HomeMy WebLinkAbout09-07-12PETITION FOR GRANT OF LETTERS
REGISTER OF WII.,LS 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: Betty J. Shepazd File No: 21 ~ 2 _ C1 ~ ~ I
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: 8/29/12 Age at death: 91
Decedent was domiciled at death in Cumberland County, PA (State) with his/her last
principal residence at 22 Wiltshire West Cazlisle South Middleton Township Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 22 Wiltshire West Cazlisle South Middlton Township 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 $ 22.000.00
If not domiciled in Pennsylvania .............................Personal property in Pennsylvania $
If not domiciled in Pennsylvania .............................Personal property in County $
Value ojreal estate in Pennsylvania .............................................................. $ 128,500.00
TOTAL ESTIMATED VALUE.... $ 150,500.00
Real estate in Pennsylvania situated at: 22 Wiltshire West Cazlisle Cumberland
(Attach additional sheen, ijnecessary.) Street address, Post Office and Zip Code City, Township or Borough County
® A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) avers) he/she/they is/are the Executot{s) named in the last Will of the Decedent, dated 4/10/11 and Codicil(s)
thereto dated _None.
State relevant dreumstancea (e.g. renunciation, death ojexecutor, eta)
Except as follows: after the execution of the instnrment(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(8), and did not have a child bom 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.6.n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate
If Administration, c.f:a. or d.b.n.c.~a., enter date of Will in Section A above and comalete 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 following spouse (if any) and heirs (attach
additional sheets, if necessary):
Name Relationship Address „~~
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Form RW-Ol rev. 10/11/201/
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND }
Official Use Only
RE Ci}~j~ L~ 1 c
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Petitioner(s) Printed Name --
Petitioner(s) Printed Address
Rita A. C enter 2 Wesley Drive
Carlisle ~ ^~~ ,4 ~ 015
CuMBERU~u C4•, PA
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 Petition~t{s) and that, as Personal Representative(s) of the Decedent, the Pion s) wi well and truly admini ter the estate according to law.
Sworn to r affirmed sub rib d before ~ ~ ' ~~ ~ , ~ ~~~~ Date ~ ~ ~ ~---
me s da ~ of C._ G Date
By' Date
For the Register Date
BOND Required: ^ YES ®NO
FEES:
Letters ....................... $ -~tJEC~,~t;
(~ )ShortCertificates(s) ...... ~u C`
( )Renunciation(s) ......... .
( )Codicil(s) ............. .
( )Affidavit(s) ............ .
Bond .........................
Commission ............... _ ... .
Other .........
Automation Fee ................ .
JCS Fee .......................
TOTAL ......................$
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To the Register of Wills:
Please enter my appearance by my signature below:
A rney Signature:
~~~~~~ 'J
Printed Name: No V. Otto III, Esquire
Supreme Court
ID Number: 27763
Firm Name: Manson Law Offices
Address: 10 East Hish Street
Carlisle PA 17013
Phone: (717)243-3341
Fax: (717) 243-1850
Email: iotto(a~,martsonlaw.com
DECREE OF THE REGISTER
Estate of Betty J. Shepard File No: 21 - ~ 2 " ~ ~1 ~
a/k/a:
AND NOW, _i~~ 1~,( ~~~~ 7 2CJ 12 , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Rita A. Caroenter
in the above estate and (if applicable) that
the instrument(s) dated April 10. 2011
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
~~
egister of Wills ~ /~'p ~ ~ J~ ~~ ,~/~ ; ,
Form RW-02 rev. /0/11/2011 ~~ ~ ~ 'I L' 7julle/F~~"~ ~ C age ~ of 2
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LOC~~'~AR'S CERTIFICATION OF DEATH
WA~~~11 isill~~g$~'to duplicate this copy by photostat or photograph.
Fee for thi~~ certificate, S6.t10 ~~~Z SEP -~ A~ ~Q: ~ ~ "Phis is to crrti(~ tFr(~ [he information here given is
correctly cvE)ied 1'rclJn aA~ original Certificate of Death
duly t-lied E:ith :n~: a>. Local Registrar. The original
('-' c rtificatc wall h( frutiv,_Jrded to the State Vital
Q~~~V ~~ "~~~! 1{ceords Ofw icc i ), :)arm Jne nt tiling.
CUM$ERLAhJD CO., PA '
P 18820816 ~ ~~
Certification w~umher
Type/Print In
Perm.nent
Black Ink
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_o ,is , ~ ~~~~~ Uate issued
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
LF RTIFI['ATO AC f]FATN
1. Decedent's Lapl Name (First, Middle, Last, Sufflw) 2. Sax 3. Seelal Saeurny Number ~ 4. Dab of Death (MO Day/Yr) (Spell Mo)
Batt Jane She and Female 156-10-5153 Au st 29 2012
Sa. Age-Lart BlrthdW (Yrs) Sb. Under 1 Veer 3c. Under 1 De B. O•ta of Birth (MO/Day ear) (Spell Month) 7e. BiRhplau (City end State or Foreign Country)
Months Daw Hourf Minutes e P 1 ani
91 September lO, 1920 7b, BlRhplaea (county?
Ba. Residence (State er Foreign Country) BD. Raaidenu (Street and NumMr - Include Apt No.) 8c. Id Decadent Uya In • TowMhip7
Penns lvania
I~Yes, decedent llwdln South Middleton TwD. twP.
22 Wiltshire Weat
8d. Rasldenu (County
Cumberland ie. Rasidenu (Zip Coda) 17015 QNe, dacedam Ilwd wlthln Ifmlb of Gty/boro.
9. Ewr In US Armed Forces? 10. MerRal Sbtuf at Tlme of Death Married Widowed 11. SurvNing Spouse's Name (N wHe, gWe name prior to rit merrlage)
Q Yes ®No Q Unknown ®Oiyorced Q Newr MarrlW Q Unknow
12. FatMYa Name (First, Middle, LaK, SufRx) 13. MotMr's Name Pnor to First Marrlap (First, Middle, Last)
Frank Miller Trout Lovice Bollinger
14a. Informant's Names 14b. RelKlonship to Decedent 14c. Informant's Mailing Atltlraas (Street and NumWr, Gty, State, LD Codel
g~ Rita
A.
Car
enter
Niece 2 WCglgy Drive, Carlisle, PA 17015
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S N Dasth Occurred In a HosPlb : InpKlent
Emerg Room/OUtpKlent Dead on Arrival 0 if Ofath Otturrad SOmeyvhire OMsr Than • HosPlbl: ~( hlofpiu FacflRy ~17eudam's Home
Nursin Heme/Long-Term Ore FaGllry Other (Specfy)
SSb. Facility Name (1/ not InKYtutlon, glw street end number; ISC. CIH or Town, Sbte, entl 21p Coda lStl. CeonH Of Death
~ 22 Wiltshire West Carlisle PA 17015 Cumberland
lBa. Method of Dlspositlon Q Burial Cremation lab. Dab of Diapoaltlon 16c. Plau Of OlsposRion (Name of cemetery, crsmKery, or Other pisu)
Q Remewl from sbta Q Donanem
Other (5 ecify
6- 012 Cremation Soc let of Penns lvania
I6d. LouHOn of Olsposklon (City or Town, State, and Zip) 17a. n of Funa 1 Sarvk nsw rsen In CMrp of Inbrment 17b. Uceme Numbet
Harrisbur Penns lYattia 17109 FD-013376-L
37c. Name and ComplKe Address W Funeral Facility
v o Yania Inc. 4100 Jone town Road Harrisbur PA 17109
~ ls. Decedent's Etluutlen -Check the box that MK daaerlMa the 19. Depdent o Hispanic Origin -Check the 20. Dautlant'a Rau -Check ONE OR MORE razes to IndicKa what
highest degree or Iewi of school completed at the Lima o1 death. box thK best describes whKhar the decadent the deudem considered hlmsaH or MneM to be.
Q Bth grade or less is SPanish/Mlapsnlc/Latlno. Check the "NO" ®Whib Q Korean
Q No diploma, 9th - 12[h grads bow If deudem is not Spanish/Hlspanlc/Latlno. Q Black or Afnun American Q Vletnameae
® Hlgh school gratluete or GED complKad J8 No, not Spanish/Hlspanle/Latine Q American Indian or Alaska Nature Q Other blen
Q Some college credit, but no degree Q Yea, Mexican, Mexlun Amarlun, Chicsno Q Asian Indian Q Nature Hawaiian
Q Associate degree (e.g. AA, AS) Q Vet, Puerto Rican Q ChlneM Q Guamanian or Chamerro
Q Bachelor's tlagrea (e.g. BA, AB, BS) Q Ves, Cuban Q Flllpino Q Samoan
Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hlspanle/Latlne Q Japanese Q Other Pacific Islander
Q Doctorate (e.g. PhD, Ed D) or Profeaalonal degree (SpaeFly) Q OsMr (S 1
pec N)
•. MO 005 DVM LLB 1D
21. Daudent's Single Race Self-DesignKion -Cheek ONLY ONE to Indicate whK the deudem considered himsaH or herseN to be. 22a. Decedent's Usual OttuPation - Indluta typo of work
® White Q lapanefe Q Samoan done during most Of working IH~. DO NOT USE RETIRED.
Q Black or African American Q Korean Q Other Paclflc Islander
Q American Indian or Alaska Nature Q VlKnamese Q Don't Know/Not Sure Clerk
Q Asian Indian Q OtMr Aalam Q Refused 22D. Kind of Business/Industry
Q Chinasa Q NKWa Hawai(an Q Other (SP•Gfy)
Q Flllpino Q GwmanNn or Ghemorro Farmer r 6 Tru6 t
U B M a. Ka rono u o ay 2 gnaturo q rson ronounc ng DaK n y an app u a c. Ucansa Num r
BY -ERSON WHO -RONOUNCE3 OR
caRTlFlgs Dgwrtf
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23d. DKe Signed o Day r) 24. me of Oerth
ZQ ~ /F~ 25. Was Madlul Examiner or Caron ntacted7 Q Yea
GAU5E Of DEATH ~ APproximab
26. Part 1. Enter the chain of events-diseases, InJunes, or complications-that dlraeeN uusad tM dHth. DO NOT enter terminal swab such as urdlac arrest, ? IntarvN:
respiratory arrest, or wnMeular flbrlllatlon w ou` sho jag tM atlol
T AB Enter 1
ne a sa en a Ilne. Add additl •I I~
if necessary ~ Onset to Death
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IMMEDIATE CAUSE ------------> b//s ~i~ {
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(Final disease er condition
D to (or K a consequence of):
resulting in death)
b.
sequemlalH list conditions, Due to (or as a consequence of):
If any, leading to the uusa
IIKed on Ilne a. Enter the i
UNDERLYING UUSE Due to (or as a consequenu of):
B (disease or Injury tMt
InKIKed the swats rasultlnB d.
~ in death) LAST. Ow to (or as a comegwnu on:
y
t7 26. Part 11. Enter other but not resulting In the underlying caul! gWen in Pir I 27. Was an autopsy rmad7
~ / Yes No
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4 to rnmPlKe t!)e eause
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! yes No
29. H Female: 30. Did Tobacco Usa COntrlbub to Death? 31. Mannar of Death
Q Not pregnant within past year Q Yes Q Probably ~ Natural Q Homicide
Q Pregnant at time of death .OI No Q Unknown Q Accident Q Pending InwstlEKlon
~' Q Not pregnant, but pregnant wlthln 42 tlsya of tleaM !~ Q Sui<Ide Q Could not ba determined
Q Not pregnant, but pregnant 43 days to 1 year before dean 32. Date of Injury (MO/Day r) (Spell Month)
Q Unknown if pregnant wlthln tM past year 33. Time of Injury
34. Platt of Injury (e.g. home; construetlon site; farm; uhool) 35. LoeaLOn of Injury (StreK and Number, City, State, Zip COtle)
36. Injury at Work 37. If Transportation Injury, Spaelly: 36. OaseHba How Injury Occurred:
Q yes Q Drover/operator p PedeKrlen
Q No Q Passenger Q Other (Specify)
3 CartMar (Check only one):
~4RHying physician - To the best of my knowledp
Oeath occurred due to Ma cause(s) and manner
tat
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Q Pronouncing a Certifying physician - To tM best of my knowledp, duth occurred at Me time, date, and place, sad tlue !o the uufe(a) and manner stated
Q Mediul Examiner/Coroner - On [ b sls of Imtlon, and/er InwKlgaHOn, in my oplnlen, death ocJe~urretl K tM time, data, and place, and tlue to eh Tj~(s) tl manner stated
~
stgnscure or certlflar: Titl. of urlfler: ~~ Cleanse Number:
U 'Q'3 r~./~2 ' L
39b. Nsma, Address d Zip de of Person Comp Ing Gus! of (Its 26) - 39c. Date ed /`/r)
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43. Amendmemb
DlsposRlon Permit No. O l O L..tc ~ O ` REV 07/2011
LAST WILL AND TESTAMENT
I, BE1TY J. SHEPARD, of South Middleton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and
declare this to be my Last Will and Testament, hereby revoking any and all former Wills or
Codicils made by me.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and
all death taxes (whether such taxes may be payable by my estate or by any recipient of any ,,~
property) shall be paid from my residuary estate as soon as practicable after my d ase and
part of the administration of my estate. My Executrix shall have no duty or obliga Ito obt~
reimbursement for any such tax so paid, even though on proceeds of insurance or ~}~rop~Ry
not passing under this will. ~~'~' ~
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I give and devise the entirety of my estate (including but not limited to my residence at 22
Wiltshire West, South Middleton Township, Cumberland County, Pennsylvania), both real and
personal property, unto my nieces, Kay B. Johnson and Rita A. Carpenter and my nephews,
Gary G. Braught and William G. Braught II in equal shares. However, should any of the heirs
predecease me or fail to survive me by thirty (30) days, their share shall be distributed to their
issue, per stirpes, and in default of any such then-living issue, such share shall be distributed to
my surviving niece(s) and/or nephew(s) .
3.
I nominate, constitute and appoint my niece, Rita A. Carpenter, as Executrix of my
estate. In the event slie is unvrilling or unabic 1o so act, th~~ I appoint my niece, Kay B. Johnson,
as Executrix of my estate.
4.
I direct that my Executrix shall not be required to file a bond or secure the faithful
performance of her duties in any jurisdiction.
initials
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5.
I authorize and empower my Executrix in her sole and absolute discretion, to purchase or
otherwise acquire and retain my investments of which I die seized or any real or personal
property of any nature, to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant
options in regard to any or all property of any kind forming a part of my estate for such terms and
such prices as she may deem advisable; to borrow money for any purposes connected with the
protection and preservation of my estate; to mortgage or pledge any real or personal property
forming a part of my estate or to join in or secure the partition of same, to compromise an_y
claims or demands of my estate against others or of others against my estate; to make distribution
in kind and to cause any share to be composed of cash, property or undivided fractional shares in
property different in kind from any other share; to employ agents, attorneys and proxies and to
delegate to them such power as my Executrix considers desirable and to pay reasonable
compensation for such services as may be rendered by such agents, attorneys, and proxies; and to
execute and deliver such instruments as may he necessary to carry out any of these powers. In
addition, 1 direct that my Executrix shall have the power to conduct an inventory of any safe
deposit box necessary to administration of my estate.
IN WITNE~WHEREOF I have hereunto freely, voluntarily and of sound mind set my
signature this ~ day of ,1 2011.
~---~
Betty J h and
SIGNED, PUBLISHED AND DE,CL~IRED by the above-named Testatrix, as and for her
Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed out
names as witnesses thereto, in the presence of said Testatrix and of each othe~~.
~r°
Page 2 of 2 Pages
T
OATH OF SUBSCRIBING WITNESS(ES)
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REGISTER OF WILLS ~~ _
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CUMBEItI-AND COUNTY
PENNSYLVANIA ~L' 1 ~' ~ f
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Estate of BETTY J. SHEPARD ~ -n
Deceased
WILLIAM G. BRAUGHT. III , (each a subscribing witness to
(Print Names)
the ~ Will ^ 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 her /his
(Signature)
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
presence and in the presence of each other.
(Signature)
5009 Apache Drive
(Street Address)
Mechanicsbure PA 170'0
(City, State, Zip)
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this y~ day
of ,~,~,
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.
TI~I t?F Pf,,,-~t' 1Pi,
Notarial Sea!
Form RW-03 rev. 10.13.06 a ~91~ ~ry ~~
Coy of Lancaster, Lancaster Cqurq-
My Commission ExpMes June 11.201$1
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OATH O ITt ~`i C~
F SUBSCRIBING WITNESS(ES) ~~ ~ , ~-T,
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REGISTER OF WILLS ~ ~' ~ -'~'
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CUMBERLAND COUNTY, PENNSYLVANIA _ -
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Estate of BETTY J. SHEPARD ,Deceased
RITA A. CARPENTER , (each a subscribing witness to
(Print Name/s)
the 0 Will ^ 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 re uest of
the Testator /Testatrix in her /his
c ~.~ ,o
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(Signature)
2 Wesley Drive
(Street Address)
Carlisle PA 17015
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this ~ day
of ~,~ , ,'X7 I'~ ,
Deputy for Register of Wills
q
presence and in the presence of each other.
(Signature)
(Street Address)
(City, State, Zip)
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this day
of .
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
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-03 rev. 10.13.06