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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: JEAN E. SHANK File No:~
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 209-12-8098
Date of Death: 02/17/2013 Age at death: 87
Decedent was domiciled at death in CUMBERLAND County, pENNSYLVANIA (State) with his/her last
principal residence at 318 AVON DRIVE. CARLISLE 17013 CARLISLE BOROUGH CUMBERLAND
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at THORNWALD HOME CARLISLE 17013 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 $ 300,000.00
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.... $ 300.000.00
Real estate in Pennsylvania situated at:
(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 JANUARY 7, 2006 and Codicil(s)
thereto dated
RENUNCIATION FOR BETH ANN SHANK ATTACHED HERETO
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 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(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.
Q' NO EXCEPTIONS O EXCEPTIONS
❑ B. Petition for Grant of Letters of Administration (If applicable)
c.t.a., dAn., d.b.n.c.t.a., pendente lite, 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 a pending divorce proceeding wherein the grounds for div(Oe had been esfaVisht!6as-Vefined
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person Q C--> R1 rn
O NO EXCEPTIONS O EXCEPTIONS W rn
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the follei2n~p<use (ifBgy) an iff(attach
additional sheets, if necessary): A ~ ~t TT ~t = t::)
Name Relationship Ad jj~e t~ C?
C7 t = :S
D 1U O
Form RW-02 rev. 10/11/2011 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND }
Petitioner(s) Printed Name Petitioner(s) Printed Address
E. ALLEN SHANK 318 AVON DRIVE CARLISLE PA 17013
L
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioners will well and truly administer the estate according to law.
Sworn to or affirmed subscribed before 17 Date 2- 3
me s 5 day of k /03 Date Z
By i ) Date
For the Register l Date
BOND Required: Q YES Q NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters S 310.00 Attorney Signature:
( 3 ) Short Certificate(s)...... 15.00
( 1) Renunciation(s)......... 5.00 4
( ) Codicil(s)
( ) Affidavit(s)........... .
Bond Printed Name: ROGER B. IRWIN, ESQUIRE
Commission Supreme Court
Other ID Number: 6282
WILL 15.00
INH TAX RETURN 15.00 Firm Name: IRWIN & McKNIGHT, P.C.
INVENTORY 15.00 Address: 60 WEST POMFRET STREET
CARLISLE, PA 17013
Phone: (717) 249-2353
Automation Fee 5.00 Fax: (717) 249-6354
JCS Fee 23.50 Email:
TOTAL S 403.50
DECREE OF THE REGISTER
Estate of JEAN E. SHANK File No:~ , r~0~ I
a/k/a:
AND NOW, i , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, I OS DECREED that Letters TESTAMENTARY
are hereby granted to E. ALLEN SHANK
in the above estate and (if applicable) that
the instrument(s) dated JANUARY 7, 2006
described in the Petition be admitted to probate and filed of rcc rd as the last Will (and Codicil(s)) of Decedent.
h a
M111k 1/1, L 'A Lu 'A
Register of Wills' ~p ( f 4
Form RW-02 rev. l0/11/30/1 q6Pa 2 Of 2
HIOS 805 REV iy!I I)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
RECORDED OFFICE OF
Fee for this certificate, ,p TR V!I~.$ This is to certifv that the information here given is
t~~15T OF ~p~[N t;F pF;=~ correctly copied from an original Certificate of Death
/$'o~~~ \rl duly filed with me as Local Registrar. The original
z certificate will be forwarded to the State Vital
25 i~
1013 FEB 25 PM 2
Il
Records Office for permanent tiling.
_ERK OF
fS' COURT ` r41E F E~ 18/ 2013
Certification Nj
, `C'OMBERLAND CO., PA Local Registrar Date Issued
Type/Print In " COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH VITAL RECORDS
Perma,e,t CERTIFICATE OF DEATH
Black Ink State File Number:
1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Sall,) Security Number 4. Date of Death (Mo/Day/Yr) (Spell M.)
Jean E_ Shank F 209 12 8098 Februa 17, 2013
5a. Age-Last Birthday (Yrs) Sb. Under 1 Yeoar 51. Under 1 Da 6. Date of Birth (MO/Day/Near) (Spell Month) 7a. Birthplace (City and Slate or Foreign Country)
Months aY, Hours Minute, Carlisle PA
87 May l , 1925 7b. Birthplace (County) Cunihierland
ga. Residence M.I. or Foreign Country) 8b. Residence (Street and Number - Include Apt No.) Sc. Did Decedent Live in a Township?
Twp.
PTS. -.nce (county) 318 Avon Di f-_ Over, decedent III d I.
CLa r-land Be. Residence (Zip Code) 17013 o, decedent lived within limits of Carlisle clty/bor..
9. Ever in US Armed Forces? 30. Marital SYatus at Time of Death 0 Married ® Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage)
0 Yes $r No 0 Unknown 0 Divorced Never Married 0 U. n.
_
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last)
Paul Monismith Laura CornTvan
14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code)
E_ A11en Shank Son 318 Avon Dr_, Carlisle, PA 17013
0
C lSa_ . ace o De-h. C ec only. one_ _
rr If Death Occurred in a Hospital: Inpatient :If Death Occurred Somewhere Other Than a Hospital: CU Hos i........ p ce Facility Decedent's Nome
Emergency Room/Outpatient ~ Dead oI Arrival _ ® Nursing Home/Long-Term Care Facility E3 Other (Specify)
15b. Facility Name (If not institution, give street and number; IS, City or Town, State, and Zip Code SSd. County of Death
Tllornwald HcaTta Carlisle, PA 17013 CLan}Cerland
LL 16a. Method of Disposition [:XBUrial 0 Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
0 Removal from State 0 Donation
Oth er (Specify) 2/23/2013 Westmislster Manorial Gardens
Z 16d. Location of Disposition (City or Town, State, and Zip) 17a. Signature f F Service Licensee rge of Interment 17b. License Number
Carlisle, PA 17013 FD 012633 L
0 17c. Name and Complete Address of Funeral Facility r
Ewd-n Brothers Funeral H~c1e Inc_ 630 South Hanover Si--- Carlisle PA 17013
m S. Decedent's Education - Check 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
,9 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.
0 8th grade or less is Spanish/Hispanic/Latino. Check the "No" Ar White Korean
Q No diploma, 9th - 12th grade box If decedent is not Spanish/Hispanic/Latino. 0 Black or African American 0 Vietnamese
0 High school graduate or GED completed ['NO, not Spanish/Hispanic/Latino 0 American Indian or Alaska Native r Other Asian
0 Some college credit, but no degree 0 Yes, Mexican, Mexican American, Chicano Asian Indian Native Hawaiian
0 Associate degree (e. g. AA, AS) 0 Yes, Puerto Rican
0 Bachelor's degree (e.g. BA, AB, B5) Yes, Cuban Chinese 0 Guama,ia, or Cham.rro
Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) Filipino 0 Samoan
0 Yes, other Spanish/Hispanic/Latino 0 Japanese 0 Other Pacific Islander
Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) 0 Other (Specify)
.MD DOS OVM LLB, JD
21. Decedent's Single Race Self-Des Ignacio, - Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work
[H White 0 Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED.
Black or African American 0 Korean 0 Other Pacific Islander
0 American Indian or Alaska Native Vietnamese 0 Don't Know/Not Sure Clerical
W 0 Asian Indian 0 Other Asian 0 Refused 22b. Kind of Business/Industry
v=j 0 Chinese [:J Native Hawaiian Other (Specify)
a O Filipino 0 Guamanian or Cham.rr. Savings & Loan Industry
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounce Dead (MO Day r) 23b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number
BY PERSON WHO PRONOUNCES OR `
CERTIFIES DEATH ~
23d. Date S'gnetl ( o/Day/Vr) 24. Time of Death A ~
o a t -t ! 3 03 ZU /4t pia 25. Was Medical miner or C.r.ner Contacted? E3 Yes No
CAUSE OF DEATH Approximate
26. Part 1. Enter the chain of ell-1--di seases, injuries, or cum plicatlOns--that directly ,used the death. DO NOT enter terminal events such as cardiac arrest interval:
respiratory arresT, or ventricular fibrillation wit t ho Ing the etbl ogy. DO NOT ABBREVIATE. Enter o nly
cause on a line. Add adtlltlonai lines If necessary Onset to Death
IMMEDIATE CAUSE a. ,VL~c.-l f~ 3C/(n. if / !iC / ILf L.c • j
(F al disease or condition Due to (or as a cons quence of):
resulting in death)
b.
Sequentially list conditions, Due to (or as a consequence of):
if any, leading to the cause
listed on Iine a. Enter the
UNDERLYING CAUSE Due to (or as a consequence of):
(disease or Injury that
F Initiated the events resulting d.
in death) LAST. Due to (o as a consequence of):
,j 26. Part If. Enter other si,nificant conditions contr'butine Y death but not resulting in the underlying cause given in Part I 27. Was an autopsy perf mad?
Ves No
28. Were autopsy findings avails bie
m to complete the cause of death?
a O Yes IM, No
a 29. If F ale: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death
V Not pregnant within past year Yes 0 Probably la< Natural 0 Homicide
Pregnant at time of death No Q Unknown 0 Accident 0 Pending Investigation
Not pregnant, but pregnant within 42 days of death 0 Suicide 0 Could not be determined
12 0 Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month)
0 Unknown If pregnant within the past year
33. Time of Injury
34. Place of injury (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 Occurred:
0 Yes 0 Driver/Operator 0 Pedestrian
( 0 No 0 Passenger Other (Specify)
v, 39a. ert ifler (Check only one):
Certifying physician - To the best of my knowledge, death Occurred due to cause(,) and manner stated the Pronouncing ffi Certifying phy ician - T. the best of my knowledge, death occurred at the time, date, and plate and due to the cause(s) and manner stated
w 0 Medical Examiner/C... net the is of examination and/or investigation, in my opinion, death 77occurred at the time, date, and place, and due to the se(~s2) a~ndma~nner stated
Signature of certifier: Title of certifl- MJ License Number: M 1~ D Upp r/ Q E
39b. Name, dress and Zip Code of Person Completing Cause of Death (Item 26) ff39~ Dare ign d (MO/Day/Vr)
40. Registrar's District Number 41. Registrar's$irratu'•re 2. Regis r Ile Dafe (MO Day/V r)
- a Lo
° 43. Amendments
O
W
6
H10S-143
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Disposition Permit No. t > O REV 07/2011
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LAST WILL AND TESTAMENT
CO CI)
f ' "n
O c7 I
Jean E. Shank no
lV C/1 t7
CJ'1 ~T'1
I, JEAN E. SHANK, of the Borough of Carlisle, Cumberland County, Pennsylvania,
declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills
and Codicils heretofore made by me.
1. I direct my Executors to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my Executors to sell any realty owned by me at my death,
and not specifically devised herein, at either public or private sale, and to give good and
sufficient deeds therefor, in fee simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every nature and wherever situate to
E. ALLEN SHANK and BETH ANN SHANK, share and share alike.
4. I nominate and appoint E. ALLEN SHANK and BETH ANN SHANK to be the
Executors of this my Last Will and Testament; they are to serve as such without bond.
5. I hereby suggest that my personal representatives retain the services of Irwin &
McKnight as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ' A day of
January, 2006.
SEAL)
J AN E. SHANK
Signed, sealed, published and declared by JEAN E. SHANK, the above-named Testatrix,
as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence
and in the presence of each other have subscribed our names as witnesses hereto.
77
~ Lx_
r
2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, JEAN E. SHANK, CHERYL L. CLELAND and KAREN S. NOEL, the
Testatrix and 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, that she had signed willingly, that she
executed it as her free and voluntary act for the purpose herein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness 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.
JE E. SHANK
CH YL L. CLELAND
1
KAREN S. NOEL
COMMONWEALTH OF PENNSYLVANIA :
. SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by JEAN E. SHANK, the Testatrix
herein, and subscribed and sworn to before me by CHERYL L. CLELAND and KAREN S.
NOEL, witnesses, this r day of January, 2006.
lary Public
COM 0NW ALTH OF PENNSYLVANIA
Notarial Seal
Roger B. Irwin, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Oct. 3, 2008
Member, Pennsylvania Association Of Notaries
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RENUNCIATION ; C~) '
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REGISTER OF WILLS 3>
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of JEAN E. SHANK , Deceased
I, BETH ANN SHANK , in my capacity/relationship as
(Print Name)
CO-EXECUTOR of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
E. ALLEN SHANK
FEBRUARY 18, 2013 f
(Date) (Signature) 1~
34538 TENNESSEE DRIVE
(Street Address)
FRANKFORD, DE 19945
(City, State, Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
before me this day party executing this renunciation and certified
of that he or she executed the renunciation, for the
purpos s stated within on /a' L~`- day
of Deputy for Register of Wills otary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
a0WO14WEALTN OF PENNSYLV
Notnria! seal Public
Karen S. Novi, Notary
Form RW-06 rev. 10.13.06 ~a11151e fro, ~tnbei riand S,t 0 5
miSSIOnP
pENN5y6VAN1A ~~~p,TIpN 8F NOTARI68