HomeMy WebLinkAbout01-07-13PETITION FO/R G/RANT OF LETTERS
REGISTER OF WILLS OF L-[-~/~.r~c'~ G-l~/V,D COUNTY, PENNSYLVANIA
Petitioner(s) named below. who islare 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:
Deceden 's Information
Name: Or'tlA:ntP /Yf, ~fYiifJ[. G
a/k/a:
a/k/a:
a/k/a:
Date of Death: f~ 3 / o?G~i,~
Decedent was domiciled at death i
principal residence at /L3 rw
File No• ~ ~ - I ~~ 15
(Assigned by Register)
Social Security No: /~~ `off ~~o,` °~'
Age at death: ~3 ,_;
~~ (Scare) with his/her last
Street address, Post Office and Zip Code City, Township or Borough Count
/ Y
Decedent died at~~t~c~ LtJ SOt~ef~ 5~ ~~/'l,i•SCP Cc~.m ~i•~C>g~ ~~/
Street address, Past Office and Zip Cnde City, Township or Borough Caun[y State
Estimate of value of decedent's property at death:
IjdonsicileAin Pennsylvania ............................ All personal property $ yC)Ot'~ . n J
/f tta[ domiciled in Pennsy!vania ........................ Personal property in Pen[tsylvania $
Ijnot domiciled in Pennsy!vania ........................ Personal property in County $
Value of realesratein Pennsylvania ......................................................... $
,~ 1 / TOTAL ESTIMATED VALUE.... $ Ob,i . cep
Real estate in Pennsylvania situated at: / ~/,~
(Annch nddi[ionn! sheets, tfnecessary.) 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
thereto dated
Codicil(s)
Slate relevant circumstances (e.g. renmmintion, dead, of executor, etc.J nl Z7 = :~ -. Cy
~j n ~ ~" :+'S -J
Except as follows: afrertheexecutionoftheinstmment(s)offeredforprobateDecedentdidnotmarry, wasnotd~rC~,toasnotapartyto,a,~ettg
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 33230; atSt~di~~tot Ita~a cltilitbatbor
adopted; attd Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ t-., ~ _ ~ r.~
^ NO EXCEPTIONS ^ EXCEPTIONS
y f.~ -~:~ ..,
J -"-•
^ B. Petition for Grant of Letters of Administratim~ (If applicable) ~ ~`' ~ `~ ~`~ ra
c.ta., d.b.a., d. b. n.c.t.a., pendentelite, durmtte absenti~'uranl'~nt~f•itute
If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs. T~t7
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined
itt 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
^NO EXCEPTIONS [l EXCEPTIONS
Petitioner(s), after a proper search has/ttave ascertained that Decedent lefr no Will and was survived by the following spouse (if any) and heirs (attach
additional sheets', i/neceesary):
Name Relationshi Address
Fn.-,~, ~w-nz ,~w. lniunnll Page 1 of 2
Oath of Personal Representative
COyt~(OV'sVE aLTH CF P~~\5`%LV.~~IL~ }
5~.
C_ 0°
Oificia; L'~su Only
e ~ ~c~ ~:c:e„
~ I 7 ~r
The Petitioner(s) above•named swear(s) or affirm(s) the statements in the foregoing Petition are tnte and correct to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law.
Swoni to or affirmed a d subscribed before ._'. p,- , ~ ~~, cr .~-~.~.~-1~ ~ ~ Date /- 7 - /~
met +'~ day of! 1~ . , 'Y , Date
By: ~ ~ ~ ~ '!l,1 Date
Far the Register ~ Date
BOND Required: Q YES NO To the Register oJWills: , _
,
FEES:
~
/ .
---,
Please enter my appearance by my signature belowr::. ~
;v t-rt
`
Letters ................... ... $ ~`~ . Attorney Signature: ~ .~~ ~~"
' ~
V~
( I )Short Certificate(s)... ... <.J t:7i -o r~ _
rn 1 C
t
~
( )Renunciation(s)...... ... ~
7p ~ ''
-
~, ..
( )Codicil(s) .......... ... ~
-,. ~
r" ~•• ~,.
( )Affidavit(s)......... ... ;,R'. - ;y: --~ „„;;
Bond ..................... ... Printed Name: cJ C"" a;.? -"'-3
Commission ............... ... Supreme Court tia '
~
Outer
....
...
ID Number: ::'; ~_'~
=:~~ !.
J .
... ~~ ._, r.
n ..
... l ~. "
Firm Name: ,~ G7
... ... Address:
..~ ~..
- Phone:
Automation Fee... .. -~
- Fax:
JCS Fee .................. ~,~
... .T~ -" Etnail:
TOTAL .................. ... $_~
DEC1~lyEE OF THE REGISTER
Estate of -~Gf7lC~lf1(r (~,~_ . QJ ~(](~~ File No: ,~ ~ -~1J1,~ - i~Ll ~,j
a/k/a:
AND NOW, ~~~~>^i J1.I 7 ~~ , in consideratio of the forgoing Petition,
satisfactory proof having been pre ented before me, IT IS ECREED that Letter ~J''~'
are hereby granted to rJ('i` ~~ i`
' in the above estate and (if applicable) that
the instrument(s) dated _)Gt'
described in the Petition be admit ed to probate and filed of
as the lash Will (and C~lici
of Decedent.
of Wills
F..,.... DLU.n) ...... ,nn ,inn„
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy I)y photostat or photograph.
REC04"~ ~ '~~~ , ~_
Fee fur this cerutlcttte. `56.00 REG n~-;, n ~ ~ This is to certify that the information here given is
~-
'~' ` --'` U( ~~ -~ correctly copal Irom an ongmal Ceruhcate of Death
duly filed ~~rith me as Loral Registrar, The original
~U.3 ~G~r~ 7 G-i? `' ilk certificate will he forccarded to the State Vital
I 1 , .~
Records Office tier permanent filing,
c~E~;~
-_~ =_- ~ ~~'-ORPHANS' C;~~g " -~~~~sc~x~ex~X' JA 3 2fl13
('crtification tiuuibcr CUMBERLAi~p ~., ~;; Local Registrar Date Issued
(YP@/PNnt In CVMMON WEALTII OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORVS
Perms"¢"` CERTIFICATE OF DEATH
1. V¢Cel¢nc•s Leaal Nam¢ (Fits[, Mltldl¢, Las[, $UMN) 2. 5@% 3. $OC191 SHCUrI[y Number 4. Da[¢ Of V@atM1 (MO/Day/Yr) ($p¢I MO)
Romaine M_ Shadle Femal 182-22-5822 December 31, 2012
Sa. Ag¢-Last Birthday (Yes) Sb. Under 1 Vear Sc. Under 1 Da E_ Data of Dirth (Mn/Day/Year) (Spill MnntF) >a. Rirtbplace (r'Ity anJ State Or For¢ign Covn[ry)
83 Months Days Hours MlnUtes Jan 28
1929 '
, >b. Birthplace (County)
Ba. R¢sldeSC
e (State or F^reign Country) Hb Residence (Street end Number -Include Apt No.) 8c_ DIJ Dece Jant Llve In a Township?
A
t' 1000 West SOUth Street wes, tlec@tlent hued In fwp.
gtl. RHSItl¢nca (County)
Cumberland 8e. Resltlence (Zip Cotle)
No, deccJCnt IlveJ wlthln limits o! Car11.410 cltV/boro.
9. Ever In U$ Armetl Forces) 1V. Marital Status a[ J line of Uea[M1 ~ Marrletl WiJOwed 11. Surviving Spouse's NHma (If wlf¢, give Hama prier M flrzi marflage)
Q Yez ® No O Unknown ~ Divorc¢d [] Never Marled [] Unknow
12. Fa[hrr'z Nam¢ (First, Middle, L?st, Sn Mn) l3. Mother's Nam¢ PHur [^ Flrzt Marriage (Fl rs[, Mltltll¢, Last)
Roy C. Shoape Velma H_ Da
14a. Informant's Nam¢ 14b, gelatlonshlp io Decetleni 14c. InformanC's Malling Atltlress (Street Hntl Number, CI[y, States, 21p Codef
o Beverly A. Britcher dau titer 1507 Terrace Ave_, Carlisle, PA 17013
c If DeatM1 Occurretl In a Hospital: Inpatlen[ ; If Death Occurred SOmewFler@ Oth@r Than a Hospital: t~ Hospice Faclll [` Decetlen['s Iloma
Q Emergency Room/OU[patlent 0 Deatl On Arrival
r Q~ Nursing Home/Long-Term Care Fa[Illty Other (Specify)
i5b. Fac111N Names (If not Insiltutlon, glue street antl number; 15c. CIN or Town, Stale, and Zlp Cotle 1Stl. <oumy of Deatli
Sarah A_ Todd Memorial Home Carlisle PA 17013
~, 16a. Matbotl of Oisposl[lon ~] Burial Q Cremation 16b. Date of Dlsposltlen
~ lGC. Plac¢ "f DlspositlOn (Nam¢ of cemetery, crematory, ur other plac¢)
p Removal from sacs p Donanon ,7
2013 Westminster Memorial Gardens
OtM1¢r (3p¢cify)
2 1Bd. Loca[lon of Disposition (CRy or Town, Sfafe, antl 21 p) >a. Sign re of Funeral 5¢rvl ¢ Lic ¢ r P r n In Charge of Interment
a 1Jb. License Number
~
~ Carlisle, PA 17013 -----~-~~-
- 013144E
E 1>r_ Name and Complet¢ Address of Funeral Facility
s _
m 18. Decedent's EJUCa[IOn Check the box [M1aC best tles[rlbes [he 19. V¢Cetl@ t Of Hlspanlc Origin -Check the 20. De[etlent's Race -CM1eck ONE OR ORF races in Indicate what
hlgM1¢s[ tl¢gr¢ r lev¢I of school coin pl¢tetl at the time of death. box [hat best d¢scrib¢z wh¢th¢r thH tl¢cetlent the tlH etlent consltleretl M1lms@If or M1erself [o be.
ffi 8th grad¢ or lass SpanlsM1/Hlspanlc/Latino. CM1eck the "NO" ® WM1ite 0 Koran
0 No tliploma, 9[M1 - 12th gratle box If tle[edent 15 not SpanlsM1/Hispanic/Latino. ~ Blatk or Afrl[an American ~ VletnHmese
p Hlgh school graduate or GED completed ® No, not Spanlzh/Hlspanlc/Latino ~ American Indian or Alaska Natlvz 0 Other gslan
~ Some college cretllt, but no tlegree O Y@s, MCxICan. M@XI<an gmencan, Chicano Q A51an Intllan ~ Nafirre Hawallan
gssocla(¢ J¢gr¢a (a.g. AA, q4) Q Yes, Puerto Rican (] CM1In@5@ Q GUamanlan Or CM1dm OrrO
~ Rachalor's da8raa (a.g. BA, AB, BS) 0 Y¢s, Cuban Q Filipino 0 Samoan
Q Mazi@~ s tl¢gr¢¢ (¢.R~ MA, M5, MEng, MEJ, MSW, MBA) 0 V¢s, Other Spanish/HlSpaniC/Latino Q laps nfs@ Q O[har PacIRC 151andar
0 Doctorate (e.g. PM1D, EtlD) or Professional tlegree ($Veclfy) ~ OtM1er (Specify) _ _ _ _._-__ _. _ _ _
. MD, DOS DVM LLB JD
21. D@cetlent'S Single 0.ace Self-Designation -Check ONLY ONE to Intllcate what [he tlecedent cons{tlereJ nim5elf or herself to be. 22a. DeCed@nt'S Usual Occupe[IOn - Intlicat¢ type of work
Whlic 0 Ice Panesa 0 Samoan don¢ tlvring mos of working Ilfe. DO NOT USE RETIgED.
C7 slack or African Am¢HCan ~ Korean ~ Other Pacific Islander HCITLIEsTfIatCEr
~ gm¢rican Indian or Alaska Native ~ VI¢[nam¢s¢ ~ Oon'[ Know/NO[ Sura
~ Asian Indian [_] Other Asian 0 Refusal 226. Kind ul gusin¢ss/Industry
0 Chln¢s¢ O NaliVa Hawallan Q Other (Specify)
~Wil Home
~ FlllPi^o [] Gua manlan ur chamurro
ITEMS 23i - 23d MVST BE COMPLETED 23a. DaC¢ Pronoun C@tl D2atl (MO Day Vr) 23b. SlRnatUrH-Of PGfSOn PrOn OU ncing Death (Only Wh@n HppIICHbI@) 23c. Llcans¢ Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH l ~ ~ / / / a
! ~ / J
)/ ~ ~ /
-
Dam caned ( o/Dav/vq
23e za. rime of Deam b /vy - L
///LrLL_ I"`~ _ N
l
J P G r L~+ LN 3/ b ~ .J f V 25. Was Metllcal Examiner or Coroner Contactetl? ~ Yas Nn
CAUSE OF DEATH APproxlmate
J5. Part L Enter the chain of a nts--Alsnasnz, Injurle!z, n mpllcatlonz--that directly r ed the death. DO NOT enter [ minal a n[z such a arllac a es[ Interval:
r
respiratory arrest, or ventrl ulcer flbrlllatlon without showing [M1e etiology. DO NV I ABBREVIA fE
.
ter Only one cause on a Ilne~ A
En
tld all
i
tl
Deal Ilnaz
lf necessary Onset t0 Dnafh
_
,
a
~
~
~
/
IMMEDIATE CAUSE - s C 1iRMl\G O'(S •5'j~4h CTYiIE PL1/r•O~./^' ! 7(SERSE sl1°AC C/~'K~T7 QJ ' ~~k'S
(Final disease o ontlinon Due to (or as a con5¢q¢enre ef):
c
resulting in deaa
)
b.
SngnentlallY Ilzl r_ ndll lainz, Due t t (a~ as a e ~rnzegnence nf)_
if any, Icaling to [h¢ C ¢
a
IhteJ on Ilnc a Enter
th¢ _
UNDERLYING CAUSE DUe to for as a consequence of):
W (tlizaas¢ or Injury tM1 at
Inltlatrd ih¢ events resulting tl. _
In tleath) LAST. Due io (or as a consequence of):
s 26. Psrt Ik Enter other IFI 1 but not resulting In tM1¢ untlerlying cause given in Pa
rt I 2>. Was an autopsy p¢rio Atli
o
~
CO'Q~JF~'[E~t-I J}(~'g r[/~CJ/1 '~~,Jf[~QE COh~~E1'T!1/E ~~F~i~VO~ ~A(L.t-l r'-~L O
~
f
O $-TEOf~QTI~R-a Y l S' C'
1~~1-I[ G A'f~~t'VM/j 28. Ware
autopSV flntlln
gs
avallable
a _
~ F~ PF-j`S r Lam, rLJ mptete [ties cause of d¢a[hi
to rnC~ Ye ~ No
4 29. If F¢mal¢: 3V. Dltl Tobac[o Vse Contribute [o Death? 31. Mannar of Death
o pregnant wltlrirr pant year ~s 0 Probably gestural O Homltltle
0 Pregnant a[ time of death Q No ~ Unknown 0 Ac ridcnt 0 Pending Inves[Iga[IOn
m Q Nnt pregnant, tint pregnant wlthln 4J days of death 0 Sulcltle Q Coultl not be de[erminetl
0 No[ pregnant, but pregnant 43 tlays to 1 year before tlea[M1 32. Da[¢ of Injury (MO/Day/Yr) (Spell Month)
Q Lln known if pregna n[ wlthln [he pas[ year 33. Tim¢ Of Injury
34. Plac¢ of Injury (¢.g. M1ome; construction site; farm; school) 35. Location of In)Ury (Scree[ and Number, Clty, S[at¢, Zip Code)
3G. Injury a[ Work ]J. If Transportation Injury, Specify: 38. O¢scrlba How Injury Ocurr¢d_
Yes Q Orlvar/Operator ~ P¢d¢zirlan
0 Na ~ Passenger ~ OtM1¢r (SPeclfyl '
39a. Ce~Slfler (Check only one):
B'Certl(yln8 Physician -TO tM1e best of my knowl¢lg¢, death o rod tlua [o [M1a cause(s) antl m statetl '.
0 Pronouncing 8. C¢rtifying physician - To tM1C bast o£ my knowlalge, l¢a[h o cad at [ha tim¢, data, and playa, and due to the c. se(c) and n stated
r
0 Medltal Examiner/Coroner - On [M1e b cis of a%amina[lon, antl/or Inv¢itiga[lonr In my opinion, tleath occurrel at the [line, tlate, antl plac¢, antl tlue
to the cause(s) antl manner stated
Slgna[ure of tertlfler; _. -._ _ __ _.._ TI[le oT [ertlf er: M~ Lic¢ns2 Number: ~'~ -0,'fe ~~ •-`- i
396. Name, Atltlress antl Zlp C"tle of Person Comple[InR Cause of Death fltem 261 39t. Data Slgn¢l (MO/Day/Yr)
tA/u-t-( w+'L+ S KYaa.fFMny[J MO f 42t spCiN6 IP_oM C~'L~I S~-E W l ~O f 3 / ~3 / zo 13
40- Regiz[~~ Dirtrl`t
NU mbar 41_ Regls[rar'z a2. Registrar FIIC Uat¢ (MO Day r)
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~~ ~ 3
a3. Am¢ntlmentz
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else^sitlnn Permit Nn. [ /4 ~ - \ ~7 `i~~ REV OJ/2011
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LAST WILL
Gloria J. McPherson, Esgtiire
CRAMER & MCPHERSON
Village Square Plaza 3-B
Shermansdale, PA 17090
I, Romaine M. Shadle, of Southwest Madison Township, Perry
:.ounty, Pennsylvania, declare this to be my Last Will, hereby
revoking all prior Wills and Codicils.
FIRST: I direct that the expenses of my last illness and
neral be paid out of my estate as soon after my death as is
nvenient and expeditious in the judgment of my Executrix,
reinafter named.
SECOND: I give, devise and bequeath my entire esta-ce to my
daughtez, Beverly A. Britcher, provided she survive me by a period
of thirty days.
THIRD: Should my daughter, Beverly A. Britcher, predecease
me or die on or before the thirtieth day following my death, then
and in that event, I give, devise and bequeath my entire estate to
my two grandsons, Shane M. Britcher and Shawn M. Britcher, in equal
shares, share and share alike.
FOURTH: Should any person less than 18 years of age be
entitled to distribution from my estate, I nominate, constitute
and appoint the parent or parents of such person to act as Guardian
of the estate of such person and I authorize and direct said
Guardian to invest the same and to pay the income arising therefrom
together as in the opinion of said Guardian is necessary or
desirable to be expended far the proper maintenance, support and
education of such person, and upon such person attaining 18 years
of age to pay to him or her the then remaining principal together
with any undistributed income.
FIFTH: All estate, inheritance, and other death taxes,
together with any interest and penalties, payable with respect to
property or interests therein subject to taxation by reason of my
death and whether passing under my will or any codicil thereto, or
otherwise, including jointly held and other non-testamentary
property, shall be paid out of the principal of my residuary estate
without apportionment. ~ w ~ ~
~ o r~ ~
SIXTH: I hereby nominate, constitute an~~poin~nmy~82ighter,
Beverly A. Britcher, Executrix of this my ~a~tr~..Wi{l. ~'~tuld my
daughter, Beverly A. Britcher, be unable to~rs~r~ f,9r ~„i~!y reason
whatsoever, then and in that event, I nom~u~$:~ cons~t~lte and
appoint my son-in-law, Donald L. Britcher, Ex~'CF~ttar Q~ th~s~.nny Last
.:,
=' ;~ .: a
c.~. 1 ~¢
y _..,
-- _.r^ fr, c~~
I 1 ~ ^~
(Will. I further direct that they shall not be required to post any
bond to secure the faithful performance of their duties in the
Commonwealth of Pennsylvania or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this my Last Will and Testament, which consists of two (2) sheets
of paper, dated this.. ~'7~ day of September, 1990.
~rn`L(Gx.¢/ /~~__~~~~r~y` __( SEAL )
R aine iii. Shadle
Gloria J. McPherson, Esquire
CRAMER 8 MCPHERSON
Village Square Plaza 3-B
Sheemansdale, PA 77090
The writing contained on this and the one preceding page was
signed and sealed by Romaine M. Shadle and by her published and
declared as her Last Will, in the presence of us, who have hereunto
subscribed our names as witnesses at her request, in her presence,
and in the presence of each other.
i ,~ ~
~,/ it - ,
2
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF PERRY
I, Romaine M. Shadle, testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes
therein expressed.
~~~21X~,,~o .) ~~~,-GJ~t~`~~
Romaine~M. Shadle
SWORN or affirmed to and acknowledged
before me by Romaine M. Shadle,
testatrix, this j'~ /6~ day of
September, 1990.
~G~ ~ C
~~ ~~
lJOtzry lic
NOTARIAL SEAL WbRtr
GLORIA d. MoPHERSON.cN n~ A
Carro!I TwP. Perry
pity Commission Exp!res Apr<! 27, 1992
Gloria J. McPherson, Esquire
CRAMER d MCP HERSON
Village Square Plaza 3-B
Shermansdale, PA 17090
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF PERRY
~~
We, V \~ok\Y~~c~., .~p-~G,~~V~~ and- ~~U~Ig (~ ~~_ l TC ffc`~,~
the witnesses ose nom are steed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw testatrix sign and execute the
instrument as her Last Will; that she signed willingly and that she
executed it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the
testatrix signed the will as witnesses; and that to the best of our
knowledge the testatrix was at the time 18 or more years of age,
of sound mind and under no constraint or undue influence.
v _ r
~ ~ ~:
SWORN or affirmed to and scribed
to before me by U1 ~ e>v~.~p ~~r~c_
and Debora ~\. ~ritCt e r itnessess~s,
this ~-i~.~v~ day of ~,pfi~,-~-~{~~r 1990.
e~~_
Notary PiXblic
NOTARIAL SEAT.
GLORIA J. McPHERSON, Notary GubNR
CarroO Twp., Perry County, PA
My Commission Expires ApFtil 27, 1992
Gloria J. McPherson, Esquire
CRAMER & MCPHERSON
Village Square Plaza 3-B
Shermansdale, PA 17090