HomeMy WebLinkAbout08-17-12PETITION 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 requests the grant of Letters in the appropriate form:
Charles W STINE Jr
i?ecedent's Information
Name: Charles W STINE File No: 21-12 ~ I iU~
a/kla:
(Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: 08!08/2012 Age at Death: 87
Decedent was domiciled at death in Cumberland County, pA (State) with his/her last
principal residence at 301 Craig St, Shippensburg 17257 Shippensburg Borough Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Chambersburg Hospital Chambersburg Franklin Pq
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 $ 500 000.00
!f not domiciled in Pennsylvania ................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ................ Personal property in County $
Value ofrea/ estate in Pennsylvania ................................................................... $ 200,000.00
TOTAL ESTIMATED VALUE $ 700,000.00
Real estate in Pennsylvania situated at 301 Craig St, Shippensburg 17257 Shi
ppensburg Borough Cumberland
(Attach additional sheets, if necessary.) 12844 Keefer Rd U er Strasbur
Franklin
Street address, Post Office and Zip Code City, Township or Borough County
® A. Petition for Probate and Grant of L tt rs Test~menta~
Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated
thereto dated
12/09/1974
and Codicil(s)
~o Codicil(s)
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(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 t- rs of Adminis rtion (If applicable)
c.t.a., d.b.n., d.b.n.c.t.a., pedente lite, durance absentia. durante minoritate
If Administration, c.t.a or d.b.n.c.t.a., enter date of Will in Section A abov ~nd comol to list of heir.
Except as follows: Decedent was not a party to 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.
^ NO EXCEPTIONS ^ EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach
additional sheets, if necessary):
N
Form RW O2 rev. >0-1 i-20J 1 Copyright (c) 2011 form software only The Lackner Group, Inc.
Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
~_~::.
Petitioner(s) Printed Name Petitioner(s) Printed Address
Charles W STINE Jr 8821 Olde Scotland Rd
Shippensburg, PA 17257
t ne retttionerts) 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 nt, Pe itio er( ill well a truly administer the estate accor ing t law.
~9 0>
Sworn to or affirmed an subscribed before ~'~-~ /~ Date g
me th' day of ~ v~ Date
By: - Date
or the Register Date
BOND Required? ~ YES ~ NO
FEES:
Letters ...................................... .... $ ~ J ~ -C~~
(~O )Short Certificate(s)..... .... S~o - nn
( )Renunciation(s) .......... ....
( )Codicil(s) ..................... ...
( )Affidavit(s) ................... ...
Bond ......................................... ....
Commission ............................. .....
Other
l~) 1 (1
l~-O~
Automation Fee ........................ .... - (~
JCS Fee .................................... _
...
TOTAL ...................................... ... $ (Qc~.~7. ~ Ci
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name: Forest N Myers
Supreme Court
ID Number: 18064
Firm Name: Law Office Forest N Myers
Address: 137 Park Place West
Shippensburg, PA 17257-9212
Phone: 717/532-9046
Fax:
E-mail: fnmyers@lawofficeforestmyers.com
DECREE OF THE REGISTER
Date of Death: 08/08/2012
Social Security No: 209-12-5340
Estate of Charles W STINE File No: 21-12 ~~ ~{~
a/k/a:
AND NOW, ~~~~~ )`\ C~ ~ ~ ~ , in consideration of the foregoing Petition,
satisfactory proof having b presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Charles W STINE Jr
in the above estate and (if applicable) that the instrument(s) dated (~' 9 ~~ q 7~(. ~-
described in the Petition be admitted to probate and filed of record as tF~e I st ill (and Codicil(s)) of
'" Register of Wills ),
Copyright (c) 2011 form software only The Lackner Group,
L ,,,; ~E,~rTRAR'S CERTIFICATION OF DEATH
f,I~~NGs-Itff~~! gal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.~~ ~ A~G ('~ A~ ~Q. ~ L
~:_
O~i'Ha'~'~ COUr~T
P 18 5 3 8 0~~~~t_A~v~ ~~f PA
Certification Number
TYPe/Prim In
Perm<nent
~~
This is to crrtif~~ that the information here given is
correctly copied~fro)r :ui original Certificate of Death
duly filed with me ~(~ Local Registrar. The original
certificate will Y)e fJrwarded to the State Vital
Kecords Otfice ftij~ permaTMjent filing.
-~ .
_~ i _ ~ t3" a ~/L
L. cal egivtrar Cate Issued
COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
CERTIFICATE OF DEATH
1. Decedent's Legal Nsme (Firm, Mlddie, Last, Suffix) 2. Sex 3. Soclsl Security Number 4. Date of Dasth (MO/Day/Yr) (Spell Mo)
CHARLES W STINE Male 209-12-5340 August 8, 20'12
Sa. Age-Cart B(Khdsy (Yrs) Sb. Under 1 e Sc. Under 1 Da 6. Date of BIKh (MO/Day/Year) (Spell Month) 7a. BiKhplace (City end Sate or Ferelgn Country)
Months Days Hours Minutes Shippanabu PA
87 May 5, '1925 7b. BlKhplace (eo~ncy) Cumberland
Ba. Residence (State or Foreign Country) Bb. Resltlenee (Street and Number -Include Ap[ No.) 8c. Did Oecetlent Llve In a Township?
P'a' 301 Craig Street Oves, decedent eyed In
iMrp
Btl. Residence (County)
CUmberla nd 8e. Resltlenee (ZIP code) ~ 7257 j$[NO, decedent Ilved within limits of $hlppengburg tlty/born.
9. Ever In US Armed Forces? 30. Marital Status at Time of Death ~ Marrletl Widowed 11. surviving Spouse's Name (If wife, give name prior to first marriage)
]Yes ~ No ~ Vnkno Q Divorced ~ Never Married 0 Unknow
12. Father's Name (First, Mitltlla, Urt, Suffix) 13. Mother's Name Prior t0 First Ma Mage (First, Mitltlle, Lsst)
Blaine W. Stine Elsie Russell
14a. Informant's Name 30b. Relatlonshlp [p Decatlent 14c. Informs M's Malling Address (6[reet and Number, City, State, Zip Code)
Charles W: Stine, Jr. Son 8821 Olde Scotland Rd. Shippensburg PA '17257
..~
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.......
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..............._..............
If Death Oecurrcd In • HDSPItaI: ~[~ In Patleni Ilf Death Occurred Somewhere Other Th<n • HOSPIUI: ~ ~~-~-~~~-~~~-~~~~~~~~~~-~~-~~-~--~- ~~~----~--~~-~-~~-~~------~--~~~""
(~ Hospice Facility ~` ~ Decedent's Home
3 Eme eery Room/Outpatient Dead On Amlvsl Nursing Home/LOn -Terre Care Fatllity Other (Specify)
SSb. F<cllity Nsm¢ (If not Inrtl[uHOn, give street and number; ISC. City or Town, Stale, and Zlp Cede 15tl. County of Oeath
Chemberaburg Hospital Chambarsburg, PA 17201 Franklin
~, 16a. Method of Disposi[lon Burial Cremation 16b. Date of Disposition i6c. Place of Dlsposldon (Nsme of cemetery, crematory, ar other place)
Removal from State Q Donation
Other Specify)
August 11, 2012
Sprjng Hill Cemetery
t 16d. Loeatlon of DlsposlHOn (City or Town, State, and 21p)
b
P 17a. Signs n ral Sa Licensee or Person in Charge of Interment
u < 17b. License Number
Shippens
urg,
A 17257 _ _ FD-014831-L
17c. Name and Complete Address of Funeral Facility
Fogelaenger-BNCker Funeral Home 112 W King St. PO Box 336, Shippensbur PA 17257
~ 18. Deeetlen['s Education -Check th• box that best describes Che L9. Decatlent of Hispanic ON81n -Check Che 20. DeudenC's Race -Check ONE OR MORE races fo intlicate what
highy~ degree or level 01 school completetl et the time of death. box that best describes whether the decatlent She decadent consitlered himself or herself to be.
~th
rade or leas I
S
i
h/Hl
l
"
"
g
s
pan
s
span
Ulatino. Check the
NO
~[ White ~ Korean
0 No diploma, 9th - 12th grade box if decedent is not Spanish/Hlapanl4Latino. ~ Black er African American ~ Vietnsmese
Q Mlgh school graduate or GED completed ~( No, not Spanish/HlspanlULaHno ' Q American Indian or Alaska Native ~ Other Asian
0 Some wllege credl4 but no degree ~ Yas, Mexican, Mexican American, Chicano [] Asl<n Intllan Q Nstive Hawaiian
~ Assedate degree (e.g. AA, AS) O Yea, Puerto Riwn ~ Chinese ~ Guamanian or Chamorro
Q Bachelor's degree (e.g. BA, AB, BS) ~ Ves, Cuban ~ FIIIPIno 0 Samoan
0 MaRer's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Yes, other Spanish/Hispanic/Latino ~ Jape ease ~ Other Pacific Istantler
0 DoROrate (e.g. PhD, Ed D) or Professional degree (Specfy) ~ Other 5
( Peclfy)
. MD DDS DVM LLB JD
21. Decedent's Single Race Self-0esignatlon -Check ONLY ONE to Intlltate what the decedent wnsitleretl hlmsal or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work
White 0 Japanese [] Samoan done during most of working life. DO NOT USE RETIRED.
~ Black or African American 0 Korean Q Other Paelfte Islander
H
l
eavy EQU
pment Ope raLOr
Q American Indian or Alaska Native 0 Vietnamese Q Don't Know/Not Sure
~ Asian Indian 0 Other Asian ~ Refused 22b. Kind of Buslne.ss/Industry
Q Chinese - 0 Native H<waRan 0 Other (Specify)
Q Filipino Q Guamanlsn or Chamorro U.S. Government
ITEMS 23a - 23d MVST B COMPLETED 23a. Date Pronounced Deatl (MO Day 23 Signature o Person P onouneing Death (Only whin applicable) 23c. License Number
aY PERSON WHO PRdNOV NOES OR August 8, 2012
CERTFIES DEATH
23d. Date Signed (MO/Day/Yr) 24. Time of DeaCh '
8:30 AM 2S. Was Medleal Examiner Or Coroner Contacted? ~ Yea ]$[ No
CAUSE OF DEATH
Approximate
26. P<K 1. Enter the chain of !vents-diseases, Injuries, or eomplicatlons-that directly caused [he death. DO NOT ant<r terminal events such as urtl lsc arrest
Interval:
.
respiratory arrest, or venMCUlar ftbriilaflon without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on s line. Add atlditional Ilnes IT necessary Onset to Death
IMMEDIATE CAUSE ----> a Cardiac arrest [ few minutes
(Final disease or condition Due to (Or as a consequence qf):
resulting in tleath)
• b, Pulmonary arrest
few minutes
~
Sequentially IIS[ contlltlons,
Due [o (or as a consequence of):
If any, leading to the cause ~ ACUte On chronic re3 ry i 46 hOUB
listed en Ilne e. Encer the plreLO 1a 11Ure
VNDERLYING CAUSE Due to (or as a conaeq uence of):
~~Tdisease or Injury that '
F Inltlatctl the events resulting d.
~ In death) LAST. --' Due to (or as • tonseq uence qf):
26. PaK II. Enter other i but not reaul[Ing In the underlying cause given in Part I f 27. Was an autopsy pertormed7
Sepsis; Hypotention; NSTEMI vas NP
28. Were autopsy findings available
~' to complete the cause of death?
~ Yas No
29. If Female: 30. Dld Tobacco Use Contribute to Deaths 31. Manner of Death
0 Not pregnant within pas[ year Q Yes ~ Probabl
N
l
~' y ~(
atura
0 Homicide
0 Pregnant at time of death j$( No 0 Unknown [] Accident ~ Pending Investigation
N
t
b
Q
o
pregnant,
ut pregnant within 42 days of deatF ~ 6ulclde ~ Could not be determinetl
ti ~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of InJury (MO/Dey/Yr) (Spell Month)
~ Unknown If pregnant within the past year 33. Time of InJury
34. Place Of Injury (c.g. home, construc[lon site; farm; school) 35. Location of Injury (6treef and Number, Clty, State, Zlp COtle)
36. Injury st Work 37. If Tra nsportatlon Injury, Specify: 38. Describe How InJury Occurred:
Q Yas ~ Driver/Operator ~ Pedestrian
~ NO 0 Passenger 0 Other (Specify)
39a. Certifier (Check only one):
Certifying physician - TO [he best Of my knowledge, tleath occurred due to the cause(s) antl manner slated
]$ Pronouncing 6 CertiTying physician - To the best Of my knowledge, tleech occurred at the time, date, end plKe, antl due to She cause(s) and manner stated
~ Medlin Examiner/Coroner - On the basis of examinatlon, and/or Investigation, In my opinion, tleath occurred aS the times, dale, end place, end due to the cause(s) and manner stated
sgnacvre of certreer: 7~ ~'.( L ~ L/ yJJ,a Tltia of certreen MD u~ense Number: MD443137
39b. Name, Address and 21p Coda of Person Completing Cause of Death (Rem 26) 39c
ned (M
Date Si
/D
/Y
Or. Shakhawan F Rashid, MD 112 N 7th St, Chambersburg, PA 17201 .
g
O
ay
r)
40. Registrar's District Number 41. Regl nature August 8, 2012
q2. Registrar Flie Date MO/Day r)
~
43. Amen
nts 0
H 106-143
Disposition Permit No. 0739489 REV 07/2011
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Charles W STINE
Deceased
Forest N MYERS
(each} a subscribing witness to
(Print Name/s)
the ~ Wii~ ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same
and that she / he /they signed the same and that she / he /they signed as a witness at the request of
the Testator /Testatrix in his /her presence and in the presence of each other.
.--~'~_
~---
(signature) Fores MYERS
137 Park Place West
(Street Address)
Shippensburg PA 17257
(City, State, Zip)
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(Street Address) ~~~
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(City State, Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed
before me this day before me this ~~~ day
of o C~~ ~ 2t~
Deputy for Register of Wills ry ublic l
My Commission Expires: 4~'~r°t~ I '115
(Signature and seal of Notary or other official ualified to
admini
NOTARIAL SEAL
ANNETTE HANK HOLLAND
Nobry Public
3HIPPEN88URG BORO, fRANKLNr COUNTY
Nly Commi:eion Expkee Apr 21, 2015
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument{s) at time of notarization.
Form RW-O3 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc.
~4
LAST WILL AND TESTAMENT
OF
CHARLES W. STINE
I, CHARLES W. STINE, of Shippensburg, Cumberland County,
Pennsylvania, being of sound and ciispasing mind, memory and understanding:
do hereby make, publish and declare this as and for my Last Will and
Testament hereby revoking any and all wills and codicils thereto by me at
any time heretofore made.
FIRST
I direct the payment of my debts and expenses of my last illness
and funeral from my estate as soon after my death as conveniently may be
done. If there be no cemetery lot available for my interment, owned by
' me at the time of my death, I authorize my personal representative to
purchase such cemetery lot with a contract for perpetual care, using
therefor funds from my estate, in such amount as he shall consider necessary
and desirable, and I authorize my personal representative to cause title
r.~
to or ownership of such lot so purchased to be vested in such pe ~
~~f_ C
as m ersonal re resentative shall desi nate. ~
Y P P g ~,~r':
C. - '`J
d`7,~
Further, in this connection, I authorize my personal nC,~- ~
O
~, c?
representative to expend funds from my estate, in such amount ~ .`
rv
my personal representative shall consider necessary and desirable,
for the purchase, erection and inscription of a suitable marker for my
grave.
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I give, devise and bequeath all my property, real, personal
or mixed, together with all insurance policies thereon unto my wife,
Beulah M. Stine, if she shall survive me by thirty (30) days. In the event
she fails to survive me by thirty (30) days, I then give, devise and bequeath
said property unto my son, Charles W. Stine, Jr., per stirpes.
THIRD
I give, devise and bequeath all the rest, residue and remainder
of my estate whether real, personal or mixed, unto my wife, :Beulah M.
Stine, if she shall survive me by thirty (30) days. In the event she fails to
survive me by thirty (30) days, I then give, devise and bequeath all the
rest, residue and remainder of my estate unto my son, Charles W. Stine,
Jr. , per stirpes.
FOURTH
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.
FIFTH
All shares of principal and income herein given shall be free
from anticipation, assignment, pledge or obligations of any beneficiary,
and shall not be subject: to any attachment or execution.
SIXT H
I nominate, constitute and appoint my wife, Beulah M. Stine
Executrix of this my Last Wi11 and Testament. In the event of the
renunciation, resignation, death or inability to serve for any reason
whatsoever of my said Executrix, I nominate, constitute and appoint my
son, Charles W. Stine, Jr. Executor of this my Last Will 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 WITNESS WHEREOF, I have hereunto set my hand and seal
to this my Last Will and Testament, consisting of three (3) typewritten
pages, the first two (2) of which bear my signature in the margin for
the purpose of identification this q day of D G C 1974.
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the
above named Testator, Charles W. Stine, as and for his Last Will and
Testament, in the presence of us, who, at his request and in his sight
and presence and in the sight and presence of each other have hereunto
subscribed our names as witnesses.
~ta~..._~" ~1 residing at I Og~~Z C. • ~L„"`k ~ • j ~ ~ `P P°"tbv r-~,sPa
1 ,r
r '~ __._. residing at C9 „~ ~