HomeMy WebLinkAbout10-11-12PETITION 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 specifed below, and in support thereof aver(s) the
following and respectfully requests the grant of Letters in the appropriate form:
Delbert Smith
Decedent's Information ~ ~ I
Name: Walter J Smith File No: 2'1
a/k/a: (!assigned by Register)
aIk/a:
a/k/a: Social Secullty No:
Date of Death: 0 9/2 612 01 2 Age at Deattr: 58
(State) with his/her last
Decedent was domiciled at death in Cumbedand County, PA
principal residence at 422 Walnut Street, Bolling Springs 17007 South Middleton Cumberland
Street etltlreas, Post Once end Zip Cotle City, Township or Borough County
Decedent died at 1203 East Chaves St Florence SC
Street address, Post Office and Zip Code Ciry, Township or Borough County Stale
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ...................... All personal property
Nnot domielled in Pennsylvania ................ Personal property in Pennsylvania
If not domiciled in Pennsylvania ................ Personal property in County
115,000.00
Value of real estate in PennsYlvania ................................................................... $ 151,800.00
TOTAL ES7IMATED VALUE E 268,800.00
Real estate in Pennsylvania siWated at
fAttacn addRronal sheets, i/necessary.)
Street address, Post Office antl Zip Coda City, Township or Borough County
® A. Petition for Probate -nd Grent of Letters Tesfamentarv
Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dolled
thereto dated -
State relevant circumatences (e.g., renunciafion, death orexecufor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not mar rues 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. Penton for Grant of attars of Administration (If aDPlicable)
c.t.a., tl.b.n., tl.b.n.c.f.a., pedente life, duranfe absentia. durance minonfate
If Administration, e.t.a or d.b.n.c.t.a., enter data of Will in Section A al,OVe and complete list of heirs.
In 23pPa C S~o§ 3323 (gj and waasnneitheath tvictim of a klllling ^or evefdetl)udlceted aneneapacitated pe~sonhad been established as defined
^ NO EXCEPTIONS ^ EXCEPTIONS ~v
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following ~ (if any) ead heir5~(~@~/r
O t_{~ C~
additional sheets, hnecessary): ~ ` c7 ~;; C
,~-7 ~ ,... '-r ~-, •.
Name
Relationship r"~ 1 ri
Address U+' - r-
~.. ~ f_ T
!V
C8
Form RW-02 rev +o-++-zm+
OBI05/2012 and Codicil(s)
Copyright ic) 2011 form software only The Lackner Group, Inc.
Page 1 of 2
~~
Oath of Personal Representative ORiciel Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Petitioner(s) Printed Name Petitioner(s) Printed Address
Delbert Smith 2544 Kingston Drive
Florence, SC 29505
n.>
ea
~.~ n.a
~~f ~ ~):
GG~ i r E'.
_
~
U
The Petitioner(s) above-named swear(s) or amnn(s) the statements rn me roregoing reuuwi aie uuc a~ ., •.•~~ ~r=..• •.. •~~~ ~ -o- -~.--. - -
belief of Petitioner(s) and that, as Personal Representative(s) o the dDep~edent, Petitionner(s) wtl well and truly administer fate ac ng to law.`-;-
p~YA ? /~{-/)~ ~ Data - ``.r +?
Sworn too affirmed an u scribed before ..
~~ Data ~_ m
me th' day of y~~
Dace cn ~
By:
For the Register Dale
BOND Required? ~ YES ~ NO
FEES:
Letters . .........................................
( 5 )Short Certificate(s).........
( )Renunciation(s) ..............
( )Codicil(s) ........................
( )Affidavit(s) ......................
Bond ... ..........................................
Commission ..~.. . .....................
Other ~Y! ~r
$ '' S~
-c iy>~-
Automation Fee ............................
JCS Fee .......................................
TOTAL ......................................... $ -
To the Register of Wills:
AttorneyyySignature:^^ ~-
J~ >~
<~
Printed Name: Mark A. Mateya
Supreme Court 78931
ID Number:
Firm Name:
Address: 55 W. Church Avenue
Carlisle, PA 117013
Phone: 717-241-6500
Faz: 717-241-3099
E-mail: mam~mateyalaw.com
DECREE OF THE REGISTER
Date o1'Death: 09126/2012
Social Security No: 183.50-1216
Estate of Walter) Smith File No: 21 ~ o ~ It
a/k/a:
AND NOW,
satisfactory proof having been presented before me, IT IS DECREED that Letters
are hereby granted to Delbert Smith
in the above estate and (if applicable) that the instrument(s) dated
described in the Petition be admitted to probate and filed of rewrd
in consideration of the foregoing Petition,
of
Register oTWills \` 7t / ~//~ yyy ~~- n N
Copyright (c) 2011 form software onlyy he Lackner roup, Inc~rp~yr ( 1 `Page 2 of 2
DEATH CERTIFICATI(71N
STATE FILE NUMBER: 139-12-030334
DECEDENT'S NAME: ' WALTBR J SMITH* SE\: MP_LE
SOCIAL SECURITY NURIISER: 783-50-1216
AKA's: NA
ARMED FORCES: NO
DATE OF BIRTH: FEBRUARY 12, 1954 AG E: 58 YEARS
TYPE OF PLACE OF DEATIi: HOSPICE FACILITY COUNTY OF DEATH: FORE SCE.
NAME AND ADDRESS OF PLACE OF DEATH: MCLEOD HOSPICE HOUSE, FLO RENCE, SC 29506
PLACE OF DISPOSITION: MT ZION CEMETERY
DISPOSITION LOCATION: CARLISLE, PENNSYLVANIA
METHOD OF DISPOSl1'ION: BURIAL
DECEDENT'S RESIDENCE: 2544 KINGSTON DRIVE, FLORENCE, FLORENCE CO CINTY, SC, 29505
PLACE OF BIRTH: PENNSYLVANIA MARITAL S9CATUS: NE'/IiR b1ARRIED
SURVIVING SPOUSE'S NAME: NA
FATHER'S NAME: DELBERT SMI"CH SR
MOTHER'S NAME PRIOR TO FIRST MARRIAGE: MARY BURGETT SMITH
INFORMANT'S NAME: DELBERT SMITH JR. RELATIONSHIP: BR07 HER
MAILING ADDRESS: 2544 KINGSTON DRIVL==, FLORENCE, SC, 29505
FUNERAL HOME: BROWN-PENNINGTON-ATKINS FH FOR CHRISTOPHER H HOIiFMAN, 306 W. HOME AVE. 11AR:J SVILLE, SC, 29550
FUNERAL DIRECTOR: CARL M PENNINGTON IV LR:ENSE NUMBER: 2772
EMBALMER'S NAME: STEVE R WINBURN LICENSE NUMBER: 3264
ACTUAL OR PRESUMED DATE OF DEATH : SEPTEMBER 26, 2012 MANNER OF DEATIi : NA'I'U RAL
ACTUAL OR PRESUMED TIME OF DEATH: 1540
CAUSE OF DEATH - PART I '
METASTATIC FANCREAT[C CANCER
OTHER SIGNIFICANT CONDITIONS -PART II
NA
CORONER CONTACTED? NO AUTOPSY I'ERFORDIED? NO AUTOPSY AVAILABLE" NA
DATE OF INJURY: NA TIME OF INJURI': NA ~ INJIURY AT W ORK? NA
PLACE OF INJURY: NA '
LOCATION OF INJURY: NA
HOW THE INJURY OCCURRED?
NA
CERTIFIER NAME AND TITLE: MD V1PUL I. SHAH LICENSE NUb1BEIt: 31225
CERTIF[ER'S ADDRESS: 1203 E. CHEVES ST, FLORENCE, SC, 29506 ~(.~
DATE FILED: SEPTEMBER 28, 2012
? ""
~ ~j
DATE OF ISSUANCE: OCTOBER Ol, 2012 ~?
:, - (
j yTi
SPECIAL INSTRUCTIONS: ' ~~~
NA C7 v..
~ ..~ r~r
7
~7
C.y~:. i~
-
~
:zi
'~ 3
b ' `~'7
=° C'7
r- T
~ i~~
SC02485659 !
P
This is a true certification of the facts on fde in the Division of Viml Records, SC Deparhment of HeaF.h and u
al Control.
ent
E~o
m ~~~.t~~~~ ``awcuuwsaunin~uuppyry'r~
~
j
~ i
Catherine Templeton Guang Zhao = D
H E (~
~ Director and State Registrar Assisrtant Slate Re;is[rar
lo
o
in
a
nc
l
d i ~
o _
-
This copy is no[ valid unless p g
.
g
ge
y
an
ssu
repared on an engraved border displaying the-Rate sea f o. __ _ V <U ,
~
Revision De[c 03/2l/7A12 ~G
~~/ ~~r ~B i~q'~~~ ~,
~~~~~~~
x~ ~~~ ~.mn .~a ,n uA
OF
LAST WILL AND TESTAMENT ^012 OCT I I AM 9~ 28
WALTER J. SMITH
-~, r
RE~'GF();.~; .1rr(;E
}~fc, ~ :_ ..a , ~. ~,~
;L~_ ,;
(JRPHAtv'S CGURT
(~1fu1F3ERLAND CO.. PA
I, WALTER J. SMITH, of the 422 Walnut Street, Boiling Springs, Cumberland County,
Pennsylvania, make this my will. I revoke any other wills or codicils to wills made by me.
ARTICLE I. DISTRIBUTION OF MY ESTATE
A. I give my tangible personal property to my brother, :Delbert Smith. Tangible
personal property includes stamp or coin collections but does not include other money or stock
certificates or other evidences of intangible rights or interests. Tangible personal property does
not include any property that is held primarily for investment purposes or used in connection
with any business in which I may be engaged or in which I may have amy interest at the time of
my death.
B. I give the residue of my estate, including any and all reap property which I own at
the time of my demise, to brother, Delbert Smith, per stirpes.
ARTICLE II. PAYMENT OF EXPENSES AND OTHER CHARGES
I desire a modest Christian funeral. It is my desire to be buried in the Burgett family plot
at the cemetery in Churchtown, Pennsylvania. I direct my Executor to pay my funeral and burial
expenses (including the cost of a monument or mazker over my grave). The estate, inheritance
and similaz taxes (including those not passing under this Will), assessable on my death shall also
be paid as a cost of administering my estate and my Executor shall not request any beneficiary to
pay any part of such tax.
ARTICLE III. APPOINTMENT OF FIDUCIARIES AND POWERS
I name my brother Delbert S...it1~. to be my Executor. Should he fail or czase to
act, I name Cazol Devore to be my Executrix (hereinafter "Executor",l. If administration of my
estate or trust should be necessary in any jurisdiction where my Executor or my Trustee is unable
to qualify, or if my Executor or my Trustee deems it necessary for any other reason, I give to my
Executor and my Trustee the power to designate any individual or corporation with trust powers
to serve with my Executor or my Trustee or in my Executor's or my Trustee's stead. I request
that no security be required of any Executor or Trustee, including an Executor or Trustee named
pursuant to the preceding sentence. References in my will to my "Executor" and my "Trustee"
aze to the one or ones acting at the time, except where otherwise specifically provided.
B. Any corporate Executor or Trustee shall receive for its :services the compensation
for which it is willing to undertake similar services for others at the time such services are
rendered, as evidenced by its published fee schedule in effect from time to time, unless it is
willing to agree upon a fee that is less than its customary fee. Any individual who serves as
Page 1 of 3
W j f W.J.S.
Executor or Trustee shall be entitled to receive reasonable compensation for his or her services
and, whether or not such individual receives compensation, shall be entitled to be reimbursed for
expenses incurred for such services.
C. I grant my Executor and my Trustee the powers set forth in 20 Pa.C.S. §§ 3311-
3332 and 20 Pa.C.S. §§ 7771-7780 respectively. In addition, my Trusl:ee may merge any trust
under this will with any trust having the same trustee and substantially the same dispositive
provisions. If at any time after my death the size of any trust under this will is so small that, in
the opinion of my Trustee, the trust is uneconomical to administer, my Trustee may terminate the
trust and distribute the assets to the person or persons authorized to receive the trust income in
such shazes as my Trustee may deem appropriate. No Trustee who is also an income beneficiary
of the trust at issue shall exercise any discretion granted in the preceding sentence. My Executor
and my Trustee may distribute tangible personal property passing to a nninor to any adult person
with whom the minor resides, and that person's receipt shall be a sufficient voucher in the
accounts of my Executor and my Trustee.
D. It is my desire that my Executor or alternate Executrix consult with Mateya Law
Firm in the handling of my estate, they being familiaz with my affairs.
ARTICLE IV. DEFINITIONS
The following definitions shall be applicable to all of the provisions of my Will except
where otherwise specifically stated:
1. The use of the masculine shall include the feminine or neuter and the use of the
singulaz shall include the plural, and vice versa.
2. The term "estate," where appropriate, shall include any Host hereunder.
3. The term "minor" shall mean an individual who has not attained the age of
twenty-one year~sy jJ
Executed this ~/ """ day of , 2012.
/W',~tk. ~- 11 rtl~.
Walter J. Smith
Signed, sealed, published, and declared for and as his last will and testament by the testator in
our presence, we all being present at the same time; and we, in his presence and at his request
and in the presence of each other, have subscribed our names as witriesses whereof, all on the
date last above written.
OF S~ _ ~~~~~(~013
.~` U .~~-o ~ ~C (a-.., OF -I ~Y . Wit- ~l ~ a~P~ 1 ]O t3
Page 2 of 3 wJ'f W.J.S.
COMMONWEALTH OF PENNSYLVANIA
CUMBERLAND COUNTY, to wit:
Before me, t e undersigned authority on this date personally appeazed Walter J. Smith, and
i2. AT£ A ,and /~V LL) 5 pCO U _ known to me to be the
to ator and witnes es, respectively, wh se names aze signe to the foregoing instrument and, all
of these persons being by me first duly sworn, Walter J. Smith, the testator, declazed to me and to
the witnesses in my presence that said instrument is his last will and testament and that he had
willingly signed and executed it in the presence of said witnesses as his &ee and voluntary act for
the purposes therein expressed, that said witnesses stated before me that the foregoing will was
executed and acknowledged by the testator as his last will and testament in the presence of said
witnesses who in his presence and at his request and in the presence of each other did subscribe
their rlalnes thereto as attesting witnesses on the day of the date of said will and that the testator,
at the time of the execution of said will, was over the age of eighteerl yeazs and of sound and
disposing mind and memory.
Sworn and acknowledged before me by Walter J. Smith, the testator,
A ~,~ ~ ~ ATE, witness, and 7'N~l~e~ ,witness, this
5~ay of , 2012.
Walter J. Smith
VV~t~~
Witness
y ~
with ss
. ~~ .rm,r~ehJ
Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seel
Frances A. Aumlller, Notary Public
South Middleton Twp., Cumberland County
My Cbmml;slon Expires March 16, 2014
My commission expires: Mamber, Pennsylvania Asses iatlon of Notaries
Page 3 of 3 W 3S W.J.S.