Loading...
HomeMy WebLinkAbout03-23-12Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYC VANIA ;~~ ~~ __ ~Y, Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as meted bel>~, ana~iti support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropt~ ~,n ~ ~ i-n ~ rv _ ~.., .r~ Cl> ~ W _; c Decedent's Information ~ _ :_ --,-; Name: ROBERT P. BURTON File No: `~ ~ ~ " ~~~ -} ~7 ~ (Assigned by ~ ter) ~ __ a/k/a: - `~ O Social Security No: 42(53-3227 -~ a/k/a: Age at death: 91 Date of Death: JANUARY 16 2012 Count PFNNSYT VANTA (State) with his/her last Decedent was domiciled at death in CUMBERLAND Y~ principal residence at 129 WALNUT BOTTOM ROAD SHIPPENSBURG PA 17257 SHIPPENSBURG TOWNSHIP CUMBER Street address, Post Office and Zip Code City, Township or Borough y Decedent died at CHAMBERSBURG HOSPITAL CHAMBERSBURG PA 17201 CHAMBERSBURG BORO FRANKLIN PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: $ 265,000.00_ If domiciled in Pennsylvania ............................ All personal property If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $ If not domiciled in Pennsy!vania ........................ Personal property in County $ 0 00 Value of real estate in Pennsylvania ............................... . TOTAL ESTIMATED VALUE.... $ 265 000 00 Real estate in Pennsylvania situated at: Ci ,Township or Borough County (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code tY A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Executor(s) named m the last Will of the Decedent, dated AUGUST 23, 2004 and Codicil(s) thereto dated NONE State relevant circumstances (e.g. 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 neither the victim of a killing nor ever adjudicated an incapacitated person. 0 NO EXCEPTIONS Q EXCEPTIONS © $. Petltlon fOr Grant Of Letters Of Adminlstratlon cI ~ ap d 6.n~~d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate 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. 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. Q NO EXCEPTIONS Q EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no W ill and was survivedby the following spouse (if any) and heirs (attach additional sheets, if necessary): Relationshi Address Name ROBERT P. BURTON, JR SON 121 USELMA AVENUE, JEFFERSON, OH 44047 SHEILA B. MALONE DAUGHTER 421 WEST MAIN STREET, WALNUT BOTTOM, PA 17266 Page 1 of 2 Form RW-02 rev. 10/l ]/2011 lla+h ..f n,......._ _..~ - - - --°---~~ ~..,,Qy,~ ~~ auirm~s) the statements in the foregoing Petition are true and correct to the best ofthe knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Dec e t, the Petitioner will we and ly administer the estate according to law Sworn to or affirmed a d subscribed before X ~' ~ ~ ~ ~J~GZE~ . met s ` rt~.day of 'tClYC4~ , ~.Cf~~,t " ~, Date ~ ~~ ~ ~ By: a r ~ Date For the Register Date Date BOND Required: Q YES ~O FEES: Letters ................... $ ~ CC C '~ ( )Short Certificate(s)... ... ` . . .. . ( )Renunciation(s)...... .. . ( )Codicil(s) .......... .. . ( )Affidavit(s)......... .. . Bond ................ ..... Commission ............ . ... Other ..... .. ~~.1 ..... .. (7 •~L' ...... Automation Fee ........... . . . . . ~~ ,C L-, JCS Fee . .................. .. ). ' L1 TOTAL ................... .. $ ~ •SC-"~60' To the Register of Wills: ~ ~ ~~ Please enter m a ~ ~~ y ppearance by my signatttr~i~~y; ~ Attorney Signature: ~ Printed Name: DAVID P. PERKINS Supreme Court ID Number: 34342 Firm Name: Address: Phone Fax: Email: 17)532-9537 DECREE OF THE REGISTER ~~~ <" cri ~ W ~2 ~ ~ n -~ ~ ~r %~ ~ Estate of ROBERT P. BURTON a/k/a: File No: _~~ - ~~~ - (~,=~,~ tom' AND NOW, ~`~~~ ~ ~,'~ rC''~ satisfactory proof having been presented before me, IT IS DECREE tters o TESTAMENTthe foregoing Petition, are hereby granted to SHEILA B. MALONE a/k/a SHEILA RAE MALONE the instrument(s) dated AUGUST 23 2004 in the above estate and (if applicable) that described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. ~Cr Register of Will ~,~~ ~1 Form RW-02 rev. 10/11/2011 Page 2 of 2 H 105.905 2EV.(S/1)) This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with the Vital Statistics Law of 1953, as amended. ~. rj ,F.. r- , - -, ~ I '}{- ,rC ~'-FINE d ~~.}( r WA~f.~1NING: It is illegal to duplicate this copy by photostat or photograph. 1.~I~.i~.-L 1 ..LV ?~~? IAR 23 ~~ 9= ! 6 CLERK ~~ ORPH~(N'S COi.~RT 6614362 Marina O'Reilly Matthew State Registrar FEB 0 3 2012 Date COMMONWEALTH OF PEN NSV LVANIA ~ DEPARTMENT OF HEALTH .VITAL RECORDS !'C RTI FIf'ATF AF I7FOT1-1 _. _ _.. __ No. Type/Print In Permanent v V~_ 3 k In l. Decetle s Legal Name (First, fiddle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell MO) p l ace (City and State or Foreign Country) Age-Last Birthday (Vrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Monts) Ta. Birth Sa ~` /^ . ~ r'~ v~ Months Days Hours Minutes ~ //}y ~f 1 ~ t `mot L~ 2b. Birthplace (C nty) 8a. ResitlenfA (State or Foreign Country) 8b. Residence (Street and Number - Inclu Apt NO.) 8c. Did Decedent Live Yn a TownshipT ~/,~ yy ~,Ves, decedent Itved In S~rl ~ _,~ _l Pt'l+Jl'~~'JU ~t._ twp. 8d. Resitl¢nC¢ (County) \Z ~ - ~• a Se. Residence (Zip Code) Q No, decadent Ilved within limits of city/born. 9. Ever in US Armed Forces? 10. Mar ital Status at Time of Death Q Married Widowed 11. Surviving Spouse's Name (If wife, give name prior To first marriage) Yes Q No Q Unknown Q Di vorced Q N¢ver Married Q Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (Firs[, Mitltlle, Last) S~~-. S~~ ~~ s cs 14a. Informant's Name 14b. Relationship to Decedent 14c. In o nan['s Mailing Address (Street and u ber, City, State, Zip Cod¢ 7 ~ F !.--~ Ong i ( 7 ~ U.+ , '(V')G. i ~ S h Uri ~~ ~ ~.- 'TA - C qn p sa: r_a~e_o Deat chec Y .......... .... .... ....... - .-..-. .-...-.. ....... ....... ..... If Dea[li Occurred in a Hospital: CJ Inpatient e lf Death Occurretl Somewhere Other Than a Hospital: Hospice Facility Decedent's Home ° Emergency Room/Outpatient Q Dead on Arrival _ Nursing Home/Long-Term Ure Facility Q Other (Specify) eat IS Facility Name (IF not institution, give street and number; lSC. City or Town, State, and 2Ip Cfq~d lSd. County of Death Gi.c.'~.b,..~~CT.' ~~.C ~Lr.GM~+.-S~ws: Chi ~~261 ~ wf 16a. Method of Disposition Q Bur al Q Cremation 16b. Date of Disposition 6c. Place of Disposition (Name of cemetery, creme<ory, or other place) Q Removal from Sate ~DOnation z ~ r ~'k ~ ~ ~ QOther(Specify) ~S .,~Y„~.r.~ s ` iia zo~ - 2 16tl. Location of Disposition (Ci<y or Town, Sta<e, and 2Ip) 12a. Signature of Funeral Service Licensee or Person n Charge of In<erment 17 Ucense Number c ITC. Name and Co ~te ddr¢ s of Fu sal Facility (, ti ~ ~ u~ 'm' 18. Dece s Educatio~- Check the box that best de tribes the 19. Decedent of Hispanic ONgin -Check the 20. Decedent's Race -Check N OR MORE rat o indicate what highest degree or level of school completed at [he time of tleath. boz Shat best describes whether the decedent the decedent considered hims¢If or herself to be. Q 8th grade or less is Spanish/Hispanic/Latino. Chick the "Nn' Whites [~ Kprean Q No diploma, 9t11 - Itch grade box if tl¢ceden[ is not Spanish/Hispanic/Latino. Q Black or African American Q Vie<na mese Q High school graduate or GED compleTed No, no[ Spanish/Hispa nic/Le<inq 0 American Indian or Alaska Natve Q Other Asian ® Some college cr¢dit, but np degree Ves, Mexican, Mexican American, Chicano Q Asian Indian ~ Native Hawaiian Q Associate degree (e.g. AA, AS) O Yes, Puerto Rican Q Chinese Q Guamanian or Chamorro Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q Filipino Q Samoan Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino Q Japanese O orner Paafl~ Islander Q Doctorate (e.g. PhD, Etl D) or Professional degree (Specify) Q Other (Specify) _ . MD DDS OVM LLB JD 21. Decedent's Single Race Self-D¢signatlon -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. DecedenT's Usual Occupation -Indicate type of work White Q Japanese Q Samoan tlone during most of working life. DO NOT USE RETIRED. $ ` Q Black or African American Q Korean O Ocher Pacific Islander ` .r.~ Q American Indian or Alaska Native Q Vietnamese Q Don'C Know/Not Sure \ t ' sc~r~L~- Q Asian Indian Q Other Asian 0 Refused 22b. Ind of Business/Industry Q Chinese Q Native Hawaiian Q Other (Specify) _ ~ Q Filipino Q Guamanian or Chamorro IYl stn LJ ~ ; a, Y1 ' REMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day r) 23b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number ' _ BY PERSON WNO PRONOUNCES OR ~ ~~~ CERTIFIES DEATH 23d- Date Signed (Mp/Day/Vr) 24. Time of Dearh 25. Was Medical Examiner or Coroner Contacted? Q Yes Q No CAUSE OF DEATH ApproximaCe 26. Part I. Enter the chain of ~--diseases, injuries, or cnmplicatlons---thaS directly caused the death. UO NOT enter terminal events such as cardiac arrest Interval: ABBREV~ATE. Enter only one cause on a lin¢. Add additional lines if necessary Onset to Death etiology. DO NO T on without showing the l la<l respiratory arrest, or ventricular fibr i ~) ' y{y S ~ ~ ~ ~ ~~ ~ G 4~ `~'~ "- T j G~ ' IMMEDIATE CAUSE --- -- ----> a. ~/ a/~tw (Final disease or condi<Ign Due to (or as a consequence of): - resulting In death) b. seq.,envagy Ilst condi<ions, one To (p az a consequence of): if any, leading to the cause listetl o Eriter [he -. UNDERLYING CAUSE Due to (pr as a conseggence of): (tlis¢ase or lnjury[hat s initiated ih¢ events resulting d. in death) LAST. Due tq (or as a consequence qf): 26. Par[ 11. Enter q[har f o di ' tin but no[ resulting In the gntlerlying cause given In Psrt I 22. Was an autopsy perform¢tlT Q Ves <@'Fo ~ 28. Were autopsy findings available to complete the cause of death? Q Y Q No es ~ 29. If Female: - 30. Did Tobacco Use Contribute to Death? 31. Mann~~ of Death Q Noi pregnant within past year Q Y Q Probably ~ rural Q Homicide m Q Pregnant at time of death )~ Not pregnanT, but pregnant within 42 days of dea[F ~~NO Q Unknown O Accident Q Pending Investigation 0 Suicide Q could not be determined ~ Not pregnant, but pregnant 43 days to 1 year before dead' 32. Date of Injury (MO/Day/Vrj (Spell Month) Q Unknown if pregnant within the past year 33. Time of Injury 34. Place of Infury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, CiTy, Siat¢, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Infury Occurred: p Y O D er/operator O PedextHan ~ NO ~ Passenger Q Other (Specify) C¢rt~~1~~r (Check only one): mortifying physician - To [h¢ best of my knowle e, death occurs d due to the e(s) and manner stated Q P ncing R Certl yziclan -TO the b of wledge ath occur t the time, date, antl place, and due to the cause(s) and manner stated h e c a us¢(s) and manner stated Q Medical Examin or - On <he basis of nd/ i Lion, In y opinion, death occurred at the time, dale, and place, and due to t ./ tr . ( ~ G~ C'E' ~ ~8' T L'-- • t ~ © License Numbers .!/ ~ Signature of certifier: a of certifier: 39b. Name, Address and Cpde of Person Completing Cause of De h (Item 6) ~/ 9c. Dat¢ Signed (MO/Oay/Vr) n /O' 2 s is/ Z 40. Registrar's District Number 41. Regi it afur egistrar Ile Date (MO/Day r) 43. Amendments Disposition Penni[ No. V tD~II -(~~ 3 REV 07/2011 LAST WILL AND TESTAMENT OF ROBERT. P. BURTON t..._ , n W ~, O . ~ i7T _ .~--- rr~~ - iT' `~ c., I, ROBERT P. BURTON, having my legal residence at 1106 Caiiti:~iiuyt: iuuii., Ivor~.~ Londonderry Township, Lebanon County, Commonwealth of Pennsylvania, do hereby declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by me. FIRST: I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. SECOND: I devise and bequeath all of the rest, residue and remainder of my estate and property, of whatsoever nature and wheresoever situate, to my wife, MARGUERITE W. BURTON, if 5iie survives ~:izirty (30j calendar days aster my death. THIRD: If my wife, Marguerite W. Burton, does not survive thirty (30) calendar days after my death, then I direct that all of the rest, residue and remainder of my estate and property, of whatsoever nature and wheresoever situate, be divided into two (2) equal shares and distributed as follows: A. One (1) equal share to my son, ROBERT P. BURTON, JR., of Jefferson, Ohio. If he fails to survive me, then I direct his share be distributed to his wife, VIRGINIA BURTON, per stirpes. B. Oise (i) ~quai ~hdre to my daughter, SHEILA RAE MALONE, of Walnut Bottom, Pennsylvania. If she fails to survive me, then I direct her share be distributed to her son, CHRISTOPHER A. MALONE. If he fails to survive me, then I direct his share be distributed to my son, ROBERT P. BURTON, JR.; and if Robert P. Burton, Jr. fails to survive me, then I direct his share be distributed to his wife, VIRGINIA BURTON, per stirpes. FOURTH: All estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and interest d ar, ^al} t 11 pc_ ~.iev • hereon, with res--ect tc dll N pt V~CY. Ly comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the (principal of my general estate, as if such taxes were admini- stration expenses without apportionment or right of reimbursement. 2 I authorize my legal representative to pay all such taxes at such time or times as may be deemed advisable. FIFTH: I appoint my wife, MARGUERITE W. BURTON, Executrix of this Will and direct that she be permitted to serve withGiit.'3uiid aZ'i(1 vV"1ti1ii1L; alit' intervention of any Court except as required by law. I authorize my Executrix to sell, encumber, mortgage, invest, distribute in kind, or retain any items of property of my estate in such manner as she shall deem proper, limited only by her own discretion. If for any reason my Executrix appointed under this Will should fail to serve in that capacity, I appoint my daughter, SHEILA RAE MALONE, my Executrix, with the same powers and privileges set forth above. Should Sheila Rae Malone predecease me or fail to serve in that capacity, I appoint my son, ROBERT P. BURTON, JR., my Executor, with the same powers and pri vil.egAc Bet firth aht>-,,P , IN WITNESS WHEREOF, I have at Palmyra, Pennsylvania, this 23rd day of August 2004, set my hand and seal to this, my Last Will and Testament, consisting of four (4) pages. ''~ ,1 ,~ Robert P. Burton 3 SIGNED, sealed, published and declared by ROBERT P. BURTON, the above named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in }r±e ~icSe nC:e Cf ~~'~=i ~% leer, ~idv~ ne~C~lIItO sub5cribCd our names as witnesses. r, ~~~~ Residence : ~ f~ C' ~ ~ ~ y ~.-~ t ~~ Witness r f, r s ' _ l~ Residence: 8~Z(v Cory.wcctl W' ness ~`"`~ i 4 OATH OF NON-SUB SCRIBING WITNESS(ES) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of ROBERT P. BURTON KIMBERLY A. SPENCER Deceased and CONNIE M. FINKENBINDER (each) being duly qualified according to law, depose(s) and say(s) that she / he /they acquainted with ROBERT P. BURTON was /were well- and am/are familiar with the handwriting and signature of the decedent, and that the signature of ROBERT P. BURTON to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ROBERT P. BURTON is in his/her own proper handwriting. nature) 1/1'/ 25 EWBL9RG ROAD (Street Address) NEWBURG, PA 17240 (City, State, ZzpJ Executed in Register's Office Sworn to or affirmed and subscribed before me this ;x ~~ C~ day of ~~~'i.l~~'l'L ,~^~, / ~" Deputy for Register of W is (Signature) 303 DUNCAN ROAD (Street Address) SHIPPENSBURG, PA 17257 (City, State, Zip) n ~. p i;:.~ a~ . _~~ ~, ~ r ~ ~ ! ~ _ ... p. l :~ rn rv t~ _ - ~~~~ w 7 ~ =,-, a D ~ ~a _~ ,~~:_ :-n c~ ~ rn Form RW-04 rev. lOJ3.06