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HomeMy WebLinkAbout03-02-12s 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 Letters as specified below, and in support thereof aver(s) the following and respectfully requests the grant of Letters in the appropriate form: Michael Shields Name: Sherley A. Shields File No: 21-12 - ,-~ - y a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 179-30-3630 Date of Death: 02/22/2012 Decedent was domiciled at death in Cumberland County, pq (State) with his/her last principal residence at 129 Walnut Bottom Road, Shippensburg 17257 Southampton Twp. Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Elmcroft, 129 Walnut Bottom Road, Shippensburg 17257 Southampton Twp. Cumberland PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death If domiciled in Pennsylvania ...................... All personal property $ 87,000.00 If not domiciled in Pennsylvania ................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ................ Personal property in County $ Value of real estate in Pennsylvania ................................................................... $ TOTAL ESTIMATED VALUE $ 87,000.00 Real estate in Pennsylvania situated at (Attach additional sheets, if necessary. Street address, Post Office and Zip Code Age at Death: 73 City, Township or Borough ^X A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated thereto dated 08/26/2004 County and Codicil(s) State relevant circumstances (e.g., renunciation, death of executor, etc.J 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(8), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. 0 NO EXCEPTIONS ^ EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d. b. n., d.b.n.c.t.a., pedente life, durante absentia. durante minoritate If Administration, c.t.a or d.b.n.c.t.a., Except as follows: Decedent was not a party to.pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323 (g) and was neither the vlctim of a killing nor ever adjudicated an incapacitated person. ^ NO EXCEPTIONS ^ EXCEPTIONS 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 (attach additional sheets, if necessary): Name Relationship Address Michael Shields Son 1984 Clinton Avenue Chambersbur PA 1720' ,.sue r- ~ ~' ~ ~Z7 '>a ~ rrt t - Form RW-02 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. J ~ ~ ~. 'D "' ~ ' ~' W ~.O {~ " Page~1 Hof 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } Petitioner(s) Printed Name Petitioner(s) Printed Address Michael Shields 1984 Clinton Avenue Chambersburg, PA 17201 C"~ r 7 '-, ~, i"J ~) J ~ -' ~ ~: ' ,. ~' ~!~ (gin The Petitioner(s) above-named swear(s) or affirm(s) the statements in t/h~e foregoing Petition are tru/e and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of~,f1 _dent, ti~~~w/~d truly administer the estate acc~di~ to law. Sworn to c affirmed and subscribed before ~ © j Dale me ~ ~ day of rl',~, ~ ~ ~~ Date By:. I~K.y ~ ~ _ i~~ ~Q ~ ~~('~ ~ Date For theRa,~ister ~-~ ~ Date BOND Required? ~ YES ~ NO FEES: Letters .......................................... $ ~~~ V -C~~ ( .~ )Short Certificate(s)......... ~~ ( )Renunciation(s) .............. ( )Codicil(s) ........................ ( )Affidavit(s) ...................... Bond ............................................. Commission .................................. Other ~d \ 1\ 1,~ . C5L Automation Fee ............................ JCS Fee ....................................... ~ TOTAL ......................................... $ c~1C ~~~~ To the Register of Wills: riease enter re: / r-- Printed N~(me: J~rry A. Weigle Esquire Supreme Court ID Number: 01624 Firm Name: Weigle & Associates, P.C. Address: 126 East King Street Shippensburg, PA 17257 Phone: 717/532-7388 Fax: 717/532-5289 E-mail: DECREE OF THE REGISTER Date of Death: 02/22/2012 Social Security No: 179-30-3630 Estate of Sherley A. Shields File No: 21-12 - ~-1 a/k/a: AND NOW, ~~~~'t9 .~'1 ,~- ~~! (~.. , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamenta are hereby granted to Michael Shields in the above estate and (if applicable) that the instrument(s) dated 08/26/$004 described in the Petition be admitted to probate and filed of record as tl}e last Will (and Codicil(s)) of Decedent. Register of Wills `" -' -' -' /J Copyright (c) 2011 form software only The Lackner Group, Inc. `~ Vt.j 1 4~,(_ ;f,~C'.~Q /1 (page 2 of 2 I J`nSC c~,'r ~. ' LO {~F~~ ~R'S CERTIFICATION OF DEATH WA , , 1~`i§"iflt o duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 ^~~ ~ ~ ~:,#~ ~ _ Z ~1'1 ~ ~ : J 1 CLERi~ OF ORPHAN'S ~ OUR T IJMR~-pl,?~v~ ;`;) pq P 1835226 Certification Number z/ This is to certify that the information here given is correctly copied lro(Yi an original Certificate of Death duly filed with me as Local Registr~u-. The original certificate will be forwarded to the State Vital Recor ~ ffice ~ per anent filing. _ _ o `Z Z Za ~ al IZegistrtr Date Issued COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS CERTtFlCATE OF DEATH Type/Print In Permanent Black Ink 1. Dewdent's Legal Nsme (Firs[, Middle, Lsst, Suffix) 2. Sez 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell MO) 179-30-3630 February 22 2012 , Sherle A. SYlie1 Spell Month) Ta. Bllthpleta (City and Sia<c or Foreign Country) Sa. Age-last Birthday (Yra) Sb. Under 1 Yaar Sc. Under 1 Da 6. Date of Birth (MO/Day/vear) ( Months Day3 HOUri Mlnutea A St 26 1930 o 73 u u $ ) 7b. BlKhpiaca (County) Ba. Residence (State or Foreign Country) Bb. Resltlence (Street and Number -Include Ap< ly^ •. '' Bc. Dltl Decedent Llve In a Tpy+ hips d LL'1~1Yt1 ~14 R B Yes, decadent Iiyed In `~DUt`•°•a't''tOn twp Bd. Residents (County) DB Ot LORI 129 W81nut CTmiberland 8e. Residence (21p Code) QNO, tlaeatlent Iiyed within IIm1t3 of city/born. 9. Ever In Vs Armed Forces? 30. Marital Status at Tlme o1 Death Married Widowed 31. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Yst ~ No Q Unknown Q Dlvor~ed Q Never Married Q Unknow 12. Father's Name (First, Mlddic, Latt, Suffix) 13. Mother's Name Prior to Firs[ Marriage (First, Middle, last) Co Doroth ler 14a. Informant's Name 14b. 0.elatlOnship to Oeeeden< 14c. t' Melling Add (Street d Nu bar, CI State, Zip ) ~' ¢ 17201 ~ ~v gf ~ H ~j Michael C_ Shields Son era urg, e_ G iam +YC inton 1 ...... ..... ... eWe It Death Occurred in • Hospital: ~ Inpatient ~ if Death Occurred Somewhere Other Than • Hospital: Hospice Facility Decedent's Home S Ems ency Room/Outpatient Dsed on Arrival ( Nursin Home/LOn -Tbrm Gre Facility Other (specify) 13 b. Facility Nama (If not tnati[ution, give rtrcK and number; lSC. City or Town, Stat nd 2 p Code ISd. County of Death ~ E f S ensbur •Shi abur PA 17257 Ctmlberland ~-, 16a. Method of Disposition Burial Q Cremation ~ 16b. Date o1 Disposition 1 c. Place of Dispotitlon (Name of cemetery, crematory, or other place) p Removal from state p Dpnatlen 2012 Feb 25 Spring Hill Cemetery Other Spacl ) , S6d. Location of Disposition (Ctty or Town, State, and Zip) 1Ta. Slgnat f Funeral Servl'cs Licens a or Ps n In Charge of interment e 176. License Number Z Shippenaburg, PA 17257 FD-138746 17 N d o plate ~drcts o r l Fat Ity i~e~so~orne~ivs ~tiiiera Hoene 725 Norland Ave. Chambersburg, PA 17201 ~ 16. Decedent's Education -Check the box that best describes the 19. Decadent of Hispanic Origin -Check the 20. Decedent's Rece - Gheck ONE OR MORE races to indicate what ~ highest degree or level of school completed at the time M death. boz that bast describes whether the decadent the decedent considered himself or herself to be. Q 6th grade Or less Is Spanish/Hlapanic/Latino. Check the "NO" ~ White Q Korean ~ No diploma, 9th - 12th grade box if decadent is not Spanish/HiSpanlc/Latlno. Q Black or African American ~ Vletnamsae High school graduate or GED completed No, not Spa nlah/Hispanic/Latino Q American Indian or Alaska Native Q Other Aston Soma college rcdit, but no degree Q Yss, Mexican, Msxipn American, Chicano Q Atlan Indian Q Native Hawaiian ~ Assaclate degree (e.g. AA, AS) Oyes, Puerto Rican O Chinese O Guamanian or Cha mono 0 Bachelor's degree (e.g. BA, AB, BS) O Yes, Cuban Q Filipino 0 Samoan ~ Master's degree (e.j. MA, MS, MEnL. MEtl, MS W, MBA) Q Yes, other Spanish/Hltpanic/Latino Q Japanese Q Other Pacific Islander O Doctoral! (e.g. PhD, EtlD) or Professional tlegree (Specify) Q Other (Specify) . MD DDS. DVM LLB JD 21. Decedent's Single Race Seif-Dasignatlon -Check ONLY ONE to Intllcate what the decedent considered himself or herself to be. 22s. Decedent's Usual Occupation - Indltate type of work hate Q Ja Penete Q Samoan done during most of working life. OO NOT VSE RETIRED. Black or Afrlean American Q Korean O Other Pacific Islander Seamstress Q American Indian Or AliSka Native Q Vietnamese Q Don't Know/NO[ Sure Q Asian Indian Q Other AsNn Q Refused 22b. Kind of Business/Industry ~ Chinese Q NaHVe Hawaiian Q Other (Speclly) p F111p1n0 p Guamanian Or cnamorro Manl.lfBCtLlring ITEMS 2!a - 23tl MUST BE COMPLETED 23a. Oete Pronounced Dea Mo/Dey/V r) 23b. Signature o Person Pronou ncing Death (Only when applicable; 23c. License Numb¢r BY PERSON WMO PRONOUNCES OR CERTIFIl3 DEATH ! ~ ~~}~ - ~j.~ ).,~/~ ~~ri ~~ 23d. Date Signed (MO/DSyMr) 24. Time Of Dea ~ ~ /t-6"t/ J'~'~f~ ~+ '1'Z ~' a 'a-- ,, i-a ~" 25. Was Medlesl Examiner or Coroner Contatted7 Q Yes ' NO CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events-dlaeases, Injuries, o mpliutlons-[hat directly csuasd the death. DO NOT enter terminal a cots such a and lac a est Interval: r n witho h Owing the etiology. DO NOT A VIATE. respiratory arrest, or ventricular Rbrillatl o ut S B BRE E n ter only one cause o a Ilne. A dtl additional Ilnes lf necessary Onset to Death n ~ t ~ / 7 ~J / ~ ~ ~ T ~ A C _ / IMMEDIATE CAUSE ---------> /V I ~ I CT SST A % tG US /~-t~ TrJ % C ~IV ~C~ ~ . (Final disease o ontlicign Oue to (or as a consequence ofl: resulting In death) b. sequennmly nsc commons, - Due to (or as a consequence ofl: If any, leading to the c e listed on Ilne a. Enter The yly DERLYING CAUSE Due to (or as a consequence of): (disease or lnjury[hat G Initletetl the events resultinF tl. ~ in death) LAST. Due t0 (ar as a consequence Ofl: 26. Pan ll. Enter other I nail n I I ri in h brat not resulting In the untlerlying cause Flyen In Pert I 27. Was en autopsy p rformed? Q Yes NO 2g l ~" [o ccomplete the cause of des h ? O Ves Q No 29. If F le: ~Ot pragne nt within pas<year ~ 30. Old Tobacco Use Contribute to Death? q Ve s Q Probably 31. a nor of Death Natural Q Homicide Q Pregnant a[ time of tleath o (."~CI Q Unknown Q Accident Q Pending Investigation ~ Q NO< pregnant, but pregnant within 42 days of death Q Suicide Q Coultl not be determined a- Q No[ pregnant, but pregnant 43 days to 1 year before deatf 32. Date Of Injury (MO/Day/Vr) (Spell Month) Q Unknown If pregnant within the past veal 33. Time Of Injury 34. Place of Injury (e.a. home; construttlon site; farm; school) 33. loca[1on of Injury (6[reet entl Number, Clty, Stat<, ZIp Code) 36. Injury a< Work 37. IT Transportation Injury, Specify: 3B. Describe ow Injury Occurred: Q Yes Q Orlver/Operator Q Pedestrian Q No Q Passenger Q Other (specify) 39a. ertifler (Check only one): .' jjJ~Certlrying physician - To the b!s[ of my kngwletlge, tlea<h occyrratl due [o the cause(s) and manner stated ~~ }a ncing & Certifying physics n - To the bas[ of my Itnowletlge, death o red a[ the t e, date, antl place, end due to the cause(s) and m toted r Q Medlcai Examiner/COr - On a basis of examination, end/o 1 atlOnr In my opinion, dlee < h occur~r d at the time, date, and place, and tlue to the (s ) d rated / /'` / ~~ ~ \ ~~ < ~ i '~~~~ L ~ S{gnature of certif er: TI[le of certifier: / / / • / J License Number: Y I UL..I_/ 39b^^®me, Addr`sa end Zip Code Pe n Cort(tsletin eth (Item 26 Q ( 39c. Da[ Signe (MO/Day/Yr) f t ` ( J 1 ~~u~ i - a.3 i 40. Registrar's District Number 41. Re Ignafyr 42. Regis r Flle Da[e (MO Dey Yr) cZ/- .Z/3~ e23 2~j Z-- 43. Amendments Dis PPVit~on Per-nit No. _-~~~_Yp_/c~________ ____-_ H305-143 RFV O?/2011 LAST WILL AND TESTAMENT ~ ~~ ;,.~ . - `_..t`I ~.... ~ .~ _. r,1 l.l_ :_. (~~ ty..; I, Sherley A. Shields, presently residing at 1575 Palm Spring Drive, Chambersburg, Franklin County, Pennsylvania 17201, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making 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. SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my beloved husband, Harry G. Shields, provided that he survive me by a period of sixty (60) days. THIRD. In the event my said husband, Harry G. Shields, should predecease me or is not living on the 60~' day following my death, I then give, devise and bequeath my said estate to my son, Michael Shields, on a per stirpes distribution basis. FOURTH. I nominate, constitute and appoint my husband, Harry G. Shields, to be the Executor of this my Last Will and Testament. In the event that he be unable to fulfill the duties of Executor, I then nominate, constitute and appoint my son, Michael Shields, to be the Executor of this my Last Will and Testament. In the event that he be unable to fulfill the duties of Executor, I then nominate, constitute and appoint my granddaughter, Stephanie Shields, to be the Executrix of this my Last Will and Testament. FIFTH. I direct that my personal representative(s) shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, Sherley A. Shields, have hereunto set my hand and seal to this my Last Will and Testament, written on one (1) page, this ;~~_day of ~ ~ _ 2004. r•~ ~-_ -. ~- ~c ~L ~; c_; O i~~ ~, ~-l.-y Vag; ~~ .' ~~' ~ (~~ (SEAL) N WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 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 each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND I, Sherley A. Shields, the person whose name is signed to the foregoing instrument, having 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. 0 ~,E~ Sworn or affirmed to and acknowledged before me by Sherley A. Shi lds, the Testatrix, this a(~ ~'`` day of t , 2004. ~~ ~. ~~ ,~ - ~r,e~,,..-~, ~. xooe WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBU RG, PA 17257-1397 -e. K /lE; COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND and ~-- ~ N fl ~ ~~_ ~~~, ~ ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Sherley A. Shields, the Testatrix, sign and execute the instrument as her Last Wi11; that she 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; and that to the best of our knowledge the Testatrix was at the time eighteen (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 i~+-~~~Mr~s rn, ~(Ll~l-~~ , and ~- rn,~A 1~ 1<~~ I~ ~h wi esses, this ~ day of u ~ , 2004. ~~ ~ t ~~~~a~e~e«nooou~rn ~ Conwnwiort Eq~Nrt ,Jun ~. xppa WEIGLE & ASSOCIATES, RC. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-7397