Loading...
HomeMy WebLinkAbout01-24-13PETITION 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: John E. Shiley. Jr. and Kimberly J. Grundon Decedent's Information Name: Barbara L. Shiley File No: 21-13 CJC~~ 1 a/k/a: (Assigned by Register) a!k/a: a/k/a: Social Security No: Date of Death: 01/01/2013 Age at Death: 73 Decedent was domiciled at death in Cumberland County, pA (State) with his/her last principal residence at 205 South Enola Drive, Enola 17025 Casa ~~ h ~ S ~ ~~riela~. Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 205 South Enola Drive ~~clr -~~ ~iy-NS 1~o,rT Cumberland PA Street address. Post Office and Zip Code City, Township or Borough County State ~~ Estimate of value of decedent's property at death: Ifdomiciled in Pennsylvania ...................... All personal property $ 50,000.00 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 $ 10/05/2006 Real estate in Pennsylvania situated at 205 South Enola Drive, Enola 17025 Enola Cumberland (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough © 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 50,000.00 100,000.00 County and Codicil(s) 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 mar 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. ~9323(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. Petition for Grant of Letters of Administration (If applicable) c. t. a., d.b.n., d.b.n.c.t.a., pedente life, durante absentia. durante minoritate 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. Except as follows: Decedent was not a party to.pending divorce proceedin wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323 (g) and was neither the vlctim of a killing nor ever adgudicated an incapacitated person. ^ NO EXCEPTIONS ^ EXCEPTIONS ~ - ~ '.'~ Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by t~ f~wing spouse (if alyy)d heirs (attach additional sheets, if necessary): ~ _,~ x> e y~ wi .viJ Y+e. rv f \ } ....~ Name Relationship Address ~ `F`° W;-, ~ - - B u..1 ~~ r w _ _ ~ i d l _ t:t .5::m ~„~ ...~,t Form RW-02 rev. f 0-11-2011 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 } Petitioner(s) Printed Name Petitioner(s) Printed Address ` ~+i ~ '~~~ _ ,; ,~ ~' . ' John E. Shiley, Jr. 225 Ridgeview Drive Marysville, PA 17053 ., ~ ~ i ~: ,,1 ~ ~ ~-' ~ ~ _, ; j n,. Kimberly J. Grundon 123 S. Humer Street ru -~ ~_~ Enola, PA 17025 ~ L L `'` `` ``' OFCm ~ ~ .. ~~~~~ ~' GUMBER~~', ~ .: . ~ ..e rCUZwnerts/ ar;'ove-names sweartsl or amrmtsl the statements In the for going Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) f t e [,3e d P 'tlo r(s) will ell and truly administer the estate accord'ng to I w.} Sworn to or affirmed and subscribed before Date ~ J me this e~ ;izy cit,~ r~ , , Date 2 / BY~ ' ~,~~ - / Date Fort a Register Date BOND Required? ~ YES ~ NO FEES: Letters ...................................... .... $ 270.00 ( 4 )Short Certificate(s)..... .... 20.00 ( )Renunciation(s) .......... .... ( )Codicil(s) ..................... ... ( )Affidavit(s) ................... ... Bond ......................................... .... Commission ............................. ..... Other Will 15.00 Inheritance Tax Return 15.00 Inventory 15.00 Automation Fee ........................ .... 5.00 JCS Fee .................................... ... 23.50 TOTAL ...................................... ... $ 303.50 DECREE OF THE REGISTER Date of Death: 01/01/2013 Social Security No: Estate of Barbara L. Shiley File No: 21-13 ~ UPI a/k/a: AND NOW, C~ , in consideration of the foregoing Petition, satisfactory proof having been pr nted before me, IT IS DECREED that Letters Testamentary are hereby granted to John E. hiley, Jr. and Kimberly J. Grundon in the above estate and (if applicable) that the instrument(s) dated 10/05/2006 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of To the Register of lolls: Please enter my appearance by my signature below: Attorney Signatures`' `,. Printed Name: Robert C. Saidis Supreme Court ID Number: 21458 Firm Name: Saidis, Sullivan 8 Rogers Address: 26 W. High Street Carlisle, PA Phone: 717/243-6222 Fax: 7171243-6486 E-mail: rsaidis@ssr-attorneys.com Official Use Only ~„ T . . Register of Wills r (' ~~~~+ I /J yV'y~,~ Copyright (c) 2011 form software only The L ner roue, Inc. M..~( ~t t ~r~. Page 2 of 2 H105.805 REV (9/I l i LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. „ .~ ~,- nr Fee for this certificate, $6. ~'~ ~~'~~ - _ ' ~ zf~ This is to certify that the information here given is ~~~' ~ ~ ~ ~ ~ '~ 1 ~--~ correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original ''.?.~ ~h~,j ~~ ~'~ `? 4~ certificate will be i~~r(h~arded to the State Vital t .J { Re ids Office for perm• nent filitng. ~sf ~ ~,'iJ•"r' Certification Number `(' ~ "`"'i ( -- ____ ~' ~ (,. r;~ Local Registrar Date Issued TYPe/Print In CUMBERL~I~;t ~; ,s. COII/1MONWEAITH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Permanent P'C OTS GS/-ATC Ar see-wTSs L i$ 1. Occident's Legal Name (First, Middle, Last, Suffix) ~ • • State Flle Number: 2 S . ex 3. Social Security Number 4. Dste of Death (MO/Dey/Yr) (Spill Mo) Barbara L. Shiley Fem l ' a e 171-30-648 1 Jan ~, 20't3 Sa A e-La t Bl hd . g s K ay (Ves) Sb. Under I Vlar Sc. Under 1 Oa 6. Data of Birth (Mo/Day/Vear) (Spill Month) 7a. Birthplace (City and State Or Foreign Country) M h ont s Day: HOUrs Minutes January 3, '1939 Harrisburg, Pa 73 7b. Birthplace (County) Dau hin Sa. Residence (State or Foreign Country) Bb. Rlsitlance (Street and Number - Inclutle Apt No ) Bc Dld Dacsdent Ll i T . . ve n a ownship? PA 205 3. Enola Dr. ~rls decedent lived in Esst Pennaboro , cwp 8d. Residence [County) C b l um er and ee. Residence (Zip Cod!) Q No, decedent Ilved wtthin limits of city/born . 9. Ever in VS Armed Forces] 10. Marital Status at Time of Death Q Married Widowed 11. Surviving Spouse's Name (If wife lue name ri t fi , g p or o rst marriage) Q Yes (~NO Q Unknown Q Divorced Q Never Married Q Unknown 12. Father's Name (Fl rzt, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) George Beltzhover Pearl Miller 14a. Informant's Name 14b R l i . e at onship to Decedent John Shiley SON 14c. Informant's Mailing Address (Street and Number, City, Sbte, Z{p Code) ~ 225 Ridpevlew Dr. Marysville, PA 17053 - ~ ,. ,,, , - .one If Death occurred In a Hos ital: •••• ..•••••••••••••••••-•........ ....... ............................. p InpaNlM (If DNth Occurred Somewhere Other Than a Hospital: ~•HOSpiC< Facility ~-Decedent's Hom e Q Emergency Room/Outpatient Dead on Arrival Nursing Home/long-Term Gre Facility Other (Spec Hy) ' 16b. Facility Nama (if not institution, give street and number; 15c. City or Tewn, S<ata, a d ilp Code SSd. County Of Deaeh 205 3 E l D . no a r. Enola, PA 'I7025 Cumberland 16a. Method of DisposlCiOn Burial Q GrematiOn lfib. Date of DlspositlOn Q Removal from stx 16c. Place of Dizposltlon (Nam! of Cemetery, crematory, or other plat!) e Q Donaupn Jan 7, 2013 other (spe~lfy) Woodlswn Memorial Gardens ~ 16d. Location of Disposition (City or Tawn, State, and Zip) 7a. Sign tore O} Funeral Service Licensee or Person In Charge of Interment 17b. License Number Harrisburg, PA 'I7909 Mario ,~. Billow FD-t 3845-L 17c. Name antl Complete Address of Funeral Facility S ~< F- ullivan Funeral Home 51 N. Enola Dr. Enola, PA '17023 18. Decedent's Eduu[lon -Cheek the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to Indicate what highest degree or level of school com l t d t th i f p e e a e t me o death. box that best describes whether the d!cldent the decedent considered himself or herself to be. Q 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" [,~. White Q Korean Q No dl ploma, 9th - 12th grade b If d d ox eca ent is not Spanish/Hlzpanic/Latino. Q Black or African American Q Vietnamese High school graduate or GED completed ~, NO not Spanish/Hlspa nit/LatlnO A , Q merican Indian or Alaska Native Q Other Asian Q Some college credit, but no degree Q Vls, Mexican, Mexican American Chicano Q Asian Indian , Q Native HawaHen Associate degree (e.g. AA, AS) Q Yes, PueKO Rican Q Chinese Q Guamanian or Cha morro ' Q Bachelor s degree (e..g. BA, AB, BS) Ves, Cuban Q Q FIIiPino ~ Samoan ' Master s O! g. ~ gree (e. MA, MS, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino Q Japanese Q Other Pacific Islander Q Doctorate (e.g. PhD, Edo) or Professional degree (Specl/y) Q Other (Specify) . MD DDS DVM LLB JD 21. Decedent's Single Racr Self-Designation -Chick ONLY ONE to indicate what the dludant considered himself or herself to b!. 22a. Decedent's Usual Occu potion - Indigt! type of work [7~ White Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. Q Black or African American Q Korean Q Other Pacific Islander secretary Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Nat Sure Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business/Industry Q Chinese Q Natlva Hawaiian Q Other (Specify) Q Filipino Q Guamanian er Chemorro Teleoommunications ITEMS 23a - 2 MUST BE COMPL D 23a. ate Pronounced Dead (Mo ay 23 . 5 sqn at Only w !n app Ica ie 23c. License Num er ure BY PERSON WHO PRONOVNCEg OR ' ~~~ ~/ ~~~~ r~~~~ ~ l CERTiFaES DEA TH 4f. ~ ~ I~ ~~ l 23d. to Sign d (MO/Day/Y) -' 24. Time of D~~a/y, ~/~~ r ~ ~ ~ J p ~ ~f ~~ 2S. Wii Madlcal Examl or Coroner COntatted? Q Yes No CAUSE OF DEATH Apprazimate 26. Part I. Enter the chain of events--diseases, Inj urles, or tom pllcatlOns-that tlirlttly caused the d ath. 00 NOT enter terminal events such as cardiac arrest Interval: s < respiratory arrest, or ventricular fibrlllatlOn without showing the etiology. DO NOT A REVIAT Enter my one cause on a Ilne. Add additional Ilnes if necessary Onset t0 Death ,/ x IMMEDIATE CAUSE ---------_____~ a, (Final disease or condition Due to (or as a Consequence of): resulting In death) b. Sequentially list conditions, Dw to (or as a consequence of): If any, leading to the cause listed on line a. Enter Che UNDERLYING CAUSE Due to (or as a consequence o1): (disease or injury that F initiated the events resulting d. in death) LAST. Due to (or as a consequence Of): _~ ~ 26. PaR 11. Enter other slgniflcant conditions contrib ti t d ih but not resulting In the undirlying cause gWen in Part I 27. Was en autopsy performed? Ves No 28. Wire autopsy findings available '$ S to complete the cause of death? Q Yes No 29. If Female: 30 Di 3 . d TobacCO Vse Contribute to Death? 31. Manner of Death ~" Not pregnant within pass year V Q es Q Probably ® Natural Q Homicide Q Pregnant at time Of death ~' ~ No Q Unknewn Q Accident Q Pending Investigation Q Nat pregnant, but pregnant within 42 days of tleath F- Q Suicide 0 Could not be determined 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. Tlm! of Injury 34. Place of Injury (e.g. home; c0 nstruetion site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Codr) 36. Injury at Work 37. Vf Transportation Injury, Specify: 38. Describe How Injury Occurred: (] Y!s Q Driver/Operitpr Q Pedestrian No Q Passenger Q Other (Specify) 39s. Certifier (Check only one): Certfying physician - TO the best of my knowledge, death occurred due to the cause(s) and manner stated Q Pronouncing & Certifying physician - To the bKT of my knowledge, death occurMd at the time, data, and place, and due to the cause(s) and manner stated tli l E Q M i e ca xam ner/COryriey- On the balls of exa-m--l n7a~tlon, and/ r investpigation, In my opinion, death occurred at the time, date, and place, and due to the causef s) and manner stated r / l ~ ~ Signature o/ certifier: Q'~r-4¢i7 6(~r-- f t-' ~\ Title of certifier: t~-7 u~en:.Number: t''iD o (44s-S ~ 39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 39c. Date Signed (MO/Day/Yr) J Ger.-.cs l.a .. T' ~ 4. t 2 / o E9 ~o...~ C~ c..- ~ .~.. ~( ~ ') o ~( 3 t Z~~ ° L 3 _ ~ ¢ . < - 40. Registrar's Dlstrlct Number 41. Reglstror s Signature 42. Registrar Fiie Data Mo Day 2 - - ?- Z / o ( ~ o o o?o a3. Amendments t1 ` ~7 r'7 1 H105-143 Disposition Permit No. 1 REV 07/2011 LAST WILL AND TESTAMENT OF BARBARA L. SHILEY I, BARBARA L. SHILEY of Enola, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by mew ~=' C ~-,-~ ~~ r~r ~- ~ r'~ ra ~ ,~~ c~ r°, t_:a I. I direct the payment of all my justrnck~G °~nd'~',~~~eral r~ ~~ ~ ; r._a e t expenses out of my estate as soon as may be ;p~~~ica~l ~ft.er my ., ~. ~. death. ~. _.. , II. I devise and bequeath all of my ~est'ate `of wha, ever nature and wherever situate to my children, KIMBERLY GRUNDON, JOHN E. SHILEY, JR., ROBERT E. SHILEY and STEPHEN C. SHILEY, the share of a deceased child to be paid to his or her issue per stirpes. III. I direct that all estate, inheritance and succession FLOWER ~ LINDSAY nnowvexsnruw 2109 Market Street Camp Hill, PA taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed shall be paid out of the principal of my general estate to the same effect as if said ~..~ ~r xp S ~.~ ad*?;i r_i o~r~~~ n a =ll tart" ~ env,a ,,F p nd prrJpPrtiT ~nr~.,l~; i~l P in my taxable estate whether or not passing under this Will shall be fx-ee and clear thereof. IV. No interest of any beneficiary of my estate either in income or principal, shall be subject to anticipation or to pledge assignment, sale or transfer in any manner, nor shall any 1 SAIDIS, LIND nnoxNexs•,-T•uw 2109 Market Street Camp Hill, PA beneficiary have power in any manner to charge or encumber his interest, either in income or in principal, nor shall the interest of any beneficiary be liable or subject in any manner while it the possession of the Executers for the liability of such beneficiary, whether such liability arises from his debts, contracts, torts or other engagements of any type. V. I grant to my fiduciaries and their successor or successors the following powers, in addition to and not in limitation of, such powers as they may hold by law: A. To retain any property owned by me at my death and to invest any funds of my estate or trust in any stocks, bonds, notes or other securities or property, real or' personal, notwithstanding that such investments may not be of the character allowed to fiduciaries by statue or general rules of law, it being my intention to give them the broadest investment powers possible. B. To sell or otherwise dispose of any property, real or personal, at any time forming a part of my estate or trust, for cash or upon credit, in such manner and on such terms and conditions as they may deem best, and no persons dealing wzth them shall be bound to see to the ~.pplication of any moneys paid. C. To manage, operate, repair, improve, mortgage or lease for any term any real estate at any time held or owned by my estate. D. To borrow money for the payment of taxes or for 2 any proper purposes in the administration of my estate. E. To distribute in cash or in kind, upon any division or distribution of my estate. F• In general, to exercise ail powers in the management of my estate which any individual could exercise in the management of similar property owned in his right, upon such terms and conditions as to them may seem best, and to execute and deliver all instruments and to do all acts which they may deem necessary or proper to carry out the purposes of this, my Will. VI. I nominate, constitute and appoint my son, JOHN E. SHILEY, JR., and my daughter, KIMBERLY GRUNDON, as Executors of this my Last Will and Testament. Neither of my personal representatives shall be required to post bond in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the 5th day of October, 2006. 01 ARBARA L. SHILEY, Tes trix SAIDIS, I.IlVDS~ nrro~ysar uw 2109 Market Street Camp Hill, PA Signed, sealed, published and declared by BARBARA L. SHILEY herein r_amed, on this and thrFe (3) other sheets of paper as and for .her Last Wili and Testament, in our preser~~~e, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~~.' ~ Name Name 3 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. WE, the undersigned, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the will as witnesses and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. ~,~ BARBARA L. SHILEY, Tes atria ,' Witness Witness SAIDIS, LINDS~ nnu~n~s.~r•uw 2109 Market Street Camp Hill, PA Subscribed, sworn to and acknowledged before me by the Testatrix, and hubscribed and sworn to before me by both witnesses, this 5 day of October, 2006. to Public Notarial Seal Sara J. Ensinger, Notary Public Carlisle Boro, Cumberland County My Commission Expires Oct.17,2008 Member, Pennsylvania Association of Notaries 4