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Home My WebLink About09-20-12PETITION 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: Bobbi Jo Jones Decedent's Information Name: Elwood G. Shiley a/k/a: a/k/a: a/k/a: Date of Death: 09/05/2012 Decedent was domiciled at death in Cumberland County, File No: 21-12 ~ ~.~~ (Assigned by Register) Social Security No: Age at Death: PA 210-26-9109 77 (State) with his/her last principal residence at 637 Bosler Ave., Lemoyne 17043 Lemoyne Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Harrisburg Hospital, 2nd St., 17101 Harrisburg Dauphin PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedents property at death: If domiciled in Pennsylvania ...................... All personal property $ If not domiciled in Pennsylvania ................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ................ Personal property in County $ Value of real estate in Pennsylvania ................................................................... $ Real estate in Pennsylvania situated at (Attach additional sheets, if necessary.) 31,000.00 TOTAL ESTIMATED VALUE $ Street address, Post Office and Zip Code City, Township or Borough ^X A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated thereto dated 04/19/2000 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 Letters of Administration (If applicable) c. t. a., d. b. n., d. b. n. c. t. a., pedente lite, durante absentia. durance minoritate If Administration, c.t.a or d.b.n.c.t.a., tenter date of Will in Section A above and complete list of heirs. 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): Name Relationship Address Z~ ~ i~ r ~~~''1 {~'/~~J r~~'i ` J W ~- 1 ~'.. 1 l ~ ..~ I..~ .K:.... '... 7 ~/ 1 ~ I~ 1 -n n' `~ :--~' cx.~ 31,000.00 County and Codicil(s) Form RW-02 rev. 10-11-2011 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 } Official Use Only Petitioner(s) Printed Name Petitioner(s) Printed Address ; .~.} Bobbi Jo Jones 428 Herman Ave ~, X1"1 ~~ Lemoyne, PA 17043 ~ :t) ~ t~ " ' c r ~ E. ~ ~ r'Tl -~- , ~ ~ t ~ i t:; ;~ C~? - d 1 {/ ' ,; ~C., ~. ~ ~ _~„.E Y `~ N ~ , , ~`-, ` `-' ~ C~ t,C' 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 Representative(s) of the,)~ecedent,°F?etiti r(s) will well and truly administer the estate according to law. -~ ~ ~ ~ ~ ~. ~'~~~~'~ l r'TL~-7 Date ~ -ZL:~' ~ :~ sworn to or affirmed and ubscribed~before ~;~, ~ , me th' ~~ y Of'~ ~~ ~~~~ i!.i_~:1L~-f ~ ''ti j'. ~ ~ Date ,~. ~~ ~ `~~ Date B ' - ~ o e R " ist Date ;• BOND Req riu ed? ~ YES ~ NO FEES: Letters .......................................... $ 90.00 ( 3 )Short Certificate(s)......... 12.00 ( )Renunciation(s) .............. ( )Codicil(s) ........................ ( )Affidavit(s) ...................... Bond ............................................. Commission .................................. Other Will 15.00 Automation Fee ............................ 5.00 JCS Fee ....................................... 23.50 TOTAL ......................................... $ 145.50 To the Register of Wills: riease enter my appearance py my signature aeiow: Attorney Si nature: ~~~ _~- , Printed Name: Lin a J. Olsen, Esq. Supreme Court ID Number: 92858 Firm Name: Hazen Elder Law Address: 2000 Linglestown Rd. Suite 202 Harrisburg, PA 17110 i Phone: 717-540-4332 Fax: 717-540-4313 E-mail: lolsen@hazenelderlaw.com DECREE OF THE REGISTER Date of Death: 09/05/2012 Social Security No: 210-26-9109 Estate of Elwood G. Shiley File No: 21-12 ~' ...~ ~? a/k/a: AND NOW, ~ ~' '~~ ~ , in consideration of the foregoing Petition, satisfactory proof having een presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Bobbi Jo Jones in the above estate and (if applicable) that the instrument(s) dated 0~l 9/ 000 described in the Petition be admitted to probate and filed of record as the last d Codicil(s)) of Decedent. Register of Wills Copyright (c) 2011 form software only The Lackner Group, Inc. ~ ~~ j''y}•r f~ t.. ~.L.IJ '~.~ ~ 2 $~~ ~ p P~3 2: Q ~ C}~Ph>~J~ , ~r; t~1MB~R ~ c:v~A r ~ ,_~ s , ~ ,~ ~.ANp CU-. PA ~ .~~~~~~~~ ~G~ ~ SEP 1'1 202 Type/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH VITAL RECORDS Permanent CERTIFICATE OF DEATH ~____ _.._ _....__.___. W D W ° 0 Z 1. Decedent's Legal Name (First, Middle, Last, ffix) 2. Sex 3. Social Security Number 4. a of Death (MO Yr) ( o) y Elwood G_ Shi1e a1a 210-26-9109 % ~~~ Sa. Age-Last Birthday (Vrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (Mo/D ay/Year) (Spell Month) 7a. Birthplace (Cites. and S tate r Foreign Country) .7 8 Months Days Hours Minutes OC t 2 1 1 9 3 4 Tower 1 ty , PA , 7b. Birthplace (County) SC uy 1 8a. Residence (State or Foreign Country) Sb. Residence (Street and Number -Include Apt No.) Sc. Dld Decedent Live In a Township? Penna _ 6 3 7 Bos ter Ave OVes, de t lived in twp. 8d. Residence (county) L Cumber 1 and Se. Residence (Zip Code) 1 7 O 4 3 emoyne 0, decedent lived within limits of city/boro. 9. Ev n US Armed Forces? 10. Mar' talus at Time of Death ~ Married ~ Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) es Q No Q Unknown ivorced 0 Never Married ~ Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) George Shiley Margaret Keister 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) 0 Bobbi Jo Jonas daughter 428 Herman Ave.,Lamoyne,PA 1743 G ........................................................... .. ..................................... 15a. Place of Death Check on one ... ............................~..............Y ...-....... ... -. . . .. - . If Death Occurred in a Hospital: npatient : . . . .. . ... ...... If Death Occurred Somewhere Other Than a Hospital: ~] Hospice Facility ~] Decedent's Home ° Emer enc Room Out atient ~ B Y / P ~ Dead on Arrival ~ Nursing Home/Long-Term Care Facility p Other (Specify) SSb. Faculty Name (If not institution, give street and number; lSc. City or Town, State, and Zip Code lSd. County of Death Harrisburg Hospital Harrisburg, PA 17101 Dauphin 16a. Method of Disposition 0 Burial remation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) m p Removal from State 0 Donation Sept. 7, 201 2 Hollinger Crematory ~ Other (Specify) ~ 16d. Location of Disposition (City or Town, State, and Zip) 1 ignatu re of Fun I Service Licensee o Person in Charge of Interment "t~'~u 17b. License Number Mt_Ho11y Springs,PA17065 „~„-~ ~_ - ----- FD-013163-L E 17c. Name and Complete Address of Funeral Facility ~, Musselman FH&CS 324 Hummel Ave_ Lemo ne PA17043 m ~°- 18. Decedent's Education -Check the box that best describes the highest degree or level of school completed at the time of death. 19. Decedent of Hispanic Origin -Check the box that best describes whether the decedent 20. Decedent's Race -Check ONE OR MORE races to indicate what the de ent considered himself or herself to be. ~ 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" kite ~ Korean ~ No c(Ipllim a, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. ~ Black or African American ~ Vietnamese igh school graduate or GED completed ~ No, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native ~ Other Asian ~ Some college credit, but no degree ~ Yes, Mexican, Mexican American, Chicano Q Asian Indian 0 Native Hawaiian 0 Associate degree (e. g. AA, AS) Q Yes, Puerto Rican 0 Chinese ~ Guamanian or Chamorro ~ Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban ~ Filipino 0 Samoan ~ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Ves, other Spanish/Hispanic/Latino ~ Japanese Q Other Pacific Islander ~ Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other (Specify) e. MD, DDS, DVM, LLB, JD 21. Deced L'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 ite Q Japanese Q Samoan done during most of working life. 00 NOT USE RETIRED. ~ Black or African American ~ Korean ~ Other Pacific Islander ma c h i n i s t ~ American Indian or Alaska Native ~ Vietnamese ~ Don't Know/Not Sure .. 0 Asian Indian Q Other Asian Q Refused 22b. Kind of Business/Industry ~ Chinese Q Native Hawaiian ~ Other (Specify) ~ et engine parts ~ Filipino Q Guamanian or Chamorro ITEMS 23a - 23d MUST BE COMPLETED 23 .Date Pron unced Dead (Mo/Day/V r) 236. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH ~r ~~// E ~ (J~r~ 23d. Date Signed (MO/Day/Yr) 24. im of at /n 25. Was Medical Examiner or Coroner Contacted? Fb Yes ~Rfo 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 flbrill lion withou howing the etiology t s D O N OT ABBREVIATE. Enter only one cause on a line. Add additional Tines if necessary Onset to Death /J ,, y- ~ ,~ ~i ~, ~1 GX~ ~l2 ~~ c IMMEDIATE CAUSE ---------------> a. ' ~~~i~ g (Final disease or condition Due to (or as a consequence of): resulting in death) ~ / ~~ o b, GG `~ r /~~~[., ~ Seq uentlally Ilst conditions, Due to (or as consequence of): ~- if any, leading to the cause listed on line a. Enter the c. - UNDERLYING CAUSE Due to (or as a consequence of): W (disease or Injury that initiated the events resulting d. v in death) LAST. Due to (or as a consequence of): 26. Part 11. Enter other sianifica nt conditions contributing to death but not resulting in the underlying cause given in Part 1 27. Was an autopsy perform ed7 ° Co ~ ~ ~~ ~ ~ ~ ' 1 Z Yes ~ , - ~ C C 2 / ~ 28. Were autopsy findings available m to complete the cause of death? Q Yes Q No a 29. If Female: 30. Dld Tobacco Use Contribute to Death? 31. Man r of Death E 0 Not pregnant within past year ~ Ves ~ Probably atural ~ Homicide v 0 Pregnant at time of death 0 No ~ Unknown ~ Accident Q Pending Investigation m ~ Not pregnant, but pregnant within 42 days of death ~ Suicide ~ Could not be determined F°- Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (Mo/Day/Yr) (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: ~ Ves ~ Driver/Operator Q Pedestrian ~ No ~ Passenger ~ Other (Specify) 39a. Certifier (Check only one): ~ Certifying physic(an - To the best of my knowledge, death occurred due to the cause(s) and manner stated ~ Pronouncing 8~ Certifyl hyslclan - To the best of y knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated Q Medical Examiner/ rover - On th b is of exam'n ion, and/ stigation, in my opinion, death o/ccxj rred at the time, date, and place, and due to th c se(s an/r7 L^'~aJnner stated ~ ~ ~ ~ ~ Title of certifier: V License NumbeD Signature of certifie ~---~ W / ~ ~ 3 Name, Ad re sand Zi od of Person ompl ~ ng Muse of D e ~lteJr a6) _, i~ ~ ~ 39 .Date Signed (MO/ ay/Yr) O ~ ~ n ~ ~ ~ / ~~/ o D/ 40. Registrar's District Number 41. Registrar's Si re 42. Registrar F il e Date (Mo/Day/V r) ? . G , 43. Amendments ~? SHOULD REA],~ %' l ~ ~~ Disposition Permit No. ~ ~ ~ Cp ~ ~ ~ H105-143 REV 07/2011 ., ~~ :7C7 LAST WILL AND TESTAMENT ~~ _ cn ~' '"` (Pour-Over Will) Z -Y- , ~~ ~~ r~ --q ~`~ ~ c~., ,- --~ __'~~ ~ d : , ~---~ ELWOOD G. SHILEY ca: {_. ~ :~_~; o c~. -_ . ---, N _ IDENTITY -° ~ o ~~`' Q --r, I, ELWOOD G. SHILEY, residing in the County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other former Wills and Codicils to Wills heretofore made by me. My Social Security Number is 210-26-9109. I have the following children: BOBBI JO JONES born July 22, 1961 and currently residing in Lemoyne, PA 17043 and CYNDI L. FOSTER born April 22, 1963 and currently residing in Harrisburg, PA 17112. DEBTS, TAXES AND ADMINISTRATION EXPENSES I have provided for the payment of all my debts, expenses of administration of property wherever situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other than any tax on ageneration-skipping transfer that is not a liability of my Estate (including interest and penalties, if any) that become due by reason of my death, under THE ELWOOD G. SHILEY REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust"). If the Revocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items from the residue of my Estate passing under this Will, without any apportionment or reimbursement. In the alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary to pay all or part of these items, plus claims, pecuniary legacies, and family allowances by court order. PERSONAL AND HOUSEHOLD EFFECTS It is my intent that all my personal and household effects were transferred to the Revocable Trust as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me this date in accordance with the provisions of the section titled "Residue of Estate." RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devices), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of the execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance with the provisions of the said Trust, including any amendments thereto made before my death. POUR-OVER WILLS ~ J/~' Page 1 (Testator) If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their substitutes and successors underthe Trust, described herein above, to beheld, managed, invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to the period beginning with the date of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any, hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. EXECUTOR I hereby nominate and appoint BOBBI JO JONES to serve without bond as my Executor of this my Last Will and Testament. In the event the first named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint CYNDI L. FOSTER to serve without bond as my Independent Executor. Whenever the word "Executor" or any modifying or substituted pronoun therefore is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally named herein. EXECUTOR POWERS By way of Illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind of partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry out the purpose of this my Will, without being limited in any way by the specific grants or power made, and without the necessity of a court order. My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others. In determining the Federal Estate and Income Tax liabilities of my Estate, my Executor shall have discretion ~~ POUR-OVER WILLS J Page 2 (Testator) to select the valuation date and to determine whether any or all of the allowable administration expenses in my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions. SPECIFIC OMISSIONS I have intentionally omitted any and all persons and entities from this, my Last Will and Testament, except those persons and entities specifically named herein. If any person or entity shall challenge any term or condition of this Will, or of the Living Trust to which I have made reference in the sections "Household and Personal Effects" and "Residue of Estate," then, to that person or entity, I give and bequeath the sum of only one dollar ($1.00) only in lieu and in place of any other benefit, grant, bequest or interest which that person or interest may have in my Estate or the Living Trust and its Estate. SIMULTANEOUS DEATH If any other Beneficiary should not survive me for sixty (60) days, then it shall be conclusively presumed for the purpose of this my Will that said Beneficiary predeceased me. ELWOOD G. SHILEY Testator This instrument consists of 5 typewritten pages, including the Attestation Clause, Self-Proving Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at the bott~f each of the preceding pages. ~Th~is instrument is being signed by me on this ~ ~ day of iG~ POUR-OVER WILLS Page 3 (Testator) ATTESTATION CLAUSE The Testator whose name appears above declared to us, the undersigned, that the foregoing instrument was his Last Will and Testament, and he requested us to act as witnesses to such instrument and to his signature thereon. The Testator thereupon signed such instrument in our presence. At the Testator's request, the undersigned then subscribed our names to the instrument in our own handwriting in the presence of the Testator. The undersigned hereby declare, in the presence of each of us, that we believe the Testator to be of sound and disposing mind and memory. Signed by us on the same day and year as this Last Will and Testament was signed by the Testator. WITN~~ SES: i , l ~ i ~ .~ • ~ C ADDRESSES: .~~f~ Sr (Printed Name of Witness) 2'r ~ / l''1 ~ f ~ S ., tc~ (Printed Name of Witness) ~~,~yN~ ,~~t , POUR-OVER WILLS ~ . Page 4 (Testator) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SELF-PROVING CLAUSE BEFORE ME, the undersigned authority, on this day personally appeared ELWOOD G. SHILEY, /~ `JU ~11i and f~/~~~ ~~~1eC3~ ~ known to me to be the Testator and the witnesses, respectively, whose names are subscribed to the foregoing instrument in their respective capacities, and all of them being by me duly sworn, ELWOOD G. SHILEY, Testator, declared to me and to the witnesses, in my presence, that the instrument is his Will and that he had willingly made and executed it as his free act and deed for the purposes therein expressed; and the Witnesses, each on his or her oath, stated to me in the presence and hearing of the Testator, that the Testator had declared to them that the instrument is his Will and that he executed the same as such and wanted each of them to sign it as a witness; and upon their oaths, each witness stated further that he did the same as a witness in the presence of the Testator, and at his request and that he was at that time eighteen (18) years of age or over and was of sound mind, and that each of the witnesses was then at least fourteen (I 4) years of age. v ELWOOD G. SHILEY Testator ~ ~.,-~- Witness I`'1 ~:, ~ i.t S „tom (Printed Name of Witness) ,~ ~ ~" ;_ (Printed Name of Witness) SUBSCRIBED AND ACKNOWLEDGED before me by ELWOOD G. SHILEY, Testator, and subscribed and sworn to bye me by and , witnesses, this the / ~ (~~ day of / L ,'~)a . Notary Pul~i~, Commonwealth-,.f._.~~n ~,l.~ania V ~y , _; ~ 1 y, pp, ~~.~t~.ti i~ ~_ ~J~ii~ S`~ ~1f rlt~i t. ' ~`-ayt i ii4~~1. 7 ~ ~ ~ t111`l? (1fiC'Iii~E'~, ~ ~%+1!"l:~y'~~~?TNi~ `r`a.~5ia~,ic'tihi~E !a~ ~J4~u(10S POUR-OVER WILLS , Page 5 (Testator)