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HomeMy WebLinkAbout06-11-12Reset 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: JANET L. SMITH File No: .C~ ~ /,2 ~ ~° ~j~~.. a/Wa: (Assigned by Register) a/k/a: a/k/a: Social Security No (Attach ndditionat sheers, iJ7recessary.) 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 thereto dated MAY 22, 2009 and Codicil(s) State relevant circumstances (e.p. 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(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. ® NO EXCEPTIONS ©EXCEPTIONS ® B. Petition for Grant of Letters of Administration (If apphcabte) c. t. u., d. b. n., d. b. n. c. t. a., pendente rite, 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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. o NO EXCEPTIONS ©EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no W i(1 and was survived by the following spouse (if any) and heirs (attac•h additional sheets, r/ necessary): Name Relationshi Address ""~ ~ ~ t.._ Z1 %_ :% -: .. ~ r '^ -; r C7 ~' ~ . ~ D •• r-- .. ~ c:n O FornRli•-nz .e~~. tmn~ntt Page 1 oft Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND )Printed Name LILLIAN;,R.. WALTERS } } $$; } 34 E. PENN ST., CARLISLE, PA 17013 r~,a ~, N ~~yy ~ fT`7 f >c rZ f.''-. ~~~ t'; °f 1 =-- 0 C.: ...~ 'n "~ C} Petitioner(s) Printed The Petitioner(s) above-named swear(s) or arm(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) ofthe Decedent, the Petitioner(s) will well and truly administer the estate according to law. Sworn,ts~ f~irtned a ed before. _ " '~ - ~ ~ ~ ~ ' me th' ~ ~ Jj ~~ ; ~~ ~ ~ ' ~ ~~~~ ~~~~~ Date // ax of a ' $y; ~_,~ / Date or t gister Date /J~ Date BOND Required: (~ YES ®NO FEES: Lette s .. . ( ~;) Short Certificate(s)..... . ( ,,! )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Qond ........................ Commission......... . O he~ ....... S (:~ ~, - i.~ 1°) JI .c:'~ ....... _ Automation Fee .............. ~"' JCS Fee . .................... ~ ~eC c',, 'TOTAL ..................... $ ~ ~ 8-~---- ~~% J: _~} Attorn y Signature: ~ , '~. c C l~ J ~~~ ~___ Printed Name: WILLIAM A. DUNCAN Supreme Court ID Number: 22080 To the Register of Wills: Please enter my appearance by my signature hP1~..-• Firm Name: DUNCAN & HARTMAN, PC Address: 1 IRVINF ROW ('ARi I4T F PA 1701 ~ 717-249-7780 717-249-7800 _hill~tlun~anhartmanla cnm t.. DECREE OF THE REGISTER Estate of JANET L. SM[TH File No: a/k/a: ~ f - ~2 ~~~ .arrD Now, ~~f~ j/ ~~ • satisfactory proof having been presented before me IT IS DECREED that Letters onsideration of the foregoing Petition, TESTAMENTARY are hereby granted to LILLIAN R. W the instrument(s) dated Mev „ ,,,,,,,, in the above estate and (sf applicable) that described in the Petition be admitted to probate and tiled of,~e~or~ct as the last Will (and Codicil(s~of Decedent inter of Wills use urmRLi'-U? rev. 101/.?/! _ ' ;~ / ~' ~,, page ~,,- ii~~}~ , t ~~ir~ ;;~(~ t>>~~ ,~~~i~}~~.~i~..,t =,~ ~l2 Jf1N I I A~ Ii: 0! ~ ~8488~.2~ __ .o Type/Print In Permanent ' 0 z ;L~z`; ORPI-~t~'S ~~~()fis ~ , L~itve. ~~~'-~.c~i~..~-t-al~e~c"' J l1N 5 -; 2 012 COMMONWEALTH OF PENNSYLVANIA _ DEPARTMENT OF HEALTH ~ VITAL RECORDS !'C~TI CI!'ATC AC 1'1CATu 1. pecedent's Legal Name (F(rst, Middle, Last, Suffix) 2. Sex 3. Social Security Number'r N4. Date of Death (MO/Day/V r) (Spell Mo) ' 12 6a. Age-Last Birthday (Yrs) 56. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/pay/Near) (Spell Month) ?a. Birthplace (City and State or Foreign Country) .79 Months pays Huurs Minutes June 9 1932 Chambersbur PA ~ , 76. Birthplace (cq~nty> rYan,c1 in 8a. Residence (State or Foreign Country) Sb. Residence (Street and Number- Include Apf No.) Sc. Did Decedent Live in a Township? PA 10 Westminster Ct _ Wyes decedent lived in Nr~.- ~- Ml a 8d. Residence (C unty) l , t t dletnn LwP~ Cumber and 8e. Residence (Zip Code) Q No, decedent lived within limits of city/born. 9. Ever In US Armed Forces? 30. Marital Status at Time of Death ~ Married ~ Widowed li. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Yes ~ No ~ Unknown ~ Divorced ~ Never Married ~ Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Midtlle, Last) J_ Frank Rotz Bernice Wagner 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, Clty, State 2Ip Code) 0 Lillian Walters sister , 34 E_ Penn Street, Carlisle, PA 17013 G .......................................................... .... .................................. 16a. P ace o Deat C ec on one ...... ................. .. Y _ ~ Pa If Death Occurred in a Hospital: In fient ~ . ....................... . :If Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facility ~ Decedent's Home Q Emergency Room/OUipatle nt Q Dead on Arrival _ ~ Nursing Home/Long-Term Care Facility 0 Other (Specify) 156. Facility Name (If not institution, give street antl number; 15c. City or Town, State, and Zip Code 15d. County of Death M.S. Hershe Medical Center Hershe Pa. 17033 Dau hin m 16a. Method of Disposition ~ Burial Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, c tory, o other place) r p Rempyal from state p pgnatipn June 6 , 201 Hoffman-Roth Funeral HOme & Cremator - Other (Specify) y 2 16d. Location of Disposition (City or Town, State, and Zlp) 1Za. nature of Funeral Se a License arge of Interment 17b. License Number Carlisle, PA 17013 138504 E 17c. Name antl Complete Address of Funeral Facility Hoffman-Roth Funeral Home & Cremato 219 North Hanover Street, Carlisle, PA 17013 m 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 tonsideretl himself or herself to be. ~ 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" ~J White 0 Korean 0 No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American ~ Vietnamese Q9 High school graduate or GED completed No, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native ~ Other Asian Q Some college credit, but no degree Yes, Mexican, Mexican American, Chicano 0 Asian Intlian 0 Native Hawaiian Q Associate degree (e.g. AA, AS) 0 Yes, Puerto Rican 0 Chinese ~ Gua manlan or Cha morro ' 0 Bachelor s degree (e.g. BA, AB, BS) Ves, Cuban ~ Q Filipino ~ Samoan ' Q Master s degree (e.g. MA, M5, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino Q Japanese ~ Other Pacific Islander 0 Doctorate (e.g. PhD, Edp) or Professional degree (Specify) ~ Other (Specify) . MD, DDS, pVM, LLB JD 21. Decedent's Single Race Self-Designation - Check ONLY ONE to Indicate what the Decedent considered himself or herself to be. 22a. pecede nt's Usual Occupation - Intllcate type of work White 0 Japanese 0 Samoan done during most of working Ilfe. DO NOT USE RETIRED. Black or African American 0 Korean 0 Other Pacific Islander Secreta ~ American Indian or Alaska Native ~ Vietnamese 0 Don't Know/Not Sure ry ~ Asian Indian ~ Other Asian ~ Refused 22 b. Kintl of Business/Industry ~ Chinese 0 Native Hawaiian 0 Other (Specify) FIIlpino ~ Guamanian or Cha morro Manufacturing ITEMS 23a - 23d MUST BE COMPLETED 23a. pate Pronounced Dead (MO/Day Vr) 236. Signature of Person Pronouncing Death (Only when applica ble7 23c. License Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH ~.7.._t Z ~~t, ' 23d. Date Signed (Mq/Day/Yr) 24. Time of Death L~ ZO 25. Was Medical Examiner or Coroner Contacted? ~ Yes Q No CAUSE OF DEATH - Approximate 26. Part I. Enter the chain of events--diseases, Injuries, o mplications--that directly causetl the tleath. DO NOT enter terminal events such a ardlac arrest Interval: respiratory arrest, or ventricular fibrillation ithout showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary Onset to Death IMMEDIATE CAUSE > ~ COY.~~IC Iw (Final disease o nditlon pue to (o as a sequence of): resulting in death) Sequentially Ilst conditions, Due to (o s a consequence of): If any, leading to the c e listed on line a. Enter the UNDERLYING CAUSE Due to (or as a consequence of): (dis injury that F Initiated the events resulting d. In death) LAST. Due to (or as a consequence of): S 26. PaK 11. Enter other significant condltlo ns contr'but'ne to death but not resulting in the untlerlying cause given In Part 1 27. Was an autopsy p rform ed? ~ tes o 28. Were a opsy findings avalla ble m com to plete the cause of death? O Yes ~ No 29. If Fe ale: 30. Did Tobacco Use Co ntrlbute to Death? 31. M of Death o Not pregnant within past year Q Pregna ni at time of death _ 0 Q Probably Natural ~ Homicide ~ Not pregnant, but pregnant within 42 tlays of death '~ "0 0 Unknown ~ Accident ~ Pending Investigation Q Suicide ~ Could not be determined ti ~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In'u 1 ry (MO/Day/V r) (Spell Month) Q Unknown If pregnant within the past year 33. Time of Injury 34. Place pf Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurretl: Ves ~ Driver/Operator ~ Pedestrian Q No 0 Passenger Q Other (Specify) 39a. Ce rtlfier (Check only one): Q Certifying physician - To the best of my knowledge, death o red due to the cause(s) and m r stated Pronouncing ffi Ce rtifyi ph - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and m r stated I Q Medical Examiner/COr the basis of examination, and/or investigation, in my opinion, dea t h o rred at the time, tlate, and place, and due to the c a u s e(s) and m r stated ne ( ~ y ~ ~ ~ ~ J J Signature of certifier: Title of certiFler~ 1 w~l License Number: ~ -l l l Z~ 39 b. Name, Address and Zlp of Person Completing Ca D T~A:S_ehl'e4tsf~ie~jr Medical Center Hershey Pa 17033 39c. Date 51 gned(MO/Day/Vr) , , . S ~-.~-.-- - y. 40. Registrar's District Number 41. Registrar's ~ 42. Registrar File Dale (MO/Day Vr) _ ~ 43. Amendments Dls position Permit No. lJ' I~O Lf7 \ O H305-143 REV 07/2011 PV }^,[ fti~ LAST WILL ~ ~ ~ : -.~.? c,~ . --- :, _.~-, TESTAMENT d c- _-~: ~„ -- c ~; , I, JANET L. SMITH, of 10 Westminister Court, Carlisle, N. MiddleTowns}~ip, -J ~ , Cumberland County, Pennsylvania, being of sound and disposing mind, memory anc~i~erstand flg, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revo~ng any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be interred within my family's burial plot in accord with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for tl~e purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give, devise and bequeath all of my estate of whatever nature, be it real, personal or mixed, and wherever situate unto my sisters, LILLIAN R. WALTERS and HAZEL C. DEAVOR, in equal shares, to share and share alike. In the event that one predecease me, then the remaining sister shall inherit my entire Estate. In the event that both my sisters, LILLIAN R. WALTERS and HAZEL C. DEAVOR predecease me, then my Estate shall pass to my niece, BARBARA PARRISH, per stirpes. FIFTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. SIXTH I hereby nominate, constitute and appoint my sister, LILLIAN R. WALTERS as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of LILLIAN R. WALTERS, I nominate, constitute and appoint my niece, BARBARA PARRISH as Executor of this my Last W iil and Testament. I hereby relieve my Executor from the necessity of posting security in connection with his duties, as such, in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executor, in his absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of one typewritten page this ;;' ? day of t ~ .(- C_"~:~,. 2009. J ET L. SMITI-~ Signed, sealed published and declared by the above named Testatrix JANET L. SMITH as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. • ~~. ,~ /~ ~.J '~, / t ~p 4 ~ ~ .. \_ COMMONWEALTH OF PENNSYL VANIA . SS. COUNTY OF CUMBERLAND I, JANET L. SMITH ,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; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. f~...P ~' ANET L. S1~IIT Sworn or affirmed to and acknowledged before me, by ~ JANET L. SMITH this ~~ day of ~,~,~ ~ , 2009. ~~ ~ ~ r Notary Public ONWEAL'lYi OF E$ENNSYLVANiA NOTARIAL SEAL .JOAN D. ADAMS, Notary Public CAriisle Boro., G'umberland County My Comm+ssmrn expires PAarch 7, 2011 COMMONWEALTH OF PENNSYL VANIA COUNTY OF CUMBERLAND :SS. We ' ~ ~/~' ~ ~ 11''~~ ~ ~ ~ ``~~'~~~ and ~,~~ ~ ~o :e~ i L.-~ ~"'~.~~ = ~ -``> the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw JANET L. SMITH sign and execute the instrument as her Last Will; that she signed willingly and that she executed 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 eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. r .. ~ ~. ~l ~,,~ r! Sworn or affirmed to and ~, ~ ti'~ F _- subscribed before me by ~ vV i >~ t ~ /1~ .~ . ~ ~~ ~ and ~~'~ ~ ~ ~ ~~~ ~ ,witnesses, this ~ day of ~"'~ , 2009. Notary Public ~` COtvIMOlYWEALTFi OF PE<•iiVaYLVAT1iA NOTARIAL SEAL JOAN D. ADAMS, Notary Public Carlisle Boro., Cumberland Ccunttyy My Commission Expires March 7, 2b11