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PETITION 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: RICHARD F. ANDERSON
a/k/a:
a/k/a:
a/k/a:
Date of Death: JUNE 8, 2012
File No: ~ ~ ' ~ ~ - (~~~
(Assigned by Register)
Social Security No: 161-34-2292
Age at death: 68
Decedent was domiciled at death in CUMBERLAND County, PENN~yL.VANIA (stare) with his/her last
principal residence at 8 EAST FIRST STREET BOILING SPRINGS PA 17007 _ SOUTH MIDDLETON CUMBERLAND
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at SARAH A. TODD MEMORIAL HOME CARLISLE 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 $ 4,000.00
If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................Personal property in County $
Value of real estate in Pennsylvania ......................................................... $
_-
TOTAL ESTIMATED VALUE.... $ 4,000.00
Real estate in Pennsylvania situated at: NONE
(Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County
A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated JUNE 7, 2012 and Codicil(s)
thereto dated NONE
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 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.
Q 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., pendente Zile, durante absentia, durante minoritate
If Administration, c.t.a. or r~b.n.c.t.a., enter date of Will in Section A above and complete 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 o 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):
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Form RW-02 rev. 10/I1/2011 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
itioner(s) Printed Name
CAROLE A. ANDERSON
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8 EAST FIRST STREET, B
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the best ofthe knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of they ]~edent the etitio
~ ,yier(s) will well and truly administer the estate according to law.
Sworn to pr affirmed subscribed before (. ~ (_ t--~ ~ l~•~'w.~.., ~. Date ~- / ~- ~ ; ~ '3
me th' '~i~~~'day of ° ' ,~~ Date
By:
Date
'F the Register Date
BOND Required: ®YES Q NO
FEES:
Letters ...................... $ ~ L Ca i)
( ~) Short Certificate(s)...... ~ y i~
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( }Affidavit(s)........... .
Bond ........................
Commission ................. .
Other
i~l ....... ~~~
~? ....... _~ - Dc~
' ....... - ._Ut~
Automation Fee ............. .
JCS Fee . .................. .
TOTAL ....................
To the Register of Walls:
Please enter my appearance by my signature below:
Attorney Signature:
Printed_ ame: JAME M. ROBINSON
Supreme Court
ID Number: 84133
Firm Name:
Address:
Official Only
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itioner(s) Printed A-~dr~s$ ".r -t-~ ~ °~;
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TURO ROBINSON ATTORNEYS AT LAW
Phone: (717) 245-9688
Fax: (7171245-2165
Email: ~ insnn tt~rnlaw cnm
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DECREE OF THE REGISTER
Estate of RICHARD F. ANDERSON File No: ~ f - ~ ~ - ~ ~%'
a/k/a:
AND NOW, / , in consideration of the foregoing Petition,
satisfactory proof ha mg been prese before me, IT IS DECREED that Letters Testamentary
are hereby granted to Carole A. Anderson
in the above estate and (if applicable) that
the instrument(s) dated June 7, 2012
described in the Petition be admitted to probate and filed of record ~s the last Wi~l (and Codicil()) of Decedent.
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Register of Wills
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Form RW-02 rev. 10/11/2011 ~ ~
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/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
manent CERTIFICATE OF DEATH
ick Ink _. _.. ..
1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo)
~ a ~ v~d~v-,~ 1~1- 3~l- ~ [~ ~t~~ ~ aria
Sa. Age-last Birthday (Vrs) 56. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (Mo/Day/Vear) (Spell Month) 7a. Birthplace (City and State or Foreign Country)
R Months Days Hours Minutes T G~ ~` h.f (.
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7b. Birthplace (County) ~ ~
8a. Residence (State or Foreign Country) Bb
Residence (SVe
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t and Number
Include Apt No.) S
c
Did Decedent Live in a Township?
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1 / 1
Lntes, decedent lived in
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8d. Re idence (County) n YS
51 {'(~.f.'_
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LL Be. Residence (Zip Codej ~ - ^No, decedent lived within limits of city/born.
9. Ever In US AJr ~ed Forces? 10. Marital Status at lime of Death Married ^ Widowed 11. Surviving Spouse's Name (If wife, glue name prior to first marriage]
^Ves BNo ^Unknown ^Divorced ^Never Married ^Unknown ~I~ ~, - PV...~
12. Father's Name (First, Middle, last, Suffix) 13. Mother's Name Prior to Firs[ Marriage (First, Middle, Last)
F i /~,~LC~~-~ ,~ ~ . , d
14a. Informant's Name 146. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Codel
o c~P V" I • 55 ~c.Lg ~ ~i ~ 5 P_'I' Ct ~ J ri ~ '] OD
ri .................................................. •........ .......................................... ........ lSa. P ace o Deat...{Check only one
z
It Death Oaurred in a Hospital: Inpatient ,
...............................
WW ., .............................................................................
:I( Death Occurred Somewhere Other Than a Hospital: L~ Hospice Facility ^ Decedent's Home
~ Emer enc Room Out anent
^ B Y / p ^ Dead on Arrival
[(Nursing Home/LOng~Term Care facility Other (Specify)
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w lSb. Facility Name (If not instltutlon, give street and number' lSc. City or Town, State, and Zip Code lSd. C
ounty of De
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th
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LL .h ,"- ' n h ow.~2_ n
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C(,<Y i , ~ C_ PA ) ~ ~) ~ ~=1~ ~^n 1~ -V-~
r 16a. Method of Disposition ^ Burial Cremation 16b. Date of Disposition 16c. Place of Disposifion (Name of cemetery, crematory, or other place)
v ^ Removal from State ^ Donation rr 11
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l a yy~
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pp
- ^ Other (Speclty) l
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kP DV~1.a rl_t Lt
4ll'ln r fuy.Q.trc
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Z 16d. Location of Disposition (City or Town, State, and Zip) 17
a Slg~ature of Funeral Service licensee or Person in Charge of Interment 17b. License Number
/
E 17c. Name and Complete Address of Funeral Facility
C.r~vYluio 3'7 E
m 18. ecedent's Educatio Check the how that best describes the 19. Decedent o spank Origin - Check the 20. Decedent's Race ~ Check E OR MORE races to indcate what
° highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be,
^ 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" hlte ^ Korean
^ fro diploma, 9th - 12th grade b
oz
if decedent is not Spanish/Hispanic/Latino. ^ Black or African American ^ Vietnamese
_
`
High school graduate or GED completed {~rvo, not Spanish/Hispanic/Latino ^ American Indian or Alaska Native ^ Other Asian
^ Some college credit, but no degree ^ Yes, Mexican, Mexican American, Chicano ^ Asian Indian ^ Native Hawaiian
^ Associate degree (e.g. AA, AS) ^Ves, Puerto Rican ^ Chinese ^ Guamanian or Chamorro
^ Bachelor's degree (e.g. BA, A8, BS) ^Ves, Cuban ^ FIIlpino ^ Samoan
^ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ^ Yes, other Spanish/Hispanic/Latino ^lapanese ^ Other Pacific Islander
^ Doctorate (e.g. PhD, EdD) or Professional degree (Specify) ^ Other (Specify)
e.. MD, DDS, DVM LLB, 1D
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Oaupation -Indicate type of work
[i.~Nhlte ^lapanese ^ Samoan done during most of working life. DO NO7 USE RETIRED.
^ Black or African American ^ Korean ^ Other Pacific Islander
^ American Indian or Alaska Native ^ Vietnamese ^ Don't Know/Not Sure e,~.
^ Asian Indian ^ Other Asian ^ Refused 226. Kind of Business/Industry
^ Chinese ^ Native Hawaiian ^ Other (Specify)
^ Filipino ^ Guamanian or Chamorro
2W: ~ ra : C)iY.
ITEMS 23a - 23d MUSt BE COMPLETED 23a Date Pronounced Dead (MO/Day/Yr) 23b. Signature of Person Pronouncing Death (Only when applicable] 23c. License Nu
ber
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BY PERSON WHO PRONOUNCES OR C~, n
CERTIFIES DEATH ~~'V'L~ Cj c~}C~ \'a- ~
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23d Date Signed (MO/Day/Yr) 24. Time
of Death \ C-'\t~y'~' 1~ ~ C `^~~''r"~Z- v
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~~ 25. Was Medical Examiner or Coroner Contacted? ^ Yes No
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 fibril
lation without showing the etiol
o
gy. 00 NOT ABBREVIATE. Enter only on
e cause on a line. Add additional lines i( necessary ~ Onset to Death
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IMMEDIATE CAUSE > a. / "~ ~ / ~ S (~ T I L /Cit=1L) {~ (~ C. C), l~ C A'17~ / A/U'r'r ~~ ' P~'Livt~ Y/-/-$
(Final disease or condition Due to (or as a Consequence ofj
resulting in death)
b.
Sequentially list conditions, Due to (or as a consequence of):
if any, leading to the cause
listed on line a. Enter fhe c.
UNDERLYING CAUSE Due [o (or as a consequence of).
(disease or injury that
F initiated the events resulting d.
u in death) LAST. Due to (or as a consequence of)-.
S 26. Part II, Enter other Significant conditions contributing to death but not resulting in [he underlying cause given in Part I 27. Was an autopsy performed?
0
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~ Liu p1'[, /'/~"/r_Cii2L_
///V C IN i /a ~~/ i~' /J [?}'L S Ml~ LL/ TIC S
^ ves No
' , 28. Were autopsy findings available
m to complete the cause of death?
^ Yes No
_ 29. I(Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death
E
o ^ Not pregnant within past year ^Ves Probably ~ Natural ^ Homicide
v ^ Pregnant at time of death ^ No ~ Unknown ^ Accident ^ Pending Investigation
m ^ Not pregnant, but pregnant within 42 days of death ^ Suicide ^ Could not 6e determined
° ^ Not pregnant, but pregnant 43 days [0 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month)
^ Unknown if pregnant within the past year 33. Time of Injury
34. Place of In(ury (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 Otturred:
^Ves ^ Driver/Operator ^ Pedestrian
^ No ^ Passenger ^ Other (Specify)
I 39a. Certifier (Check only one):
I ~ Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated
i, ^ Pronouncing & Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated
~~,. ^ Medical Examiner/Cor
e
r - On the
bas's of examinat
i
on, and/
o
r Investigation, in my opinion, death
ccurred at the time, date, and place, and due to the cause(s) and manner stated
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er:
Title of rertiher:
License Number:
39b. Name, Address and Zlp Code a erson Completing Cause of Death (Item Z6) 39c. Date Signed (MO/Day/Yr)
/SAnnr=c~a.~ tNvvn, ~rf~ 13Si~ Luxr2.rn~,v i~ pd,~7niv- S{'2 DES /'r} /7u~7 ~~. // -~~,-
40. Registrar's District Number 41. Regis r' 'gnat a 42. Registrar Flle Dale (MO/Day r)
d~~a~~ ~ ~i~rf'~>~
43. Amendments
y ) H105-143
Disposition Permit No. ~~ / ~ / ~ REV 07/2011
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RICHARD F. ANDERSON ~~~ My ~ _T' , r~
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I, Richard F. Anderson, of 8 East First Street, Boiling Springs(' Cumberland
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County, Pennsylvania, being of sound and disposing mind, memory and understanding,
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do make, publish and declare this to be my Last Will and Testament, hereby revoking
and making void all previous Wills and Codicils heretofore made by me.
FIRST
I order and direct my personal representative hereinafter named to pay all of my
just debts, funeral expenses and expenses involved or connected with the
administration of my estate as soon after my death as is reasonably possible. However,
my personal representative need not accelerate and pay those unmatured obligations
which, in her opinion, it might be proper and more advantageous to retain or renew and
pay as they become due and payable. If I do not own a burial plot or a grave marker at
the time of my death, I authorize my personal representative, in her sole discretion, to
purchase a burial plot and to erect a suitable marker at my grave, and to expend sums
from my estate for this purpose.
SECOND
I give and bequeath the following items of property to the persons listed,
providing they survive me by sixty (60) days:
1. To my beloved daughter, Alice L. Anderson, of Harrisburg, Dauphin County,
Pennsylvania, I leave four (4) rifles of her choosing, one for each of my
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grandchildren and one for her, and I leave any item of property that may have
special sentimental value to her.
2. To my beloved daughter, Sonny J. Goodyear, of Camp Hill, Cumberland
County, Pennsylvania, I leave one item of my property that may have sentimental
value to her, if she so chooses.
3. To my beloved daughter, Amy L. Zilka, of Mechanicsburg, Cumberland County,
Pennsylvania, I leave one item of my property that may have sentimental value to
her.
4. To my dear friend, Danny Gould, of Steelton, Dauphin County, Pennsylvania, I
leave my binoculars in the blaze orange case.
5. To my dear friend, Brian Gould, of Steelton, Dauphin County, Pennsylvania, I
leave my long-range binoculars and tripod which I know he will properly care for
and use during future hunting trips.
6. To my wife's son-in-law, Mark E. Biggs, of Mechanicsburg, Cumberland County,
Pennsylvania, I leave my 357 Magnum handgun, or such other handgun he may
want.
7. To my best buddy, Greg Giles, of Boiling Springs, Cumberland County, I leave
my Ruger 204 caliber single shot rifle. ~~ ~ ~~ ~ ~,~~ j
THIRD
I give, devise and bequeath rest, remainder and residue of my estate together
with all insurance proceeds thereon of whatsoever nature and wheresoever situate to
my beloved wife, Carole A. Anderson, providing that she survives me by sixty (60)
days.
FOURTH
I nominate, constitute and appoint my wife, Carole A. Anderson, of Boiling
Springs, Cumberland County, Pennsylvania, Executrix of this my Last Will and
Testament. I direct that my personal representative shall not be required to give or post
bond for the faithful performance of her duties in this or any other jurisdiction.
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FIFTH
I hereby declare it to be my expressed desire that my personal representative
employ Turo Robinson Attorneys at Law, of Cumberland County, Pennsylvania, for legal
advice and assistance regarding this my Last Will and Testament, they having
considerable knowledge of my affairs, views and wishes respecting any matters that
may arise at the probate of this instrument, the administration of my estate, and the
execution of the powers herein mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and
Testament this ~ `~ day of ~~ ~ -,~ , 2012.
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Witness
.~ _
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Richard F. Anderson
t t ' ~ f k ~ f s ~1' ~ 1 E
W tness ~
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
I, Richard F. Anderson, the Testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to the law, do hereby
acknowledge that I signed and executed the instrument as my Last Will and Testament;
that I signed it willingly, and that I signed it as my free and voluntary act for the
purposes therein expressed.
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Richard F. Anderson
Sworn or affirmed and acknowledged before me by Richard F. Anderson, the
Testator, this ~' '~'~ day of _.~ ~~.~ .~, ~-~ , 2012.
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CONPMONVilEALTN C?A= r~::~P,~~Y~e~,rANIR
Notarial Seal
James l~. Robinson, Notary ~-~~l~+lic !
Carlisle i0oro, Cumberlan+s County
My Commission ~x~irea June 6, 2013
Member, Penn3ylvao~ia ,~ss+,~.i~£son of`"
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
We,
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whose names are attached to the foregoing document, being duly qualified according to
the law, do depose and say that we were present and saw Testator sign and execute
the instrument as his Last Will and Testament; that he signed willingly and that he
executed it as his free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the Testator signed the Last Will and
Testament as witnesses and that to the best of our knowledge the Testator was at the
time 18 or more years of age, of sound mind and under no constraint or undue
influence.
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Sworn or affirmed and subscribed before me by >._ ~..~ ~. -;:~Y~ ~ .~._~ and
~~~~~~:-r~r~~. ~~:~~~~~_~~~~.~ this ,~- ~-~~ day of ~~~:-.~ 2012.
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Notary Public
nravr~9~!V~HL~'H OF ~ENNSi'LVANIA
fVotarial deal
~ya~!es tUt. Robinson, NC~t~~~y P;ablic
Ca+!~5~~' B6P0, Ca~mberland G~aunty
y Comr;3ission Expires ,rune 6, 2(t13
e~, Penitsylvanla Ass~oci~ti~ n ~,~ ~~~r.e~