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PETITION FOR GRANT OF LETTERS
REGISTER OF WII,LS OF C'_~rn~~ 1t1Y1 COUNT', PENNSYLVANIA
Petitioner(s) named below, who is/aze 18 yeazs of age or older, apply(ies) for betters as specified below, and in
support thereof aver(s) the following and respectfully request(s) the grant of Letters ins the appropriate form:
Decedent's Information
Name: SYlir1tT~ , ~YYxY~xr~
a/k/a:
a/k/a:
a/k/a:
Date of Death: 'IYYI V YI'l . aC)1 ~
Decedent was domic
principal residence at
Decedent died at '~(~
Street
Estimate of value of decade
Ijdomiciled in Penns)
Ijnot domiciled in Pe.
Ijnot domiciled in Pe.
Value of real estate in
at death in (~,(lmhp Y N x~il c~
address, Post OtBee and Zip Code
Post
File No: oL ~ - ~~ - ~/ /V
(Assigned by Register)
Social Securiity No: I Q 5- 3 2- - ('A c~S 3
Age at death: ~ oZ
(State) with his/her last
Ctty, Township or
County
City, Township or
sty at death:
....................... All personal property
ia ........................ Personal property in Pennsylvania
ia ........................ Personal property in County
Real estate in Pennsylvania sihjated at:
(Attach additionaf sheets, if necessary.)
TOTAL ESTIMATED VALLfE... .
Codhty State
~~hga+zon ~nl~
$~
$~
S 0 00
Street address, Post Omce and Zip Code City, Township or Borough County
A. Petition for Pro ate and Grant of Letters Testamenta
Petitioner(s) aver(s) he/sh /they is/are the Executor(s) named in the last Will of the Decedent, dated _l i la- 1 q ~ and Codicil(s)
thereto dated '~
'. State relevant c[rcumstances (eg. renunciadoq death of executor, ,etc)
Except as follows: after th execution ofthe instrument(s)offered for probate Decedent did not marry, was notdivorced, was notaparty toapending
divorce proceeding where~n the grounds for divorce had been established as defined in 23 Pa. C.S. {¢ 3323(8), and did not have a child bon or
adopted; and Decedent w neither the victim of a killing nor ever adjudicated an incapacitated person.
NO EXCEPTTONS ~ EXCEPTIONS
^ B. Petition for Grant of Letters of Administration (If applicable)
', at.a., d.b.n., db.n.c.t.a., pendente lice, durance absentia, durance minoritate
If Administration, cjt.a or d.b.n.c.t.a., enter date of Will in Section A above and comulete list of heirs.
Except as follows: Decedent was not a party toapending divorce proceeding wherein the grounds fior divorce had been,~s3ablished as defined
in 23 Pa. C.S. § 3323(8) d was neither the victim of a killing nor ever adjudicated an incapacitated perso~ "=e
`O rJ ~
NO EXCEPTIONS EXCEPTIONS rTt C"'>
ti ~
Petitioner(s), afterapropet~search has/have ascertained[hat Decedent left no Will and was survived by thefoil Spouse (iP&ly)an~i~attach
additional sheets, if neces.)ary): +- ~:'. 1 ~ ~. ~?~
~r~~- ~ ::-i C7
Name Relationshi Ad s "O
C ~. =C
~,' F. m
T
Form RW-02 rev. fonuaou Page 1 oft
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
/~ } SS:
COUNTY OF \ a)(Y1hP.1" ~CIYI f'~ }
Official Use Only
The Petitioner(s) above-named wear(s) or affirm(s) the statements in the foregoing Petition are tme and coaect to the best of the knowledge and belief
of Petitioner(s) and that, as Per oral Representative(s) of the ,Decedent, t~hle nPetitioner(s) will well and truly administer the estate according to law.
Sworn to or a~trmed a d ,ubscribed before ~W ~'tG eex Date 1 l~ - ~ 3- 20 I Z
m 213 ~ day of ` Date
$~ ~ Date
For the Regisrer n Date rwu'`
~ i~ n
O
~ ~ C)
BOND Required: Q YE~ O To the Register of Wi((s: 17 t`.: ~' ac _ T
Please enter m a ance b m sin ~~~elow: -' ~'~
FEES: Y P Y Y g ., t r t n~
Letters .......... IL ..... $~I~` Attorney ature: ~' . ~ ,; ;'.
~L ~ T.
( ~) Short Certificate(e ......
( )Renunciation(s)......... " '"' ' v ~~
.. ~-. rl
( ) t.'Odlell(a) . ............ ~ L7
( ) U.....
Affidavits ~ ~ ~ ~ • • note s
Bond .............. I...... ' ~
Commission........... i,...... Supreme Court
O he ..... ID Number: Rt~p--~
I is. o~ ~1 yy
..... Firm Name: K~IL1~- '~ C~ ~~~
~. ..... Address:
I
..... Phone: ~JJ-]~ ~ C~
Automation Fee........ all ...... Fax:
JCS Fee ..............:....... _=~~~~~~ Email: ('_YY)fiYC/'t .CCU
TOTAL . .............I...... $
I, DECREE OF THE REGISTER ~--7
Estate of File No: ~~ ~ - ~t~ - ~~
a/k/a: // J~ /gym
AND NOW, Lp~ y, ~Vf A I 1 ,r ~U ~~in consid ration of th foregoing Petition,
satisfactory proof having een presented before me, I'1' IS DEC~E th t Letters~^
are hereby granted to f20 f l lti (~ t~Q.~2 lLf
in the above estate and (if applicable) that
the instrtmnent(s) dated ~ D V 2YY) ~~-; ~
described in the Petition a admitted to probate and filed of record as the last Will (ancl Codicil(s)) of DecedQent.
C I"
'I Register of Wills ~~~
Form RW-oz rev. roiunou III Page 2 of t
O.'\"
LOCA ~~rr 'S CERTIFICATION OF DEATH
WARNM I I~ga~plicate this copy by photostat or photograph.
I
n '~J;Ci~' ,. ..-v
Fee (or this certificate, $6.00
~ 6Y
P 18487910
Certification Number
Pa/P,Int m
?alt NOY -6 PPS i~ I I
ORPWa~V"s ~OURi
i;l1MBERLAND CO., PA
This is to certify that the information here given is
correctly copied from an originx] Certificate of Death
duly filed with me as Local Registrar. The original
certificate will he forwarded to [he State Vital
tt,,~'~~Records Office for permanent tiling.
L_.~titvr•~1~~+~xa~>E~cti,~.,¢,r' MAC 2 9/2012
Local Registrar Date Issued
COMMONWEALTH OF PFNNEV LVgNIA • DEPARTMENT OF HEALTH VITAL RECOR03
!`C OTE CEf`wre• rx
Oacaaant•x lapl Nama (Flirt, Mltlal um06 `r:
as , u 3 Sen 5 al5acu,l<y Numbs, q. a e or D¢a<M1 (MO Day/Y,) (Hpell Me)
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flEV OT 3011
~~~t i11 ~.n~ C~TP~t~tmPnt
I, SHIRLEY J. GRAHAM, Penn Township, Cumberland County,
Pennsylvania, declare this to be my last will and revgke any.'-~iril:
previously, made by me.
~~
?~ ~ i
~ T7 ~_'
m -r~ c ~ -~
n 1:: ~
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v~-,-
I. I devise and bequeath all of my estate oit~everys
~11
nature and wherever situate to my husband, RO)!IALD G. ~tP~iAM,
N
providing the shall survive me by thirty days.
I~,I. Should my husband RONALD G. GRAE[AM, predecease me
or die on or before the thirtieth day following my death, I
devise and' bequeath all of my estate of every nature and wherever
situate iri three equal shares to such of the following persons a
survive mei by thirty days:
A. One share to my son, DANIEL J. GRAHAM. Shoul
my son, DI~NIEL J. GRAHAM, predecease me or die on or before the
thirtieth'day following my death, I devise and bequeath the shat
of such chjild to his issue per stirpes living on the thirty-fi
day following my death.
B. One share to my son, RONALI> G. GRAHAM, JR.
Should my 's on, RONALD G. GRAHAM, JR., predecease me or die on or
before the thirtieth day following my death, ]: devise and
bequeath the share of such child to his issue per stirpes living
on the thirty-first day foilowin my death.
i
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C. One share to be distributed equally among my
daughter, DEBRA C. SHIELDS, my grandson, BENJi!1MIN E. SHIELDS, and
my grandson, ANDREW A. SHIELDS, or to the survivors or survivor
of them living on the thirty-first day following my death.
D. If there is any share to which no one is
entitled under the preceding provisions of this paragraph, such
sihare shall~l be added equally to the other shares provided for in
thhis paragraph.
III. I appoint CCNB BANK N.A., OF NEWVILLE, CUMBERLAND
COUNTY, PENNSYLVANIA, or its successor, guardian of any property
w]iich passes either under this will or otherwise to a minor and
w:ith respect to whom I am authorized to appoint a guardian and
have not otherwise specifically done so, provided that this
I a~>pointmenjt of a guardian shall not supersede the right of any
fiduciary I~in its discretion to distribute a share where possible
j to the miner or to another for the minor's benefit. Such
guardian s~all have the power to use principal as well as income
from time o time for the minor's support and education
i
j (i.ncluding~college education, both graduate and undergraduate)
without re~ard to his or her parent's ability to provide for such
support an~Z education, or to make payment for these purposes,
without fu~ther responsibility, to the minor or to the minor's
parent or ~o any person taking care of the minor.
IV. I direct that all taxes that may be assessed in
consequenc@ of my death, of whatever nature and by whatever
jurisdictipn imposed, shall be paid from my residuary estate as a
part of the expense of the administration of my estate.
V. I appoint my husband, RONALD G. GRAHAM, executor of
this my list will. Should my husband RONALD G. GRAHAM, fail to
qualify oY cease to act as executor, I appoint my son, DANIEL J.
G'.RAHAM, executor of this my last will. Should my son, DANIEL J.
GRAHAM, fail to qualify or cease to act as executor, I appoint my
i
~ son, RONA~,D G. GRAHAM, JR., executor of this my last will.
~I. I direct that my executor and guardian or their
successor shall not be required to give bond for the faithful
I
i performan e of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this
~~~
~ I LEY J. GRAH~
I
The receding instrument, consisting of this and two other
typewritt n pages identified by the signature of the testatrix,
SI~IRLEY J. GRAHAM, was on the day and date thereof signed,
published and declared by SHIRLEY J. GRAHAM, the testatrix
therein na ed, as and for her last will, in tYie presence of us,
who, at her request, in her presence, and in the presence of each
oi:her h ve sub 'bed our names as witnesses k~ereto.
~" ~
°~ ~ ~ -i ~~
~E~~~~ ~~~__ i rl ,t 0
RFT:, ~ I i c
2~I!2 tdOV -6 Ply 1 ~ 12
ORPi-1A;do ~;~Uhl' OATH OF SUBSCRIBING WITNESS(ES)
CUMBERLANC CO., ~A
REGISTER OF WILLS
L.~l r~ COUNTY, PENNSYLVANIA
Estate of ~~ ~`'~ ~ - ~ ~~ ` " 7 ~~ / ,Deceased
~ ~ C ~ 'L/
/Z
~ ~
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r
, j each) a subscribing witness to
0
the~Will D Codici (Print Names)
(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she / h /they was /were present and saw the above Testator /Testatrix sign the same
and that she / he / hey signed the same and that she / he /they signed as a witness at the request of
the Testator /Test trix in her /his presence and in the presence of each other.
r
e,
~ ~~
(,gnaMr V/~ L / ..t~ ~ ~~°. l (Signaturel/ r /(/~ ~h /- /.~~'~~-~~y/~~., ~ r' G'/J ~
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(Scree! Address) (Street Address)
(City, Smte, Zip) (City, State, ZiP)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirme and subscribed Sworn to or affirmled and subscribed
before me this ~ day before me this _ day
of ~ , cQ ~r~-. of ,
Deputy for Register f ~ Is Notary Public
My Commission Eixpires:
(Signature and Seal of Notary or other official qualified to
~, administer oaths. Show dare of expiration of Notary's Commission.)
NOTE: To 6e taken by Offi~per authorized [o administer oaths. Please have present the original or copy of instrument(s) at time of notarization
Form RW-03 rev. 10.13.06