Accident ~ Pendin gatlon ~ Unknown if pregnant withlh the past year 32. Date of InJury (MO/Day/Yr) (Spell Month) 0 Suicide ~ could notnba determined 34. Place of inJury (e.g. home; construttlon site; farm; school) 33. Time of In)ury 33. Location of InJury (Street and Number, CI ty, State, 21p Code) 36. inJury at Work 37. if Trans nation In u P 1 ry. SPeciTy: [] Yes 0 Driver/O~erator ~ Pedeatrlan 3B. Describe Haw In)ury Occurred: ~~~ 0 N° ~ Passenge O Other (Specify) 39a. Certl~ r (Chats oni^ one): ~r3{FrtHying phy icls - To the bJy t of my knowledge, death o Q Pronouncing 8a Certifying physician - To the beat of my knowladred due t occu c se(a) and manner sated ~~ ~ Medical Examiner/Coroner - O ie, tleath rrcd at She time, date, tl place and due to the cause sis of examination, and/Or Investigation, in my opinion, death oc retl at the rim (s) antl manner stated Signature Of certifier: (^~ e, dale, and place, and due to the cause s 39b~, gdtlre Title of ttrtifler:_ / /rte Q ( I and manner stated ( nd Zip Code of on Complet~iing Cause/off De th It 26) License Number:_ Q O (O 7 ~ 40. Reaiet.~ (. ~ \ ~ ... I 2 Oe ~Q I l~ ~_a ~'~F-e~-: _ .. / C .c 1 • . r _ _ ao~ .._~_ ~.__ .._ _ ~ ~ / '~ K ~~~,/ w a' ~ zo ~ o~~ ~ H305- 43 REV 07/2011 DispozitlOn Permit NO. y~ ' 1 \ ~ ~J Yu,l p.,, LAST WILL AND TESTAMENT OF MARY G. SHIELDS I, Mazy'. G. Shields, of 5 West Main Street, Borough o'~Newbu~, Cumberland Cpunty, Pennsylvania, being of sound mind, memory and disposition, do hereby mare, publish and declare this my Last Will and Testament, hereby revoking and rrlaking void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOl~. I give and bequeath the sum of ONE THOUSAND DOLLARS ($1,000.00) to n1y daughter-in-law, SHIRLEY M. HEBERLIG, provided that she survives me. Irk the event Shirley M. Heberlig predeceases me, I then give and bequeath the sum of one thousand dollars ($1,000.00) to her children, Sherry L. Piper and Bryan D. Heberlig, to be divided into equal shares. THIRD. I give, devise and bequeath all of the rest, residue, and remainder of my estate, reel, personal and mixed, whatsoever and wheresoever situate, to my beloved children, in equal shares, as follows: A. ONE-SIXTH SHARE to my son, DALE B. HEBERLIG. B. ONE-SIXTH SHARE to my daughter, JOANN E. SPRECHER. C. ONE-SIXTH SHARE to my son, A. WAYNE I-~BERL,IG. D. ONE-511XTH SHARE to my son, NELSON H. HEBERLIG. E. ONE-SIXTH SHARE to my son, RONALD L. HEBERLIG. F. ONE-SIXTH SHARE to my daughter, M. DARLENE DAVIDSON. FO_ In the event any of my children should predecease me or is not living on the thirtieth (30th) day following my death, leaving issue who survive me, I then give, devise and bequeath said deceased child's share to his or her issue who survive me, on a Jeer stirpes distribution basis. {~fl"1 ~. ~.:; ir3 ~!'~ SIXTH. 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 a part of the expense of the administration of my estate. SEVENTH. I nominate, constitute and appoint my son, Dale B. Heberlig, and my daughter, JoAnn E.Sprecher, or the survivor thereof, to be the Executors of this my Last VG~ill and Testament. EIGHTItI. I direct that my personal representatives shall not be required to give bond for the raithful perfor~~ance tii tl.ei. duties irx ~.ny 3urlsdletlcn. IN WITNESS WHEREOF, I, MARY G. SHIELDS, have hereunto set my hand and seal to this my Last Will and Testament, written. on two (2) pages, the first page signed for identification only, this ~l sr day of February, 2009. (SE ) This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of e.:~ch otliei, ~~e'f~eii~Jiiig h: tv ''~ of ~o~,z:~d and disposing mind and memory, have hereunto subscribed our names as witnesses. ~w0 G~ C1.,k~p f COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND § I, Mary G. Shields, the person whose name is signed to the foregoing instrument, ha~ring been duly qualified according to law, do hereby acknowledge that I signed and executed the 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 expressed. Sworn or affirmed to and acknowledged before me by 1V~ary G. Shields, the Testatrix, this ~ day of February, 2009. Wi~~?~~:a?i1~' ~,i~,,~aia4l~~.as 'J+dictaria 1 N i ::, ~_'ai~~~ll~ic ~i~pga~tst~~. ,~ .a ' ~ ~ ~L tY tComt~; Jct:15',~~0 ~M9k~reF;~Ae~~~ ~,a~atlanof~ BF~~s COMMONWEALTH OF PENNSYLVANIA Notarial Seal Victoria N. Perkins, Notary Public Shippensburg Boro, Cumberland Courtly MyCommissian Expires pct. 15, 2010 Member, Penn,T; ~ _ c :~ :-?cfalion of Notaries COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND § We, D~.vid P. Perkins and Francis H. Norton, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and sad that we were present and saw Mary G. Shields, the Testatrix, sign and execute tie instrument as her Last Will and Testament; that she signed willingly and lthat she executed it as her free and voluntary act for the purposes t?~erein expressed; t>~a± each of ~!s i;~ the hearing and sight of ±he Testatrix, signed the will as witnesses; and that to the best of our knowledge the Testatrix was at the time eighteen i(18) or more years of age and of sound mind and under no constraint or undue influence. ~~ Sworn or affirmed to and subscribed before me by David P. Perkins and Francis H. Norton, witnesses, this a i ~" day of February 2009. COMMONWE LTi~ C}F PENNSYLVANIA Notaria9 Seal Victoria I~. Perkins, Notary Public Shippensbu Boro, Cumberland County My Commis ion Expires Oct. 15, 2010 Member, Penns~'S~~r, •_ +:;ncation of Notaries