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HomeMy WebLinkAbout04-25-12Reset 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 Letters as specified below, and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information ~ ., ~ Name: ALICE C. SMITH File No: - ~r a/k/a: (Assigned by Register a/k/a: a/k/a: Social Security No: 171-28-7212 Date of Death: APRIL 20, 2012 Age at death: 75 Decedent was domiciled at death in CUMBERLAND County, pENNSYLVANIA (Stare) with his/her last principal residence at 378 GREENSPRING ROAD, NEWVILLE 17241 NORTH NEWTON TOWNSHIP CUMBERLAND Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 210 BIG SPRING ROAD NEWVILLE 17241 WEST PENNSBORO TOWNSHIP 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 $ 6,100.00 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.... $ 6,100.00 Real estate in Pennsylvania situated at: NONE (Attach additional sheets, if necessary.) Street address, Post Office 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 MARCH 19, 2008 and Codicil(s) thereto dated NONE Stste relevant circumstances (eg. renunciation, death of executor, etc) Except as follows: after the execution of the instnunent(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. Q NO EXCEPTIONS Q EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate If Administration, c.t.a. or db.n.c.r+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 ~ EXCEPTIONS Petitioner(s), after aproper seazch has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): ,-~ _ ___ :a~ Name Relationshi _.:. Address `rr -~ '~"" ~ ' ~ :;~ ~ _ _'.' `LT ~ ~.~ ` t'".. ~ _- ., 1 __ J ~~T _~ N T> (~ J `_~ --..i „~ ~; Forn Rw o2 rev. ]0/11/2011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND _- OP~Bi se Only = y . _ ' ~ _ ,~ T-.>, . _:; ~ ~ - `~: ~ U - ;~ ~, _ _, ~ - Petitioner(s) Printed Name Petitioner(s) Printed Address ~t % ~' ROBERT E. SMITH 378 GREENSPRING ROAD. NEWVILLE. PA 17241 The Petitioner(s) above-named swear(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 Personal Representative(s) of the D e P itione (s ' 1 well y administer the estate accordin to law. Sworn r affirmed d ubscribed be ore f ~ Date ~ ~ ~~~ me tb~i~~~;da3~~ ~~ , ,/,~~ Date By: Register Date Date 13UNB Required: Q YES Q NO .~ ,rEF~ . Letters ..................... . ( 4) Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ $ ~~ .cF • ~ Ct~ Commission ................. . Ott ~e r~ . ..... . , / /~/ , ~`~ . Automation Fee ............... ~~ JCS Fee . .................... ~ ~S 4~ TOTAL ..................... $ - To the Register of Wills: Please enter my appearance by my signature below: Attorney Si ature: _ ~ "~ ~ r ~ ~ ... _,~~ ~. ~4_- ~ __ l~ ` ~~ Printed Name: HAROLD S. IRW ,III Supreme Court _ ID Number: 29920 Firm Name: Address: Phone: 717-243-9200 irwinlawoffice('l~mail _com C~~~~~ DECREE OF THE REGISTER /I ~ / Estate of ALICE C. SMITH File No: ~ ~- ~ it -~~ ~y a/k/a: AND NOW, ~~ ,-y~~~ in consideration of the foregoing Petition, satisfactory proof Navin been presented before me, IT IS DECREED that Letters Testamentary _ are hereby granted to ROBERT E. SMITH in the above estate and (if appliczble) that the instrtunent(s) dated MARCH 19, 2008 __~ described in the Petition be admitted to probate and filed of record,~s the last Will (and Codicil(s)) of Decedent. Register of Wills ~~~~ .~ `~ ~ /~ i Form RW-02 rev. 10/11/2011 ~" ~ Page 2 ~ 2 I: ~' r.: f I~Cf' IUC i~11A L:i'fli~tC~1.i `ni)(~t "'°Ii~ !'",!'} ,I.~ ~. i-~ rn(11 G~J ~II C.•~~ - C~ER~ ~~= ORPNiA~~'~; C i ,=1R' Cl1Pwf~l~ ~ L, ; r;:.~~ pq ~. - 4 ~ ~ ~. ~_ ~ ~_~~ ~~~~.c-~r-`ie~Uetz~' A P ~ 2 2 2 012 ~~ Type/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS Permanent P'F QTIFIf"ATC !lC f1C ATu 0 1. Decedent s Legal Name (First, Middle, Las[, Suffix) 2. Sex 3. Social Security Number rv4. D to of Death (MO/Day/V r) (Spell Mo) Alice C_ Smith. F_ 171-28-7212 A ri1 20 2012 6a. Age-Lase Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/D ay/Year) (Spell Month) 7a. Birthplace Cit and State or Forei n Count ) ~~ Mpntns Days Hpgrs Minutes g ry Mt _ Ho~~ S rin s PA 7 5 Aug _ 1, 1 9 3 6 76. Birthplace (cpgn[y> Cumberland Sa. Residence (State or Foreign Country) 86. Residence (Street and Number- Include Apt No.) Sc. Did Decedent Live in a Township? 378 Gri=anspring Rd_ Owes decedent rYed in N_ Newton , tysp. Sd. Residence (County) C Limber 1 and Se. Residence (Zip Code) "~ 7 2 4 ") ~ No, decedent lived within limits of city/born. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death (] Married 7Qa Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Yes [~NO 0 Unknown O Divorced ~ Never Married Q Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (Firs[, Middle, Last) John M. Nelson ' Charlotte A1da Hockle 14a. Informant s Name 146. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Codc) g C Robert E_ Smith Son 378 Greens rin Rd. Newville PA 1724 i s ........................................................... .......................................... If Death Occurred in a Hos ital: CJ` I ti t - ......... 1Sa: P ace o Deat-.- C ec only one .................. = ` - ° p npa en Q Emergency Room/Outpatient Q Dead on Arrival 1f Death Occurred Somewhere Other Than Hos - LXam, pital: Hospice Facility ~] Decedent's Home _ l:J Nursing Home/Long-Term Care Facility Other (Specify) 156. Facility Name (If not insfitution, give street and n mbar; 15c. City or Town, State, and Zip Code 15d. County of Death Green Rid e Ret_ Center Newville PA 17241 Cumberland 16a. Method of Disposition $] Burial 0 Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory or other place) Q Removal from State (] Donation , p ouer(sPeafy) 4 24 201 2 Mt _ Hol S rin s Cemeter Z i6d. Location of Disposition (City or Town, State, and Zip) 17 gnatu re of Funeral 5 e Livens _ rson I rge Interment 176. License Number a Mt_Ho11 S rin s PA 17065 FD-011932-L 0 12c. Name and Complete Address of Funeral Facilityrj O 1 N Ba 1 t imori= ve _ Mt.HO~1 S rin s PA 17065 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to indicate what ~ highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent consideretl himself or herself to be [~ 8th grade or less (~ No di loma 9th 12th d is Spanish/Hispanic/Latino. Check the "NO" . White ~ Korean p , - gra e box if decedent is not Spanish/Hispanic/Latino. 0 Black or African American 0 Vletna mese ~ High school graduate or GED completed g] No, not Spanish/Hispanic/Latino ~ American Indian or Alas ka Na[Ive 0 Other Asian ~ Some college credit, but no degree 0 Yes, Mexican, Mexican American, Chicano Q Asian Indian ~ Native Hawaiian Q Associate degree (e.g. AA, AS) Q Ves, Puerto Rican Q Guamanian or Chamorro ~ h n 0 Bachelor's degree (e.g. BA, AB, BS) ' ~ Ves, Cuban F i ine P Q Samoan ~ ~ Master s degree (e.g. MA, MS, MEng, MEd, MSW, MBA) 0 Yes, other Spanish/Hispanic/Latino Ja ~ panese ~ Other Paci Fic Isian der ~ Doctorate (e.g. PhD, Ed D) or Professional degree fy) (Speci ~ Other S ( pecify) (e. MD DDS, DVM, LLB, JD 21YD~.eYC"e"dent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. hite 22 a. Decedent's Usual Occupation -Indicate type of work L, w 0 Japanese ~ Samoan Q Black or African American ~ Korean ~ Other Pacific Islander done during most of working Ilfe. DO NOT USE RETIRED. American Indian or Alaska Native ~ Vietnamese ~ Don't Know/NO[SUre Saleswoman ~ Asian Indian ~ Other Asian ~ Refused 226. Kind of Business/Industry 0 Chinese 0 Native Hawaiian Q Other (Specify) ~ Fill Pino ~ Guamanian or Chamorro C10thing $t.Ori= ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pr ced ead (MO/Day/Yr) 23 b. Signature of Person Pronouncing Death (Only when applicable) 23c. Ucense Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH y a ca ~ a ~ ~ / 2 ` 23d. Date Sig ed (MO Day/Vr) 24- Time of Death / / ~ \\ ~„ Q/{~,~_1V 7 (~ R ~ ~~ ~ d Z5. edical Examiner or Coroner Contacted? Ves Q No CAUSE OF DEATH Approximate 26. Part I. Enter the chain of a ents--diseases, Injur mplications--that directly caused the death. p0 NOT enter terminal events such a ardiac arrest Interval: respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add add(tional lines if necessary Onset to Death ~~ IMMEDIATE CAUSE > ~ (F al disease o ndition Due to (o as a consequence Of): resulting in death) Sequentially list conditions, Due to (or as a consequence f if any, leading to the cause o ) listed on line a. Enter the UNDERLYING CAUSE Due to (or as a consequence ofl. (dis injury that t o _ Initia ed t he events resulting d. m death) LAST. Due to (or as a consequence of): - S 26. Part II. Enter other significant conditions contr--but na to death but not resulting in the underlying cause given in Part I 27- Was an autopsy pertorm ed? ~ ~ Yes ~ No ' 28. Were a opsy findings a aila ble io mple the of death? co ca O Ves O No - 29. If Female: 30. Did Tobacco Use Contribuxe to Death? 31. Manner of Death o ~ Not pregnant within pas[ year ~ Yes ~ Probably Natural 0 (] Homicide (] Pregnant at time of death ~ No 0 Unknown ~ Accident ~ Pending Investigation 0 Not pregnant, but pregnant within 42 days of death ~ Suicide 0 Could not be determined ~ ~ Not pregna ni, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month) 0 Unknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm, school) 35. Location of In jury (Street and Number, City, State, Zip Code) 36. Injury a[ Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: ~ Ves 0 Driver/Operator ~ Pedestrian (] No ~ Passenger 0 Other (Specify) 39a. C r (Check only one): Certifying physician - To the best of my knowledge, death o red due to the cause(s) antl m r stated ~ Pronouncing S Certifying phy ici n - To the best of my knowledge, death occurred at the time, date, and place, antl due to the cause(s) and m r stated O Medical Examiner/Coroner - th basis of exa m(nafion, and/or investigation, in my opinion, death red a i the time, date, and place, and due to the cause(s) and manner stated ` ~ Signature of certifier: Title of certifier: ~ / - License Number: ~~O ~l ~ - ~- 396_ Name, Address and Zip Co arson Completing Cause of Death (Item 26) 39c . D a Sig d (MO/Day/Vr) ? , 1 ~ -i ~~~ Z 40. Registrar s District Number 41. Registrar's S~ cure ~ 42. Registrar File Date (MO/Day/Yr) ~l - a.~0 ~ _ ~_ - aa, ap ~a- a3. Amendments Disposition Permit No. c~(i~«- aa. REVD07%2 11 L:ADocuments and Settings\Roger\My Documents\Smith, Alice C\Alice Smith Will.doc _ ^,` ? _ i7 T + -^_ '7 ~ L. ~ - " -ii_T: ~'ti~ ~.i .? "__ I .•r. J t OF ALICE C. SMITH I, ALICE C. SMITH, of 378 Greenspring Road, Newville, Cumberland County, Pennsylvania, declare this as and for my Last Will and Testament, in manner and form following: FIRST: I hereby expressly revoke all Wills and Codicils heretofore made by me. SECOND: I hereby direct my Executor to pay all my just debts, funeral and administrative expenses out of my estate, as soon as practicable after my death. THIRD: I direct that all taxes which may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid out of my estate as a part of the administration of my estate. FOURTH: Should my son, ROBERT E. SMITH, survive my death, I give, devise, and bequeath the remainder of my estate, real, personal, and mixed, whatsoever and wheresoever situate, to my son, ROBERT E. SMITH. FIFTH: Should my son, ROBERT E. SMITH, predecease me, or should he not be living on the 3lst day following my death, I give, devise and bequeath all the said rest, residue and remainder of my estate to my daughter-in-law, LISA L. SMITH, provided that she survives my death. Should my daughter-in-law, LISA L. SMITH, fail to survive my death, I give, devise and bequeath all the said rest, residue and remainder of my estate to my granddaughter, AMY N. EPPLEY. SIXTH: I nominate, constitute and appoint my son, ROBERT E. SMITH, as Executor of this my Last Will and Testament. Should my said son fail to qualify or cease to act as Executor, I nominate and appoint my daughter-in-Iaw, LISA L. SMITH, as Substitute Executrix of this my Last Will and Testament. I relieve my personal representative (as well as any substitutes) from the necessity of posting security in connection with his or her duties as such in any jurisdiction in which he or she may be called upon to act insofar as I am able by law to do so. SEVENTH: All income or principal held for the use and benefit of the beneficiaries of this Estate shall not be in any way or manner subject to anticipation, assignment, pledge, sale or transfer, nor shall any such interest, while in the possession of my Executor, be liable for or subject to the debts, contracts, obligations, liabilities or torts of any beneficiary, or to attachments, executions or sequestrations under process of law. EIGHTH: If any beneficiary of the Estate shall, in the sole opinion of my Executor, be or become mentally or physically incapacitated, by reason of illness, accident, minority or other circumstance, my Executors may apply either income or principal for the support and welfare of such beneficiary directly or to the person who has the care and control of such beneficiary, without the intervention of any Guardian and without obligation to supervise application of said amounts in any way. NINTH: In addition to the powers conferred by law, I authorize my Executor (and his successors) in his absolute discretion: A. To retain in the form received, and to sell either at public or private sale any real or personal property. B. B. To manage real estate. C. To invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principle of diversification. D. To exercise any option or rights arising from ownership of investments. E. To compromise claims without court approval, and without the consent of any beneficiary. IN WITNESS WHEREOF, I hereunto set my hand and seal this ~ ~ day of March 2008. ALICE C. SMITH SIGNED, SEALED PUBLISHED and DEC RED in the presenc of: ,- COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF I, ALICE C. SMITH, the Testatrix whose name is signed to the attached or foregoing instrument, having being 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 ALICE C. SMITH, the Testatrix, this ~ day of March 2008. ALICE C. SMITH, Testatrix ~~ ~ Notary Public NOiAR1Al ill ROfiER M MORGEN1ilAl ~Y h~'7MC FIARRISlURC COY, QAII-NNd COIINII/ My CO~nMNon ExpMN Mor 29, ZO10 COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF DAUPHIN We, `~ 1 ~~ ~ ~-- . ~ ~ T Z- and ~C~1~ ~ ~ i ~1C~ ~~, ~C`~.4 ~ ~~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we are present and saw Testatrix, ALICE C. SMITH, sign and execute the instrument as her Last Will, 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 that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me this ~ 9 day of March 2008. fitness n __,. , Witness %zr w Wt.y...~- Notary Public ~~~ NOTAIiU1l EFAL R06ER M MORGHd11ML ~Y ~~ F1ARR1!lURG CRY, QMJRIN COUNfII My ComrtNWon Expitet Mar 29, 2010