HomeMy WebLinkAbout06-04-12PETITIO~f FOR GR:arT OF LETTERS
REGISTER OF ~~'ILLS OF ~{~Yti~~L~.~~~ k~l~ COUtiTY, PE~,~~SYL~" 1~I~
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Decedent's Information
dame: _,~- ,t? ~ yi
a/k'a:
a/k%a:
ai lv a:
Date of Death: __ !4'( ~ ~y ~ ~~ /1
Decedent was domiciled at death in
principal residence at /00 ~ C
(stare) with 1~' /her last
Street address, Post Office and Zip Code City, Township or Borough ~ ~ Coum
Decedent died at /D<ay C~<Q vt ~ rvty.~ '~'% ~ y'S t h~ ~"' vt ~ ~ / /„tom !'
Street address, Post Office and Zip Code City, wnship or Bornugh Co-only Slate
Estimate of value of decedent's property at death:
If domiciled in Pennsy!vania ............................ All personal property $_~. ~> G ~ , ~ 3
If not domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $
/f not domiciled in Pennsy!vania ........................ Personal property in County $
Value of real estate in Pennsy[vania ......................................................... $
TOTAL ESTIIV[ATED VALliE.... $_2 ~ 3
Real estate in Pennsylvania situated at:
(Attnch ndditionnt 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) }y~/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~~ /'Y/ /;.~ / S /~ and Codicil(s)
thereto dated
State relevant circumstances (e.g. renunciation, deaUi of executor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did trot 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 leave a child born or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
~NO EXCEPTIONS ^EXCEPTIONS
^ B. Petition for Grant of Letters of Administration (If applicable)
c. t. u., d. b. n., d.b.n.c.t.a., pendentelite, duranteabsentia, durmueminoritate
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
itt 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
^NO EXCEPTIONS ^ EXCEPTIONS
Petitioner(s), after a proper search hasJhave ascertained that Decedent lefr no W ill and was survived by the following spouse (if any) and heirs (attach
ndditionals'heets, if necessary):
Name Relationshi Address
r
C
:-t t
C ) A- _.
i
_,
~I'`
File No:~~_~ t-l.-r ~~~
(Assigned by Register)
Social Security No: /~~ ~ ~~ ~~ ~'
Age at death: ~,j'-
Fo~,n nw-oz rw. lniuiznl~ Page 1 of 2
Oath of Personal Representative
CO~I~[Oiv~.~,'E.~LTH OF PEVNSYLVA~'IA }
ss
C~)~':A~T`r' OF
~~~~~rc;-~ ;,~.i=f ~E QF
~~
-~~ ,~EF~a~ sc C3nl~..;.~.~
~._ .. _
i~~4? .1U~! -4 Aid 10~ 2~
ni +~f'}e i ~f
Ott-.!._.:
.r~• ~r~.f
~ a.dc ,
,,t s ~t°~ i
? O
v ~-,
~ .
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are tnte and correct to the best of the knowledge and belief
of Petitioner(s) and ;hat, as Personal Representative(s) of the Decedent, the Petitioners will well and truly administer the estate according to law.
Sworn to or aff:rme~i ana subscribed before ~~- Dace - ,>.~ c y ~( ~
m~ t `' day of - ~ ~ ~-- ,
- ~ Date
B~' ~ •-1~~--,1TL~L ~ ~ ' 1 ~ Date
ror the Regi,ter Date
BOND Iteyuired: 'YES ~NO
FEES:
Letters ...................... $ ~`~(.l v~l
( ~.. )Short Certificate(s)...... _~' u~
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................1-) - y V
Commission ................. .
Other _
J~i~l _ ....... j ~ . ('
Automation Fee ...... ........ , ~j' (.`^~!
JCS Fee . .................... i~'^ - <,
TOTAL ..................... $__~~
Ta the Register of Wiiis:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of _ 1-~~ ( ~ ( ~ 1 v \ i~ l f 1 G' iLl~'t,) File No: _, ~~ ~ ,~ ~ ~; ,; y%, ~( ~
a/k/a:
AND NOW, ,~ Lti~.'~ ~ .~ ,-~('; } ;~ , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters ~ S-}(j {'~(1,° I ~~ y (( pZ f
are hereby granted to _ ;~~('~ 1 ~ , ~'~ {~-~~~~~~~ ~,1t;; ~~ i
in the above estate and (if applicable) that
the instnunent(s) dated _ ~~ `~' '- '~
described in the Petition be
F~„~~ Rb~-01 rev. l0/!1/10/1
to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
.1 ~
Register of Wills ~
Page 1 of 2
ILC~~~~;~peRAR'S ~~LR~~~'~rAY~C~~~I ~~,r~"
~~o: if i~,,~~il~al to duplicat~Y sP-~i~ ~c~i:~y ~a~ , „~t(as#'~t ;r s.~tsc ~~c~ :~=i;"i
,:,
gee ~~)( r,,,. certtri~~~,re ~~ ~~~~~~ ~u~ -~ ~~ ion a~ ,
e1i 1.•
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(~Q{~~j~~~~p~}\1l (1(C~+ +f}^( ~`~ ,~ :• " ~ r '. 1 ~t ( I i I ~i r E i ) ( ) ~ 1 i
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* ~ A
--- -- _ _ _ _ _ j
.:, ,,
ertlh~ahon "~un~h~~~ -. )~;:, - ~!..;,.~'~..L1_i
~~~
Type/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORD'-:
Permanent
1?i
0
1. Decedent's Legal Name (Fl rst, Middle, Last, Suffix) va ~ a ^ State Flle Number:
2. Sex 3. Social Security Number 4. pate of Death (MO/Day/V r) (Spell Mo)
Adeline G. Thomas
F "165 l2 0930
Sa. Age-LasT 6lrthda Ma 29 , 2 Q ~ 2
y (Yrs) Sb. Untler 1 Year Sc
Untler 3 Da 6
D
')i .
.
ale of Birth (MO/Day/Vea r) (Spell Month) 7a. Blrthplac¢ (City and State or Foreign Country)
Mpnrns Days Hqurs Ml
t
n°
es Shi ~nsbur PA
95
March ~ 2 , ~ 9 ~ ~ 26
Birth
l
c
N
.
p
ace (
penty)
ot available
9a. Residence (State or Foreign Country) eb. Residence (StreeT and Number -Include A
t No
) 8
p
.
c. Did Decedent Live In a Township?
A
Yes, decedent Ryed In Middlesex
8d. Residenre (County)
l 000 Claremont Rd
.
awp
l
C>
~)be
d
r
-
a2l
8e. Residence (21p Code) 0 No, decetlen[ lived within limits of
cKy/born.
9. Ever in US Armed Forces? 10. Marital Status at Time of Death ~ Married ~ Widowed 11
Survivi
S
'
.
ng
pouse
s Name (If wife, give mane prior to firs[ marriage)
Q Ves ~ No Q Unknown ~ Divorced ® Never Married ~ Vnknow -
12. Father's Name (First, Middle, Last, Suffix)
'
13. Mother
s Name Prior to First Marriage (First, Middle, Last)
Robert W _ Handshew
Ruth M _ Bowl-la
14a. Informant's Name 14
o b. Relationship to pecede nt
David L_ Handshew Son
n2 s
14c. Informs Maiiing Address (Street and Number, City, State, Zip Code]
G 09 Monte C
r1o Dr. , Oxn
ar CA
a
oc -° ..........................°.......... ......... ........................................_...,..}sa. P aye n oat c e~
If DeaTh Occurred in a Hospital: ~] In dent .. ... ........... ... . .....
Pa ~ ?
f
3
_
o I
Death Occurred Somewhere Other Than a Hospital:
...~
H ........
-o---..d.....
~'] Hospice Facility ~ ~ ~ '""'
~ Emergency fto°m/OUtpati¢nt Q Dead on Arrival
ece ent s ome
ad ~ Nursing Home/Long-Term Care Facility Other (Specify)
lSb. Facility Name (If not Institution, give street and number; • SS
Ci
C.
ty or Town, State, and Zip Code 15d. County of Death
Claremont Nursin & Rehab
Cente C
li
l
"
"
.
ar
s
e, PA
170
I3 Ciurtl-Berland
S6a. Method of Disposition 0 Burial
$ Cremation 16b. Date of DlsposlTion 16c. Place of pisposition (Name of cemetery
0 Removal from State ~ D
crematory
or othe
l
l
,
,
r p
ace)
onai
on 6~2~20 ~ 2
Other (Specify)- ~' C7a1'1S CrQt)ation S2rv1CaS
16d. Location of Disposition (City or Town, State, and Zip) S7a. Signature of Fu ner 1 Service Licensee o
i
$
y n
n of Interm en< 176. License Number
Leo1a, PA _
FD 0"12633 L
1Z
0 C. Name and Complete Address of Funeral Facility
Fhvin Brothes-s Funeral Homo, 2nc_ 630 S_ Hanover St
Carli
l
A
m .
s
e
17O~3
38. Oecede nx's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20
D
'
~ .
ecedent
s Race -Check ONE OR MORE races to Indicate what
highest degree or level of school completed a[ the time of death. box that best describes whether the tle
tl
ce
ent the decetlen[ considered himself or herself to be.
~' 8th grade or less is Spanish/Hispanic/Latino. Check the "NO"
No tli 1 hits ~ Korean
~ p oma, 9th - 12th grade
box If decedent is not Spanish/Hispanic/Latino. ~ Black or African American ~ Vietnamese
~ High school graduate o GED completed
o not Spanish/Hispanic/Latinp ~ American Intlfan or Alaska Native 0 Other Asian
~ Some college credit, but no degree O Yes
M
i
,
ex
can, Mexican American, Chicano ~ Asian Intlfan ~ ~ Native Hawaiian
Q Associate degree (e.g. AA, AS)
~ Yes
Puerto Ri
,
can Chinese
Q Bachelor's degree
(e.g. BA, AB, BS) ~ Yes
Cuban ~ ~ Guamanian or Charnorro
,
~ Samoan
Q Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) 0 Yes, other Spanls h/Hispanic/Latino
i
Q Japa
nese
~ Doctorate (e.g. PhD, Ed D) or Professional degree
~ Other Pacific Islander
(Specify) ~ Other 5
. MD DDS, OVM, LLB, JD ( Pecify) __
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be
22a
D
Whit
d
'
.
.
ece
ent
s Usual OccupaTlon -Indicate
e ~ Japanese 0 Samoan
tYPe of work
done Burin
~ Black or African American 0 Korean ~ Other Pacific Islander g most of working life. DO NOT USE RETIRED.
~ American Indian or Alaska Native Q Vietnamese ~ Don't Know/Not Sure Crystal MpL7t-]t
Q Asia
I
er
di
n
.
n
an ~ Other Asian ~ Refused
~ Chinese 0 Native Hawaiian ~ Other (Specify) 22b. Kind of Business/Industry
~ FIIIPino Q Guamanian or Chamorro
ITEMS 23a - 23d MUST BE COMPLETED 23a. Dat¢ Pr ou ¢d D
d~Day Yr) 23b. 51 MC~O ~'1eCtrOn1CS , =nC _ '~
( Bnatur Person Pron c n D¢a
BY PERSON WHO PRONOUNCES OR /
. J
th (
O
nly wh
n a
p
p l
fCa blel 23c
Li
/
`~
J
e
c/e N b
/
CERTIFIES DEATH
/
. f
{-/
y
~
/
23d
a SI
~
~
~ ~e~
.
( Da 2q Ti f De
~ / /~ si
,v
~ r)~ /fit r-~
/ o/ ~
~ 2
`.!
5. Was Medical Examiner or Coron r Contacted] 0 Ves No
e
CAUSE OF DEATH
26. Part 1. Enter the chain of events--tliseases, injuries,. or cum plicatlons--that directly caused the d
APProximate
h
eat
. DO NOT enter terminal events suc
respiratory arrest, or ventricular fibrlllatlon Ithout showin he etiolo has cardiac arrest Interval:
'^~ g t gy. DO NOT ABBREVIATE
E
.
nTe)r only one cause on a line. Atltl additional Ilnes If necessary Onset to Death
IMMEDIATE CAUSE -- ------
(
~I"Q
`Z
~
------> a. ___
~
~y\ I L
.C
R! /' (^ r{_
(Final disease
di
i
or con
t
on Due to (or as a consequence of): "'---
resulting In death) -
b.
Sequentially list conditions, Due to (o equence of):
if any, leading to the ca u.se as a cons
listed on line a. Enter the
UNDERLYING CAUSE
pue [o (or sequence f
(disease or injury that as a con o) -_
F initiated [he events resulting tl.
_
in death) LAST. Due to (o as a cons¢q ue rice of): - -
S 26. Part 11. Enter other significant condition t Ib t'ng to death buT not resulting In the untlerlying cause given in Part 1
~ 27. Was autopsy p med?
r
~ Yes No
~ 28. Were autopsy findings available
^' to complete the ca of death?
29. If Fe ale: 3D. Did Tobacco Use Contribut
~ Yes Q No
i
D
h
s
' e
o
eat
?
pregnanT within past year 31. Ma er of Death
~ Pregnant at time of death Q Yes ~ Probably atural [~ Homicide
~ ~ Not pregnant, but pregnant within 42 days of d¢a[f ~ NO ~ Unknown ~ Accident [~ Pentling InvesTi
atlon
~ g
~ Not pregnant, but pregnant 43 days [0 1 year before deatF ~ Suicitle (~ Coultl not be determined
32. Date of Injury (MO/Day/Yr) (S
ll M
pe
onth)
Unknown if pregnant within the
past year
33. Time of Injury
34. Place of Injury (e.g. home; construction site; farm; school) 35
L
i
.
ocat
on of Injury (Street antl Number, CI
ty, State, Zip Code)
36. Injury at Work 37. If Transpo rtatfon Injury, Specify: 38. Describe How Injury Occurred:
Q Yes ~ priyer/Operator 0 Pedestrian
No O Passenger Q Other (Specify)
39a. rrtifler (Check only one):
~
e living physician - To the best of my knowledge, death occurred due to the cause(s) and m
anners ted
Q Pronouncing 6 Certifying physician - To the best of my knowledge, death occurred at the Tlme, Sate
and place
and du
~ M
t
th
di
l
,
,
e
o
e
ca
Examiner/Co
e cause(s) and manner stated
roner - On the basis of exams ion, and/or inyesilgatlon, In my opinion
tleath occurr
d
t
h
~
I
,
e
a
T
e tfm¢, date, and place, and tlue to the cause(s) and m
~ ~ / TIC tatetl
1
Signature of certifier: V ~l/tA
A A
~-~
~
~
s
3
~
,
TITIe of certifler:
/
~t )
~ Licens¢ Numbr_r: OS~ ~~
3_~-`
yb. Name, Address and Zip Code of Person Completing Cause of Death (Item 6) s
_
T
T
'
39c. Date 51
~/ ,. r~
~ /~ lit ~~ /5 ~ '""~ cgO (MO/ aY/Yr)
e ~
V
' I
C
~ ~
O
4 0. Registra is Dlsirict Number
-+
/ Z
`
41. Registrar'
42. Re trar ile Da (MO Day
~ - a o ~ p~~__' gi= r
4 3. Amendments 0 a
Disposition Permit No. V Y/ ` y ~ ~ H305-143
-- REV 02/2011
LAST WILL AND TESTAMENT
OF
ADELINE G. THOMAS
I, Adeline G. Thomas, of Carlisle, Cumberland Cou
~ ~;
"''
~ '
~ C
Pennsylvania, declare this instrument to be
'~'-)
my Last Wi ~f~d ~
~
~ ~
c ~; rC
--+'~=~
r' ~ ~
~a
:, ;
Testament , in manner and for the following : +
,~-~
,,,,
; r`f-
ri ~
. ~~
~, _- _ C">
t_, ~ r.r,
1. I hereby expressly revoke all Wills and Codicils R, "°
heretofore made by me.
2. I give, devise, and bequeath my entire estate, real and
personal, to my son, David L. Handshew, if he is living thirty (30)
days after my death; If he is not then living, I give, devise, and
bequeath the same to my grandchildren, Jennifer L. Handshew and
Jill L. Handshew, in equal shares per stirpes.
3. I appoint Farmers Trust Company, guardian of any
property which passes, either under this Will or otherwise, to a
minor and with respect to which I am authorized to appoint a
guardian and have not otherwise specifically done so. Such
guardian shall have the power to use principal as well as income
from time to time for the minor's support and education
(including college education, both graduate and undergraduate)
without regard to his or her parent's ability to provide for such
support and education, or, to make payment for these purposes,
without further responsibility, to the minor's parent, the minor,
or to any person taking care of the minor. A minor, as used
herein, is one who is under the age of twenty-one years.
~ ~~~ 7
/~
4. 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 by my personal representative
as an expense of the administration of my estate.
5. I appoint, my son, David L. Handshew, executor to settle
my estate. If he fails to qualify or ceases to act as such, I
appoint Farmers Trust Company of Carlisle, Pennsylvania executor
to settle my estate.
IN WITNESS WHEREOF, I have signed and published this my
Last Will and Testament in the presence of the Subscribing
Witnesses, this 28th day of March, 1995, declaring it to be my
true will and testamentary wishes.
Adeline G. Thomas
We, the subscribing witnesses certify that the Testatrix
signed this Will in our presence after reading the same and
declaring it to be her Last Will and Testament. we, further
certify that the Testatrix was of sound and disposing mind and
memory and under ng,constr~int Qr undue influence.
Witness:
Witness:
/ADDRESS: One West High Street
e Carlisle, PA 17013
ADDRESS : jl~l" '"•~~~-~ ~~° ~~
~- ~r
w
ACKNOWLEDGMENT TO LAST WILL
AND TESTAMENT OF
ADELINE G. THOMAS
COMMONWEALTH OF PENNSYLVANIA )
)SS:
COUNTY OF CUMBERLAND )
I, Adeline G. Thomas, Testatrix, whose name is signed to the
within Last Will dated this 28th day of March, 1995, having been
duly qualified according to law, do hereby acknowledge that I
signed it willingly as my free and voluntary act for the purpose
therein expressed.
~, ~~
C~.~ P.~.~-~.t ~a ~~~-~,o~~yy~~L...,~
Adeline G. Thomas
Sworn to and acknowledged before me by Adeline G. Thomas this
28th day of March, 1995.
.---~
Nota y Public
NOTARIAL dEAI
MICM~,LE C, RtRSON, NOTAR'~ ~IJiUG
CARLISLE 80ROUDM, CUMIQILAMp 00„'A
MV COMMIa$IgN EXPIRES MMCM 1~, ili0tl
~t ~J r
AFFIDAVIT OF WITNESSES
COMMONWEALTH OF PENNSYLVANIA )
)SS:
COUNTY OF CUMBERLAND )
We, Edward W. Harker, Esquire, and Sandra L. Sellick, the
witnesses whose names are signed to the Last Will of Adeline G.
Thomas, dated March 28, 1995, being duly qualified according to
law, do depose and say that we were present and saw the Testatrix
sign and execute the instrument as her Last Will; that the
Testatrix signed willingly and 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 kno ledge the Testatrix was
at the time eighteen (18) or more years age, o:f 'souy~ mind and
under no constraint or undue influence ,i"-1 % ~ / 1
Sworn to and subscribed before me by Edward W. Harker, Esquire
and~~.c'+s~ ~.~1\,e K, witnesses this 28th day of March, 1995.
Nota y Public
NOTARIAL SEAL
MICHELLE D. RiSt~ON, NOTARY PUBUC
CARLISLE 80ROUGH, CUM86ilAND CO., PA
MY COMMISSION F~(f'IRES MARCH 14, 1998
~ ~ 7