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Home My WebLink About08-28-12PETITION 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 request(s) the grant of Letters in the appropriate form: Decedent's Information Name: WILLIAM M. JOHNSON n File No: 21-12- `1 3~ tea' (Assigned by Register) a/k/a: tea' Social Security No: 186-26-8707 Date of Death: 8N /2012 Age at death: 97 Decedent was domiciled at death in CUMBERLAND County, PENNSYLVANIA principal residence at 5225 WILSON LANE MECHANICSBURG 17055 LOWER ALLEN TOWNSHIP (CUMBERLAND er last Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 5225 WILSON LANE MECHANICSBURG ~ 7055 LOWER ALLEN TOWNSHIP Street address, Post Office and Zip Code CUMBERLAND PA City, Township or Borough Coun Estimate of value of decedent's roe ~' State p p rty at death: !f domiciled in Pennsylvania ................................All personal property $ 47 000.00 !f not domiciled in Pennsylvania .............................Personal property in Pennsylvania $ !f not domiciled in Pennsylvania .............................Personal property in County $ l~alue of real estate in Pennsylvania ................ . ............................................. $ 0.00 TOTAL ESTIMATED VALUE... , $ 47 000.00 Real estate in Pennsylvania situated at: (Attach additional sheets, ifnecessary.) Street address, Post Office and Zip Code City, Township or Borough County ® A. Petition for Probate and Grant of Letters Testamentar Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated 7H ~+/ 008 thereto dated and Codicil(s) State relevant circumstances (eg. renunciation, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, 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. ® NO EXCEPTIONS ^ EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (lf applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate If Administration, c.ta. or d.b.n.c.za., enter date of Will in Section A above and com lete 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. ® NO EXCEPTIONS ^ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following sp6u~e (if any) ancfiheirs (attach :a.'- additional sheets, ifnecessary): -' ~~ ~ ~~ ;-n Name Relationship Z~ G') __ Addre ~>. ~~ E v - coo -_ _. .. ~ - _ C~~ ._ .- ~ Oo ~ ~ ~ ri i- D t11 ~ ~ I FormRW-02 rev. 10/!I/2011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } Official Use Only Petitioner(s) Printed Name I Petitioner(s) Printed Address 62 LONGWOOD DRIVE 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 Reprcces,~~entati~v~e(~s~) of the Decedent, the Petitioner(s) will well a~tuly administer the estate according to law. Sworn t ~ ~~firmed and~~be~t be~/_l"~- ~ r:lf~.~?-~'._-ta.,,,~ (%~~au,~~ Date' rS':'~`55~' ~L me' By: For the Register of BOND Required: ^ YES ®NO FEES: Letters ....................... $ - 1 . ~~ ( ,~`) Short Certificates(s) ...... ( )Renunciation(s) ......... . ( )Codicil(s) ............. . ( )Affidavit(s) ............ . Bond ......................... Commission ................... . Other Automation Fee ................ . JCS Fee ....................... TOTAL ......................$ ~ 3 • S~- Attorney Signature: /, Date Date Date below: Printed Name: MURREL R. WALTERS, III Supreme Court ID Number: 24849 Firm Name: MURREL R. WALTERS. III Address: ATTORNEY AT LAW 54 E. MAIN STREET MECHANICSBURG PA 17055 Phone: 717-697-4650 Fax: 717-697-9395 Email: ~O ~^a ~1 DECREE OF TAE REGISTER rn T ~ rx7 ~ =; ~~- N _ .. Estate of WILLIAM M. JOHNSON File No: 21-12- ~~ ~ r AND NOW ~ ~~~ ~d.-L ~ ~~ ~`- ~'^' _ ,-, ~~ , in considerati~~66 a~+the fore~ing Ptelztt~, satisfactory proof having been pr ented b ore me, IT IS DECREED that Letters TESTAMEIa'T'ARY ~~ are hereby granted to WILLIAM C. RANGE in the above estate and (if applicable) that the instrument(s) dated 7N 5/2008 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. C~, ~'~Q; ~ , ~ ~ ~ ~: ~, register of Wills ~' ~ %~ L(~, ~~ ~~ ,~ Form RW-02 rev. 10/11/2011 ~ ge To the Register of Wills: Please enter my appearance Fee for this certificate, $6.00 P 1~~~7432 Certification Number TY{(e/Print In Permanent %~~~~ AtiG 28 ~~~ a 4~lF~N~U S CtJU~~ CUMBERLjgND CO., This is to cert)t.~ chat the infornrjti(:n hhre given i eorj-ectly ajpied t~ron~ au or(~inal t'eruficate of Death duly filed with )r;e as Lrlcal Rey*ist(-ar. The original certificate will t~e i~x~w~arded to the State Vital Kecords E~fficr: f,;,. ~~er~(t)mtent fili)7.t. ~'"`' ~ A~~_ 2 2012 ~=- - L_- Loca] Registrar COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH • VITAL RECORDS 1_~,)te. IsSUe({ x CERTIFICATE OF 1. Decedent's Legal Name (First, Middle, Last, Suffix) DEATH William M _ Johnson z. sex 3. sp<lal se<uri State File Number: Sa. Age_Last Birthday (Yrs) Sb. Under 1 Y¢ar Male LY Number 4. Date of Death 97 Sc. Under 1 Da 6. Data of Birth (MO/Da 186-26-$707 (MO/Day/yr) (Spell Mo) Months Days Hours M(nutes Y/Year) (Spell Month August 1 , 2012 Aug 13 , 1914 ) 7a. Birthplace (city and state pr Fpreign cpunTry) 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number - Include Apt No.) 8c. Did Decedent Livebin ai Towlnship~ unty) Bd. Residence (County) 5225 Wilson Ln, Room 30 ~jYes, decedent lived In Cumberland 8e. Residence (zip Code) 3. Ever in US Armed ForcesT 30. Marital Status at Time of Death 17055 ~ No, decedent Ilved withtn limits of Yes twp, No Unknown Q Divorced ~ Married Widowed L2. Father's Name (First Mitldle, Last, Suffix) 0 Never Married ~ Unknow 13. Surviving Spouse's Name (If wife, give name city/boro Harry A • .'JOF-tnve-et-. Prior tr, a.~. ~_-_.. ----_ •-xi~ xenzie-~_ ....'.. ^^'OOIe, Last) O 1 Zam Ran a 14 b. Relationship to Decedent G ........................ FY~iend _ _ __ _ es, street a M~NUm g If Death Occurred in a~HOSpltal: - - ity, state, ZIp~COde) o ...~•lnpatlent ..........val ...................'..a. ace ° 62 pLongta IloOd d ive, chan -+ Q Emergency Room/Out -•• ..............eat o patient ilf Death Occurretl somewlherecOiher Than a Hospital Dr 050 2 lsb. Facility Nam 0 Dead on Arri ' ~{] Nursing Home/LOn F 1 "-'--^• e (If not Institution, give street and number` g-Term Care Facility Hospice •---•i C D .....PAS, 17 p Code Other (Specify) ty 8 ur LL Bethan Villa a Reti ls<. aty or Town, state, and zl a<i De<edenT H ...... rement °~^e -. 16a. Method of Disposition Q Burial C.r matclron Mechanicsbur , PA 17050 Removal from State 15d~. Co`un`ty_of p $n ~. ~ 16b. Date of Dispositio Cumberl Other (Specify) 0 Donation Aug 2 , 2012 16c. Place of Disposition (Name of cemete d ~ 16d. Location of Dis offman-Roth Eti]nei..al ry' crematory, pr other place) position (City or Town, State, and Zip) H~ & Cr'@matory ~ Carl isle , pA 17013 17a. s e of Funeral Service U 0 17c. Name nd Complete Address of Fu n¢ral Facility r Person in Charge of Intermen' 17b. License Number ~ HoPPman-Roth Fur><(~L-al Home & 0131441, 18. Decade is Education -Check the box that bast describes ShCr@Ii1D t dent of H 219 highest degree or level of school completed at the time of death. North Hanover Street O atn grade or less box that best descrlbesiwh0 they the decedent f Carp-sle , PA 17013 20. Decedent's Race -Check ONE OR MORE races to Indicate what Q No diploma, 9th - 12th grade Is Spanish/Hispanic/Latino. Check the "NO" the decedent considered himself or herself to be. ~ High school gratluate or GED completed deced ~ Wacite box if ant is not Spanish/His ~ Some college credit, but no degree IXN°, not spanish/HI panic/Latino. ~ BI k or gfrican American spanic/Latino ~ Korean Associate degree (e.g. ,a„e„ qs)_ [] Ves, Mexican, Mexican American, Chicano 0 American Indian o ~ VI r glaska Native etnamese Bachelor s degree (e.g. BA, qg~ gs) ~) Yes, Puerto Rican ~ Asia India 0 Other Asian O Masters degree (e.g, MA, M5, MEng, MEd, MSW, MBA 0 Yes, Cuban ~ Chinese Q Native Hawaiian 0 Doctorate (e.g. phD, Ed D) or Professional de ) 0 yes, other Spanish/Hispanic/Latino 0 Filipino ~ Guamanian or Cha morro . MD DDS OVM LLB lD grae (specify) O lapa nese O Samoan 21. Decedent's Single Race 5¢If-Designation -Check ONLY ONE to indicate what the decedent considered himself or hersOelf to be. (s 2a 1 Decedent's Usual OccuO Other Paclflc Islander Y] White ~ Japanese Q Black or African American ~ Samoan Q American Indian or Alaska Native ~ Korean Q Other Pacific Islander done Burin Patlon -Indicate type of work ~ Asian Indian 0 Vietnamese Q Don't Know/Not Sure H r^°sT of working life. DO NOT USE RETIRED. Chinese Q Other Asian 0 Refused S'elf' '1~[1 10 ea Q Filipino Q Native Hawaiian Q Other (specify) Guamanian or Cha morro 226. Kind o Business/Ipdustry ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounce Dead (MO Day Yr) 23b. sl F~ Ser'V1Ce BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH ~ S - Q' ~i/~ gnature o Person Pronoun~cin~~g JD~(e/a/t~h~C/(.O~~n-is 23d. Date Slgned~M~/Da /Yr) ~'_ - C..l Y w~ plicab a 23c. License Number 24. Time of D¢athC ~ ~~ '` ~ _•J 25. Was Metlical Examiner or Coroner Contacted7f ~~ S~~v `~7 26. Part 1. Enter the ch 1 f _ CAUSE OF DEATH ~ Y¢s O No respiratory arrest, or P diseases, Injuries, or complications--that dir ventricular fibrillation without showing The etiolo ectly caused The death. DO NOT en BY. DO NOT qgg REVIATE. Enter onl ter terminal events such as cardiac arrest. ° Approximate IMMEDIATE CAUSE ---___ 1 K ~i N - ` Y one cause on a line. Atld additional lines if necessa Interval: (final dise^se or condition s 1 L ( ~ ~ (~ /~/ - ry Onset to Death sulHng i death) a Due to (or b. Sl= N~) L E O Fra-t as a <pnseque <e p~: 31-r>m, i-h seq~ennally lest <onditipns, EN-~T - /~ n /} (,21 ~-(-~r~ ~~ ' ~~--- If any, leading to the cause Due to (or S r listed on Ilne a. Enter the as a co nsequen<e pf): ~ ~/ P ~_ He~av UNDERLYING CAUSE ~ -~_~ w (disease or Injury that c Due to (or F Initiated the events resulting d as a consequence of): ~ In death) LAST. ~ ~_ S 26. Part 11. Enter other sleniflc t conditl Due to (or as a consequence of): g b t t but not resulting in the underlying caus - e given in Parr I 27. Was an autopsy performed? Yes m9~ 3 29. If Female: 28. Were autopsy findings available - Eo Q Not pregnant withtn past yea 30. Did Tobacco Use Contribute to DeathT t° complete the c ofodeath~ _ ~ 0 Po gna nt at time of tleath r ~ 0 Probably 31. M ~e of D ~ Vas a 0 N ~. [] N t P egnant, but ~~ ~`+ ~_ ~r eath Not pregnant within 42 days of tleath Q Unknown BR tural Q Homicide pregnant, but pregnant 43 days to 1 year before death ~ Accident ~ _ ~ Unknown if pregnant within the 32. Date of Injury (MO Da Yr S ~ Suicide Pending Investigation past year / Y/ ) ( pelt Month) 0 Could not be determined 34. Place of Injury (e.g. hom¢; construction site; farm; school) 33. Time of injury Z 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: ~ No ~ Driv¢r/Operator ~ Ped¢strian 3B- Describe How Injury Occurred: Passenger ~ Other (Specify) -,_- 39~a-yC~_rtlfler (Check only one): • ~-' "°rtifYinB Physician - To the best of my knowled Q Preono ncxem~ Certifylo BO, death occurred due to Che c se(s) and [] M dical E in ng Physician - To the best f my knowledge, death o - au manner steered er/CO ner - On the basis of examinaHOn, currednat tohe time, date, ndlp'acea and du Signature of certifier: /~^d/~~ Investigation, in y pinipn tleath occ a to the cause(s) and man er stated r~i ed t the time, date, and place, and due to the cause 396. Name, Address and Zip Code pf Person Co Titl¢ of certifier: M D (s) and m m pleti'g 4~e~f Dea~'l1~ z4 ~ Ucense Number: IV\ ~ tatetl a r-.-f ~s-i a i--ct ~ (tel. ~ {G~t, J d ~+ 4Zl a. Sty 40. Registrar's District Num(b¢r 1st yy, '.i-~ ~(~ 39c. Date signed (Mo/Day/Yr) ~V~ 41. Registrar s s Pa l'l O (~ _ ~.y't `^ U ~ Zo t z 43. Amendments ~~ti~_~-_`__~- 42. Registrar Filn n•.e ... _ _ LOCAL REGISTRAR'S CERTIFICATION OF ®EATH WARNING: ~~fi,~,,~1,.~C~,~~, to this co b 1 ~t,~~ py y photostat or photograph. r~ ..~.IJ Disposition Permit No. t ) • I~+(~' '~F_ 'C7 _:'~::_ ~-~ -^~ ~ ._ _ C't'I Z ~ G'°7 ; ~ ;. LAST WILL ANI7 TESTAMENT ~ ~~ '~ ' ' r`' -'-' -- ~ BE IT REMEMBERED THAT _~ ~J ~ c.~ `~ --n I, WILLIAM M. JOHNSON, a resident of Cumberland C~: County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am married not married, my beloved wife, ANNABELLE S. JOHNSON, having predeceased me. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III 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 from my residuary estate as a part of the expense of the administration of my estate. IV I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment as follows: FIVE THOUSAND DOLLARS ($5,000.00) to my great-nephew, STEVEN SMITH, per capita. ONE THOUSAND DOLLARS (~ 1,000.00) to my niece, DIANE RANDOLPH, per capita. ONE THOUSAND DOLLARS (~ 1,000.00) to my niece, ROSALIND SMITH, per capita. TEN T~IOU~SAND DOLLARS (~ 10,000.00) to GETTYSBURG COLLEGE. TWO THOUSAND DOLLARS ($2,000.00) to ARTHUR E. DAVIS, per capita. ONE THOUSAND DOLLARS ($1,000.00) to KENNETH MOOR, per capita. FIVE THOUSAND DOLLARS ($5,000.00) to CHASE MICHAEL FUNK, pursuant to terms of the hereinafter included Trust. TEN THOUSAND DOLLARS ($10,000.00) TO BETHANY VILLAGE NURSING SCHOLARSHIP FUND. V All the rest, residue and remainder of my property, whether real or personal, including any property over which I may have a power of appointment, I give, devise and bequeath to WILLIAM C. RANGE and KAY E. RANGE, husband and wife, or the sur<,ivor thereof. If both WILLIAM C. RANGE and KAY E. RANGE shall predecease me, then I give, devise and bequeath all of my property, whether real or personal, including any property over which I may have a power of appointment, to SUSANNE E. FUNK, per stirpes. VI TRUST The gift that I have made to CHASE MICHAEL FUNK shall be maintained in Trust until he reaches the age of twenty-two (22) years. I direct that the funds be used for his education. Full discretion as to all payments shall be determined by the Trustee, SUSANNE E. FUNK. VII It is my desire that my Executor retain the services of MURREL R. WALTERS, III, ESQUIRE to assist in the administration of my estate, as he has detailed information about my affairs and my desires. VIII I nominate, constitute and appoint WILLIAM C. RANGE as Executor of this LAST WILL, to serve without bond. If WILLIAM C. RANGE is unable or unwilling to act in that capacity, then I nominate, constitute and appoint ARTHUR E. DAVIS, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, WILLIAM M. JOHNSON, have set my hand to this LAST WILL this 15~ day of 14 ~ Y 2008. ~F -~ WILLIAM M. JOHNSON Signed, sealed, published and declared by the above-named WILLIAM M. JOHNSON, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. 'l% 3 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. I, WILLIAM M. JOHNSON, Testator, 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 as my free and voluntary act for the purposes therein expressed. ~~`~1' ..t sYl WILLIAM M. JOHNSON Sworn or affirmed to and acknowledged before me this ~ ~`~~ day of ~ . ,. %,~,~'. , 2008. _. ~ ~. ,1 4 / Notary Public 4 NOTAft1Al fEAt DIANE M SMtTN Notary t~lic :ti1~CHANtt'SBURCs 8080, C Sworn or affirmed to and acknowledged, before me . ,_, Testator, this ~_J ~d~ day of c c.. ~ c ~~.. by WILLIAM M. JOHNSON, 2008. ~.----__ Notary Public NoTAaIA~ sEAI DIANE M SMITH Notary oUbliC MteCMANIGSdIIRG sORO, Ct/MeERLA10? My Commtss~on Explt~= Jun 22. 201! AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 5:~. We, r`1 t~:~~"t L ,~' G~1~ ~~i~I?~ and ~~ , r'~ ~`~' ~ ~' `~~ 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 Testator sign and execute the instrument as his LAST WILL, that WILLIAM M. JOHNSON signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in t,~ie hearing and sight of the Testator signed the Will as witnesses; and that tot best of our knowledge, the Testator was at the time 18 years of age or more, ;. f sound mind and under no constraint or undue influencE