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HomeMy WebLinkAbout02-10-12Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Petitioner(s) named below, who isJare ] 8 years of age or older, apply(ics) for Letters as specified below, and in support thereof aver(s) the following and respectfully request(s) the grant of Lcttcrs in the appropriate form: Decedent's Information nno21 -1 l - OSo~J Name: Mary Daisy Sampson File No: o~ ~ ~ ' n ~' Yy a/k/a: Daisv Z. Samnson (Assigned by Register) a/k/a: Daisv Samnson a/k/a: Social Security No: 202-20-1048 Date of Death: 3/2/2011 Age at death: 92 Decedent was domiciled at death in Cumberland County, pennsylvania (State) with his/her last principal residence at 90 Salem Church Road. Lot 526 Mechanicsbure, PA 17050 Street address, Post Ott'ice and Zip Code City, Township or Borough County Decedent died at 503 N. 21st Street, Camn Hill Cumberland PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of .~alue of decedent's property at death: 7f domiciled in Pennsylvania ............................All personal property $ 4,900.00 If not danririled in Pennsylvania ........................ Personal property in Pennsylvania $ If not donucrled err Pennsylvania ........................Personal property in County $ 6 slue of real estate in Penttsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ 4.900.00 Real estate in Pennsykania situated at: (,9ttnch additional sheets, if necrs.cary.J Street address, Post OfTice and Zip Code City, Township or Borough County A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated May 23, 1989 and Codicil(s) thereto dated State relevant circumstances (eg. renunciation, death ojexecutor, etc.) ~.xcept as follows: ailer the execution of the instrument(s) offered for probate Deceden' did not marry, was not divorced, was not a party to a pe.7ding divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born ar adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS Q EXCEPTIONS B. Petition for Grant of Letters of Administration (If applicable; c•. t. a., d. b. n., ...b.n.c.:.a., pendente life, durante absentia, durante minoritate If Administration, e.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the gn~unds for divorce had been established as defined in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS ~ EXCEPTIONS Petitioner(s), afters proper search has/have ascertained that Decedent left no Wi11 and was survived by the following spouse (if any) and heirs (attach additional sheets, irnecessary): ~ a~ Name Relationshi Address ~~ ~' ~~~ W ~~ T-. < ,~ ;.~-~© c ~- ~ ca -- n o ~,, t~7 r; rt r, Form RW-02 rev. 10/II/?011 Page 1 Of 2, Oath of Personal Representative COMMONWEALTH OF PLNNSYLVANiA COUNTY OF CUMBERLAND } ~ ss: } ni rn~. r`r Petitioner(s) Printed Name Petitioner(s) Printed ~ . ~ Ma Mills 90 Salem Church Road, Lot 529 ~~~~~' t~!I-,~~~~ ~~~ . ~ Mechanicsbur , PA 17050 The Petitioner(s) above-named swear(s) or afrrm(s) the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of P°titioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate accor ing to law. ~,vorn to or affirmed an subscribed before Date ~ (o _ tie thi ay o ~ ,'• /02/ Date By. Date or the Register ~ Date BOND kequired: Q YES t~NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ..................... . (a )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ w tli ........ ~ ~ 11e 1 • ~V Automation Fee ............... ~rj • OD JCS Fee ..................... TOTAL ..................... $ ~ ~ @-' Attorney Signature: Printed Name: Stephen J. Hogg, Esquire Supreme Court ID Number: 36812 Firm Name: Law Offices of Stephen J. Hogg Address: 19 S. Hanover Street_ Ste. 101 Carlisle, PA 17013 ,,,, - 1~~~2 F~'B I Q P~~f 3~ Qa Phone: 7172452698 Fax: 7172450829 Email: DECREE OF THE REGISTER a ~ _ ~ ~G~~~/a5 Estate of Marv Daisy Sampson File No: - t3~ a/k/a: Daisy Z. Sampson, a/k/a Daisy Sampson AND NOW, ~~(1 ~~1 ~(~ ,~, in consideration of the foregoing Petition, satisfactory proof having been presen ed before me, IT IS DECREED that Letters ~Ts~l Yl/t P ~~~~-(~ C1 I_I are hereby granted to i ~ l Ct I~(_/ j'~~/~ _~(, ~_ ~ _5 in the above estate and (if applicable) that the instrument(s) dated _ described in the Petition be Form RW-02 rev. 10/17/20/1 to probate and filed of record as the last Will (and Codicil(s)) of Decedent. 41~~ ~ L~l~'11 ,I 'Y',l y,~,-~~d~,/Ca ~Z- Register of Wills ~ ~- Page 2 of 2 HIOS BO$ F2P~ ii11 lll% LOCAL REGISTRAR'S CERTIFICATION OF DEATiH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fec for this certificate. $(~.(1)? ___ P 17 0 4 813.1._..___ Certification Number TfEM# f7C SHOULD READ AS FOLLOWS: Q~ 1~ "'his is to certify thai the information here given is rurrectly copied from an original Certificate of Death duly filed with me as 1_oca] Registrar. The original certificate ~/il! he fi~rvvarded to the State Vital F:ecords Office for herlnanent filing. ~~ Ma o ~ oar ~~~ ~ ~Q Local Rer~lstrar ~ • Date Issued ~.~v ~-- o ^~ ~, x; ;-r, '_,, ~ ~ "'~~ ~ n'1 r~ ~ r~-} l~~z t7C ~- -r ~J -~ rn -+ W .. /~ ' 0 C ) `` ''~T ~.. tai REV ttnaDll COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS EE I~N~ IIN euclc INK CERTIFICATE OF DEATH (See InetnJCNona and exampbs on roveroe) STATE FILE NUMBER 1. Nona d Deoedera 1~ mMdb, bet, euAk) 2. Sea 3. SocW Sedalry NunOx 4. Deb d Deets (Madh, day, year) Hart' Daisy Sampson Female 202 _ 2Q _ 1048 March 2, 2011 5. Ape (Lam Bhlhday) lAider 1 IArder 1 B. Dale d elan 7, BI ud Wb err ee Pleas d Oamh GFxk eta Yaraw D•Ya ~" M1i11a H gqbl: Omer: ~« ~ ,I 9 2 y~y. Dece~er 20, 1918 South Hatwver Ttwp. PA. 6d lnperbd ^ ER I W~edenl ^ DOA ^ Nurevp Hama ^ ResWence ^ Omer - sPeay: Bb. Couray d Drm Bc. OAf', Boro, Twp. d Deem BE. FetlXry Nww I9 nd krtlUrtlm.9M mreet eM numMr) 9. Wr DacedxA a Feepenb Odginl ®Fb ^ Yes 19. Refs: Amerkan IM,mt, Black WHM, ak. • G.><Dberlattd East Pennsboro TWp. IM Yee, epedly Cuban. (Specify) Holy Sprit Hospital Mamcan, Puerb Rlcel, ek.j White 11. DsrdsM'a tMal d warkdons moms Yb. Dond em 12. wee Dacsdra ewx b tlr 13. Deadwlya EAldtlon ISpeafy ody N9l•m RaEa ~4btd) 14. McAel Shea: Merrle4 Never Menbd, 15. Survivkp Spaur Itt vets, PFe maiden name) gndd WorN IBrm d BlnFietl/InAatry Housedut> es U.S. Armed Fp«eq Ebmenlery / Sgcondery (612) OoNepa (11 « St) ~ /'~°O~1 , Wl ~ tj ^Yr ~No • 18. Decederrya Meiing Address (Street, tllyltown. ebb, zlp codel 90 Sal® (hutch Rd Lot 526 DeoeMd's Dld Decedem AaueRrperae t7e.Sbb nc.I~Yea,DeceMnturetlin Silver SDr~i ,p, Two. ~~ N . MQChnanicsbur , PA (7050 T e p2 17b. county 17tl. ^ ND, Decetlan lhred wimin AGbm amts rn Gn/ Bom 1B. FetlNre Name (Flret ndtlde, feel eu86c) 19. elaMh Noma (FAat, nydda, rrken •anernal Samuel D. Brown Dai J. Footman 2oa. Inkrrned's Name (Type I Prld) 280. MormenYe Meflrq Addrw (Slroel, o8Y /ban, ebb, zlp soda) Mary Mills 90 Salem (hutch Rd. Ivt 529 Mechanicsbur PA 11050 27a. Method d Obpasibon r ^ O~yy~ ^ ~1eya„ 21b. Dab d DYp«Aan (Monet, der, Y••rl 21c. Pb« d dap«Mlm IN•n• d canabry, aamebq' a char place) 21tl. Laceeon (city/ sown, mats. zip code) ® ewbl ^ Removm hen Store i Wr Cranlaeen « Darlatlarl Aehalyd ^ ~- rbyllaAeeEsaruYUrfCa«rrt ^Yr^No March $, 20I I Druon De S p0 it Csretery South Hanover 1t9p. PA 17033 ~ 22a. Siprane d Funeal Lkerrr la Person adhq ere each) 22b. Lk«wa Number 22C Name ant Addrer d F~dMy . ~ FD 012774-L Richardson Funeral Home Inc. 29 South Et7ola Drive Enola, PA 17025 Don4bte Meta 23e-coat' when prlXykp phymcbn M not amMde a Ana d deem b 23e. To the oxnM m Me andPlece abbd (51prMna rm Wle) 23b. Lkxue Nl arter z&. Deb signtl (Month, tley, year) a.rtMy cane a dse8i. / ~ y y R a ay ! ~.y~ I' ~RT~, ~ D I • Mme 2428 oaaf M carrlAmed try Person ho • d m 21. Time a Deem ~ 25. Dab Dead (Mwim, day, year) /nl ~~ 28. Wtl Car b abdcal Ezerrwler / Coroner for a Reeaon Omar Than CaertalWn or DonaBatT w PraauaM r . ; 3V M. , Ter o~~' ^ Yr cAU8E OF DEATH (ew Inavueeorw and •arrrPlaal r ApprexYrb antrum: Pad II: CyRer aewr 28. Did TODecco Ur Carar6me b Deem? . Mm 2t'. Pert I: Firbr the I~ah91A'9Ne- dWaeas, inpriea, «amgcatlona -Mal dk«ahy urad Bte drN. DO NOT sorer brmetm eveae ouch ere «rdec street, ~ Ones ro Dtlm bet rat reatltlng In me underlylrg ease given in Pert I. ^ Yee ^ Probably mpesbry mrtl4 «waimcubr Ilbrfletlon woad ehowep 1M etldogy. Um arty erne cause on aerh Ate. j ^ No mridtlon ~qn demh) _~ e. ` QrQ~ y 7~8 ~C. f ~FJ(l~ r S' ~d /C ~ i 29. II Female: ^ N Due b (a tl e mrequntw a4): i d pregnwd wimp Pam year Yet eoridleana, B ery, E. ~ • ^ ~j Due b (« tl a mroepuerae o% r ~ Nd pregned, bet pregnant wflhin 42 days ypy seems reafdWq~ In deem) LAST. a' ~ of deeM ^ Due b (a tl a coraaefrerae dl: r Nol pregnant, red pregnant 13 tleys a t year d. r r before deem ^ Unknown a prognent wimM Bw peat year 3Be. Wee an Aulapay 38b. Wee Autopry Feaenge 37. Afarcw d Dtlm 32a. Dale a ~Y (Morlm, day. yam) 32b. Dtledba Flow Irlpay Occurred 32c. Place d Injury. Flame, Fefm, Sheet Factory. Pedmned7 Aveerb Prlor b Canplmbn ~Nmurm ^ Fi mi id Office Bull6ng, etc. /SperJlyJ d Csuee d Deam7 o c a ^ Yea ~ No ..~~{{ ^ YN 2C1 Na ^ ACdMm ^ Pendng Im•sagatlm 32d. TYr d InMxy 32e. MJwy s1WOM 321. tt Trerwporbtlon blwY (Spac+ryj 32g. Locaaon d inJury (Sheet. tlfy I town, ebb) ' ^ SWCide ^ CouN Na W Dmenrwrd ^ Yw ^ No ^ ~r/Operator ^ Peeeerper ^ Pedestrian M Omer-Spaf~y: 33e. Cardfie (akr* ant' o^a) • 9 PNY•~^ IPhYe~n prtllYb9 acme a deem wfbn Tamar phyeioen htl pmauracatl tletlh end aartiPlmed Mort 23) TotMhaedmylootlaOpa,Meh ooararad eeamtna cauaya)and mrawrA.bd-__-'----__.._____________________ ^ 33b. Slgianae end TMb a Grdeer ~/ G~ f ~~~~~ Oroneurrdng and aartltyeg PAy~ IPIMIabn ooe~ pmriaaaep Meet ant artllYm9 b aver d Meet) 33c. Licenr Number 330. Dora signed IMOnm, My, )'~) Ta Mrlwtdmy bFalbd0a, dash oausredeMrtxr,Mb, rrtl Pbaa rd duabeN Cr.e(.)rrd nwrrrreabd__________________^ /YJQL 36 S 3 ~ 3/ ~/fir • M.Arl Earr9rwlCoraw ,. , On tM eaab d a>ramNratlon am / «wvatlgatlm, M my opfnbn, Jaen aawnad efts tlme, dw, and pFar, and dr mtna osuagp ere mamw r abbd_ ^ 34. Name vet Atldsee d Paman who Conpbbd Cwe d otlm (Mm 271 Type /Pam gOil.. W f3~iE'E O rot 35. RsgLtrer':SIMe~e and..Uleh(d ' Fall /i ~ ~I ~I / 1 ~ 38. Dab t MY. 0~'' , a. I a,s~S~c~ec-t SD3 rv~~~L . / ,3 c d ~ - ~e-~- Dlroomean Permh No. ~ ~ /G / °~ Q WILL OF DAISY Z. SAMPSON I, Daisy Z. Sampson, of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my last Will and hereby revoke all prior wills and codicils. 1. I direct that all my just debts, funeral expenses, grave- marker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. a ~5 cn °' ~~ ~~ ~ :_,..:: ~ ~: ~: _, cr o ~.~., ci' ~~ cn ~... ~'' ~-.~ CU 2. I direct that all inheritance, estate, transfer, success- ion and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 0. 3. I direct that my entire estate be distributed as follows: G r A. I leave my entire estate of whatever nature and wherever =r, situate to my daughter, Mary S. Nissel, should she survive cr me . B. Should my daughter predecease me, I then give all of my estate of whatever nature and wherever situate to my grand-daughter, Annette L. Nissel. 4. I appoint my daughter, Mary S. Nissel, as Executrix of this my last Will. If she should predecease me or cease to act in such capacity, I name my grand-daughter, Annette L. Nissel to so serve. 5. The Executrix of this Will shall have the power to dis- tribute my estate in kind or in cash, or partly in either. 6. I direct that no Executrix acting under this Will shall be required to enter bond in any jurisdiction. IN WITN SS WHEREOF, I have hereunto set my hand this 2 3 ~ ~ day of 1989. Daisy Z. S n LAW OFFICES OF STEPHEN J. HOGG 135 N. HANOVER ST. CARLISLE, PA 17013 eS'~? C' i ~.a The preceeding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by Daisy Z. Sampson as and for her last Will in_.the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. LAW OFFICES OF STEPHEN J. HOGG 135 N. HANOVER ST. CARLISLE, PA 17013 ACKNOWLEDGMENT Commonwealth of Pennsylvania County of Cumberland ss I, Daisy Z. Sampson, 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 the instrument as my last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Daisy Z, on LAW OFFICES OF STEPHEN J. HOGG 135 N. HANOVER S7. CARLISLE, PA 17013 Sworn to or affirmed and ack~wledged before me by Daisy Z. Sampson, the tes~tla-~t-ri~x, ~t~hi~s ~ ~ day of ~~ ~. 1989. STEPIiEN J. 1iCGG, iVCTRr~Y PUCsLIC ~ sCy Commission Expires June 19, 1389 Carlisle P~ Culnberiand Cour,~l o ary P is/Att `ey AFFIDAVIT Commonwealth of Pennsylvania County of Cumberland ss Wei ~Sc~s~~ ~, CQr.~1e~ and _~;~h~r1v 1~, ~,~C~c ~ the witnesses whose names are signed to the attached or foregoing in- strument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instru- ment as her last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testa- trix signed the Will as a witness; and that to the best of our know- ledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn ~ or affirme and subscribed to before me by witnesses, this ~3`' day of ~c , 1989. S tPIaEP1 1. HCGG, iVCTARY P f?LIC i~~'.y Ccr.,rrse:on Expires June 19, 1389 Notary P 1C/AttO e ,Car~isie, Fi; C;ul~?berlacd ~:,o.r~i