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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: Annie C. Wilkinson
a/kla:
a/k/a:
a/k/a:
Date of Death: 06/27/2012
File No: ~ ~ ~ ~~`-~ ~ ` v
(Assigned by Register)
Social Security No: 208-24-1779
Age at death: 92
Decedent was domiciled at death in Cumberland County, pennsvlvania (State) with his/her last
principal residence at 13 Victory Church Road, Gardners 17324 South Middleton Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 13 Victory Church Road, Gardners 17324 South Middleton 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 $ 1,000.00
If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................Personal property in County $
Value of real estate in Pennsylvania ......................................................... $ 75,000.00
TOTAL ESTIMATED VALUE.... $ 76,000.00
Real estate in Pennsylvania situated at: 11 Victory Church Road, Gardners 17324 South Middleton Cumberland
(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 May 23, 2012 and Codicil(s)
thereto dated n/a
State relevant circumstances (e.g. renunciation, death of executor, ete.)
Except as follows: after the execution of the instnlment(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 (1f applicable)
c. t. a., d. b. 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(8) and was neither the victim 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 followin8 sp~se (if any) anc~irs (attach
additional sheets, if necessary): ~ Q ;..~ ~~ ~r~,,
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Form RW-OZ rev. 10/11/2011 Page 1 Of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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Petitioner(s) Printed Name Petitioner(s) Printed Address ~~,~'
Connie K. Santia o
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13 Victo Church Road, Gardners, PA 17324 n~:`~ ~ ~ F
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The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are tnie and correct to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law.
Sworn to graffirmed a subscribe before ~, - Date ,~' ~~ ~ ~~ ~~
me this ~ ~ " ~ ~~ day of G ~ ~'~ ; ~i,~ " Date
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For. e Register
Date
Date
BOND Required: ~ YES ~ NO
FEES:
/1, ~ ~
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Letters ..................... $ ! l.`
( ~) Short Certificate(s)...... .L7 L?
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Ot e• .......
~ ....... - D t.~
Automation Fee . ..............
JCS Fee . .................... - (BLS
TOTAL ..................... $ •--&A8
To the Register of Wills:
Ptease enter my appearance by my signature below:
Attorney Signature:
~` `~~,
,~
Printed Name: Adam R. Deluca, Esq.
Supreme Court
ID Number: 311738
Firm Name:
Address:
~~~-~
DECREE OF THE REGISTER
Estate of Annie C. Wilkinson File No: ~~~ ~.,~- ~ 7~
a/k/a:
AND NOW, L.1 ',1~5 ~ ~ ~~~., in consideration of the foregoing Petition,
satisfactory proof having bee presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Connie K. Santiago
in the above estate ar~d (if applicable) that
the instrument(s) dated May 23, 2012
described in the Petition be admitted to probate and filed of record asAthe last Will (and Codicil(s)) of Decedent. „
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Register of Wills
Official Use Only
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Fornt RW-OZ rev. 10/11/?011 Page 2 of 2
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH ~ VITAL RECORDS
['FRTIFIIC'~TF n~ nFnT~..~
1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Numbery` 4. Date of Death (MO/Day/Yr) (Spell Mo)
June 27, 2012
Sa. Age-Last Birthday (Yrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Dale of Birth (MO/Day/Yea r) (Spell Month) 7a. Birthplace (City and State or Foreign Country)
~~ Months Days Hours Minutes Gardners PA
92 S e t. _ 9 1 9 1 9 7b. Birthplace (county) Cumb _
8a. Residence (State or Foreign Country) 86. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Live in a Township?
Pp, 1 1 ViCtOry C1-lurCh Rd _ Yes, decedent lived in SO _ Middleton tw
8d. Residence (county)
Gardners PA p.
Cumber 1 n He. Residence (Zip Code) 1 7 3 2 4 Q No, decedent lived within limits of city/born.
9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage)
Q Ves ~No Q Unknown Q Divorced Q Never Married Q Unknown
12. Father's Name (First, Middle, last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last)
Cletus Bream B"Pssie Harman
14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code)
o Connie 13 Victory Church Rd_ Gardners PA
~i ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,•, •._., P-•••
If Death Occurred in
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~ lSa. lace of Death Chec only one
"' """""'••• •• - ••••--
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:
p
n atrent
:
~ Emergency Room/Out atient
p Q Dead on Arrival If Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facility ~ Decedent s Home
Q Nursing Home/Long-Term Care Facility Q Other (Specify)
15 b. Facility Name (If not institution, give street and number; lSc. City or Town, State, and Zip Code lSd. County of Death
LL Gardners P Cumberland
--
C° 16a. Method of Disposition Burial ~ Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
0 Removal from State Q Donation
Q Other (Specify) 7/ 3~ 2 n 1 2 i~Zt _ V 1 CtOr Cemetery
y
v 16d. Location of Disposition (City or Town, State, and Zip) 17a. Si atu re of Funeral Service Licen a or P rson in rge of Interment 17b. License Number
~, Gardn rs FD-011932-L
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V
°' 17c. Name and Complete Address of Funeral Facility 5 O 1 N _ Batt ore AVe _
° 18. Decedent's Education - Check t e box that bes describes the 9. c den o Ispanic Origin -Check th O. Dece nt' Race - Check O MORE races to indicate what
r
- highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be.
8th grade or less
No di
l
a
9th
12th
d is Spanish/Hispanic/Latino. Check the "NO" White Q Korean
p
om
,
-
gra
e
~ High school graduate or GED completed box if decedent is not Spanish/Hispanic/Latino.
No, not Spanish/Hispanic/Latino ~ Black or African American ~ Vietnamese
Q American Indian or Alaska Native Q Other Asian
~ Some college credit, but no degree ~ Yes, Mexican, Mexican American, Chicano ~ Asian Indian ~ Native Hawaiian
Q Associate degree (e.g. AA, AS) Q Yes, Puerto Rican 0 Chinese ~ Guamanian or Cha morro
Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban ~ Filipino Q Samoan
Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino ~ Japanese Q Other Pacific Islander
Q Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other (Specify)
e. MD, DDS, DVM, LLB, JD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work
$] White 0 Japanese Q Samoan done during most of working life. DO NOT USE RETIRED.
Q Black or African American ~ Korean ~ Other Pacific Islander
Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure Hou S eW ].. f e
Q Asian Indian ~ Other Asian Q Refused 22 b. Kind of Business/Industry
Q Chinese Q Native Hawaiian
Q Other (Specify)
Q Filipino Q Guamanian or Chamorro Dome s t i c
ITEMS 23a - 23d MUST BE COMPLETED
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH 23a. ate Pronounced Dead (Mo/Day/Yr)
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J~~e- ~~ t tl~--~ f 7"" 23 .Sig tore of Person Pronou Hein ath (Onl hen a
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23c. License Number
~~~~Var-f/ ~«
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23d. Date ,ne~ (~~ ~ Y/~'r)
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7_ O~ t T 25. Was Medical Examiner or Coroner Contacte ?
Q
Ves No
CAUSE OF DEATH
Approximate
26. Part 1. Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval:
respiratory arrest, or ventricular fibrillation w
i
thou
t showing the
eti
o
logy. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary Onset to Death
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IMMEDIATE CAUSE > a ~/.~-T ~/~ (,~(~ ~ /~~~. f~~
(Final disease or c ndition ~ Due to (or as a consequence o/7:
resulting in death)
b.
Sequentially list conditions, Due to (or as a consequence of):
if any, leading to the cause
listed on line a. Enter the c.
UNDERLYING CAUSE Due to (or as a consequence of):
s
w (disease or injury that
initiated the events resulting d.
w in death IAST.
Due to (or as a consequence of):
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S 26. Part 11. Enter other siKnifica nt conditions contributive to death but not resulting in the underlying cause given in Part I 27. Was an autopsy performed?
0
~
Q Yes Q No
28. Were autopsy findings available
m to complete the cause of death?
a Q Yes Q No
a
29. If Female:
30. Did Tobacco Use Contribute to Death?
31. Manner of Death
E
~° ~ot pregnant within past year
Pre
nant at tim
f d
th
/~C'/f
Q
~Vatural Q Homicide
m g
e o
ea
Not re Want, but
~ p g pregnant within 42 days of death ~n
Unknown
~'`_ Q Q Accident Q Pending Investigation
0 Suicide 0 Could not be determined
~°- Q Not pregnant, but pregnant 43 days to 1 year before deatF 32. Date of Injury (MO/Day/V r) (Spell Month)
Q 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 Injury (Street and Number, City, State, Zip Code)
36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred-
~ Yes Q Driver/Operator Q Pedestrian
~ No ~ Passenger ~ Other (Specify)
39a. Certifier (Check only one):
`Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated
Q Pronouncing & Certifying physician - To the best of my know ge, death occurred at the time, date, and place, and due to the cause(s) and manner slated
Q Medical Examiner/Coroner - On sis of examin /or rnvestigation, in my opinion, deatJi.p000 rred at the time, date, and place,-and due to the caus
e
(s
)
and
m a
nner stated
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Signature of certifier: Title of certifier: ~ /Lit 5 ~ License Number: ~S V ~ ~7 GV~~-~
3 b. Name, Address ip~e of Perso pleting Cause of Dea em 26)
~ 39 .Date Si Wed (MO/Oa r)
~ ~
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40. Registrar's District Numbhher 41. Registrar'
nature
~ 42. Registrar File Date (Mo ay/Yr)
V ~ ~ `L 0
43. Amendments
// r~ H105-143
Disposition Permit No. ~~ ~~ 3 ~ l0 4 3 _ REV 07/2011
LAST WILL AND TESTAMENT OF
ANNIE C. WILHINSON
I, ANNIE C. WILKINSON, of Cumberland County, Pennsylvania, declare this to
be my Last Will and Testament and hereby revoke all prior Wills and Codicils.
1. I direct that all my just debts, funeral expenses, and administrative
expenses shall be paid from my estate as soon as practicable after my death. It is my
wish that upon my death, my body shall be buried, next to my beloved husband, in our
plot in Mount Victory Cemetery, Gardners, PA.
2. I direct that all of my real and personal property that I own at the time of
my death shall be sold and the proceeds shall be distributed according to this Last Will
and Testament.
3. I direct that the proceeds from my estate shall be given to my seven (7)
children, Helen Boyer, Anna Schoffstall, Kenneth Wilkinson, Shirley Torres, Sherman
Wilkinson, Connie Santiago, and Vonnie Perdue, in equal shares, per stirpes.
4. I appoint my daughter, Connie Santiago, as Executrix of this my Last Will
~, and Testament. In the event that Connie is deceased, unable or unwilling to serve or shall
cease to serve for any reason whatsoever, then I nominate, constitute and appoint my
granddaughter, Maria J. Coover, as alternate Executrix of this my Last Will and
~~ Testament.
5. I direct that no Executrix acting under this Will shall be required to enter
.~, ~ bond in any jurisdiction.
6. I recommend that my Personal Representative retain the law firm of Allied
Attorneys of Central Pennsylvania, L.L.C., to probate my estate.
`~~
IN WITNESS WHEREOF, I have hereunto set my hand this ~ da
Y
of ~~ " - , 2012.
~.
ANNIE C. WILKINSON
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The preceding instrument consisting of this and three other pages was on the day and date
hereof signed, published and declared by ANNIE C. WILKINSON, as and for her Last
Will and Testament in the presence of us, who at her request, in her presence and in the
presence of each other have subscribed our names as witnesses hereto.
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Page 2 of 4
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
I, ANNIE C. WILKINSON, the 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 and Testament; that
~ I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein
~'° expressed.
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~ ANNIE C. WILKINSON
~~
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_ COMMONWEALTH OF PENNSYLVANIA
~~ ~ S.S.
COUNTY OF CUMBERLAND
On this ~? day of (~~~:' , 2012, before me personally
appeared ANNIE C. WILKINSON, known o' me (or satisfactorily proven) to be the
~~ erson whose name is subscribed to the within instrument and she acknowled ed that
p ~ g
'~ she was the declarant who executed the same for the purposes therein contained.
---~~.' IN WITNESS WHEREOF I hereto set my hand and official seal.
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Page 3 of 4
AFFTT)AVTT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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WE, ~ " ~ c~ and t ~~C~i~:~ ~ ~~ G~ ~~ '~~ - ~
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the witnesses whose names are attached to the foregoing document, being duly qualified
~ ~ according to law, do depose and say that we were present and saw testatrix sign and
execute the instrument as her Last Will; that she signed willingly and that she executed it
as her free and voluntar act for the u oses therein ex ressed• that each subscriben
y p ~ p ~ g
~' witness in the hearing and sight of the testatrix signed the Last Will and Testament as
witnesses and that to the best of our knowledge the testatrix was at the time 18 or more
,~ years of age, of sound mind and under no constraint or undue influence.
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Sworn or affirmed and subscribed before me by
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Z~ day of _ , 2012.
~~
otar ,dub is/Attorney
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