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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 rr~~
Name: CATHERINE V. DAVIDSON File No: n[ -
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 168-24-4706
Date of Death: February 10, 2013 Age at death: 82
Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last
principal residence at 50 Water Street, Walnut Bottom, PA 17266 South Newton Township Cumberland County
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 210 Bic Spring Road, Newville, PA 17240 West Pennsboro Township Cumberland Pennsylvania
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 $ 125,000.00
If not domiciled in Pennsylvania Personal property in Pennsylvania $
If not domiciled in Pennsylvania Personal property in County $
Value of real estate in Pennsylvania $ 125,000.00
TOTAL ESTIMATED VALUE.... $ 250,000.00
Real estate in Pennsylvania situated at: 50 Water Street, Walnut Bottom, PA 17266 South Newton, Cumberland
(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 February 19, 2003 and Codicil(s)
thereto dated
James W. Davidson died on 2/24/10_ Lawrence James Davidson & Diane Louise Free renounce to Robert Allen Davidson.-
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 0 EXCEPTIONS
B. Petition for Grant of Letters of Administration (If applicable)
c.t.a., d.b.n., 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.
c=
00 Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divots had been eswishe3 as fined
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. e ~ rn M c'>
C)
0 NO EXCEPTIONS Q EXCEPTIONS m CD v> :;a
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the follo 9 4o; (if am and M,r ttach
additional sheets, if necessary):, C1>
. -VIZ C> ¢J
Name Relationship Add,fts~
rU rn
U-1 "rl
Form RW-02 rev. 1011112011 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
Robert Allen Davidson 447 West Main Street Walnut Bottom PA 17266
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 they, ede t, the ti~.ie~ner(s) wj l well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before „ Y ((~(tt~ Date ' r- Jar a 0_0J me 'day o , X I Date
By ~ I )At7 JEJ T~a ~Wm' Date
For the Register Date
BOND Required: 0 YES Q NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters $ 310-OD Attorney Signature:
) Short Certificate(s)...... ~Q'00
^
( ) Renunciation(s).........
( ) Codicil(s) .
( ) Affidavit(s)........... .
Bond Printed Name: Thomas P. Gleason
Commission Supreme Court
Other ID Number: 82259
1 5 -)Q
e ft is •D(7 Firm Name: Thomas P. Gleason, Esquire
r 1. (D Address: 49 West OrangeVAreet c M
Shippenshurg, PXl 57 m
W -o t t!a
~L3 D' t"' N rtt rtl
Phone: (717) 532-3270 ~ z rn
Automation Fee. D Fax: 717 532-6673
JCS Fee - Email: tomgleason .tn .'4
TOTAL $ 0-00-- C_- r, c s
DECREE OF THE REGISTER
Estate of CATHERINE V. DAVIDSON File No:/ ' /_'-3 Lq 3
a/k/a:
AND NOW, UJ V , in consideration of the foregoing Petition,
satisfactory proof having been pr ented before me, IT IKfiECREED that Letters Testamentary
are hereby granted to obert Allen Davidson
in the above estate and (if applicable) that
the instrument(s) dated February 19, 2003
described in the Petition be admitted to probate and filed of record as the last Will (and Codi '1(s)) of Decedent.
Register of 1_s~_
Form RW-02 rev. 1011112011 Page 2 of 2
H105.8(IS REV (4/I l)
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, $6.00 Tjn, i, t( - cltlf that the information here IfiNcn is
REGISTER OF VV ILLS ff FF ~
corrcctly copicd from an original Certificate ol'Death
(10k tiled ith rte as Local RcListrar- The original
~.'013 FEB 26 PM 12 5$ y 11 s; II)Iicalr \krll he iijrnarded to the State Vital
a•I Rc(ord,, Office for permanent filing.
CLERK
P 19336913 BRPHQNSfCOURT
~~\EhT tl\`TSC - -
Certification Number CUMBERLAND CO., RQ - -J(1 1 e,Ti u-ar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS
Permanent
Black ink CERTIFICATE OF DEATH State File Number:
1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (Mc,Day/Yr) (Spell Mo)
5a. Age-Last Blrthday (Yrs) 5b. Under 1 Year 51. Under 1 Da 6. Date of Birth (Mo/Day/year) (Spell Month) 7a. Birthpl a (City and State or F ign C nty) O 3
p~ Months Days Hours Minutes ~LW b
U IQ -j e~l 7b. Birthplace (Co..-)
`f
8a. Resident State or Foreign Country) Sb. Residence (Street and Number- Include Apt No.) 8c. Did Decedent Live in a Township,
l jres, d¢~¢tlent Iw¢d in aJ aU~~
ad- Residence (County)~j Q ~j{ ~ r,3; WArcY _ _P.
Ct, VI I,00 <f , r Se. Residence (Zip Code) 2 to 0 No, decedent lived within limits of city/bon.-
9. Ever In US Armed Forces. 10. Marital Status at Time of Death 0 Marrle11 M Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage)
0 Yes No Q Unknown 0 Divorced 0 Never Married (3 Un..."
12. Father's Name (First, Middle, Last, Suffix) 13. MZt Cme Prior to`Firsf Marriage (Firs[, Middle, Last)
14a. informant's Nam, ,t--~ 14b. Rela[lonshlp to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, ZIP Code)
Ssa. P a o h.... only one 6 o A Z
G ce
If Death Occurred in a Hos ital M i.n
p pat en[ ilf Death Occurred d S Somewhere Other Than a Hospital: `t~` -Hospice Facility [,J` D,c
Ej Emergency Room/Outpatient 0 Dead on Arrival Nursing Home/Long-Term Care Facility Other (Specify) dent's Home
uuu I5b. Facility Na (If not institution, give street and number) •15, City or Tov,U1 St nd Zi Code 15d. County of Death
l eta .L v, «a C- 1 ib a
36a. Method of Disposition ® Burial 0 Cremation 16b. Date o.' Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
p Removal from state C Donation
otner(specifyl S 2013 C a rrlcn~ \ ~CY~ma~~~ l
16d. Location of Disposition (City or Town, State, and Zip) 17a. Signature of Funeral Service Licensee or Person in Char
ge of Interment 176. License Number
Ccc ado ~1~- (~lZ$23t^L
g 1. Name and Com a Address of Fuyne` al'Facllity ` e~'~ C- e ) .1~[J -rte
l H6 ,0.Y ~Y' G~• ~iJV C. V o • Q `~2.•^7 -C
m 18. Deced is Education - Check the box that best describes the 39. Decedent c•= :spa nit Origin - Check the O. Decedent's Race - Chec O E OR MORE rat _to Indicate what
I- highest degree or level of school completed at the time of death. box the best describes whether the decedent the decedent considered himself or herself to be.
0 81h grade or less is Spanish/Hispanic/Latino. Check the "No" White 0 Korean
0 No diploma, 9th - 12th grade box if decedent Is not Spanish/Hispanic/Latino. M Black or African American E3 Vietnamese
O High school graduate or GED completed EN No, not Spanish/Hispanic/Latino 0 American Indian or Alaska Native 0 Other Asian
0 Some college credit, but no degree 0 Yes, Mexican, Mexican American, Chicano (:3 Asian Indian Q Native Yawalian
0 Assoclat¢ degree (e.g. AA, AS) 0 Yes, Puerto Rican Chinese
0 Bachelor's clear.. (e.g. BA, AB, BS) 0 Yes, Cuban 0 Guamanian or Chamorro
0 Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) _ M yes, other S arnish/His 0 Filipino C3 Samoan
0 Doctorate (e.g. PhD, Ed D) or Prof¢ssional degree V panic/Latino 0 Japanese 0 Other Pacific Islander
(Specify) Other (Specify)
. MD, DDS DVM, LLB D, I
-
21. Decedent's Single Race Self-Designatlon -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation - Indicate type of work
M White 0 Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED-
0 elk or African American 0 Korean 0 Other Pacific Islander
0 American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure bOt•el
0 Asian Indian 0 Other Asian 0 Refused 22b. Kind of Business/Industry
0 Chinese 0 Native Hawa Ilan 0 Other (Specify)
0 Filipino 0 Guamanian or Chamorro \ C7f. Tl\t
ITEMS 23, - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day Yr) 23b. Signature of Person Pronouncing Death (Only when applicable] 23c. License Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH
2 Date ~,j d (MO/Day/Y,) 24. Tim of Death p
16 '9 Jqxii K 0 o~ 31 W- i 3 0 I l~ 25. Was Medical Examiner or Coroner Contacted. 0 Yes No
CAUSE OF DEATH Approximate
26. PaR 1. Enter the chain of events-diseases, Injuries, or compllcatlons-that directly caused the death. DO NOT enter terminal events such as cardlac arrest Interval:
respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE- Enter only 11, cause I. a line. Add additional lines if necessary Onset to Death
IMMEDIATE CAUSE a. L CL L1 S v C-~- / J!_
(Final disease or condition Due to (or as a sequence f)'
res. sting In death)
le. Sequentially list conditions. Due to ce nseq..¢nce of): -
if any, leading to the ,use -
listed on line a. Enter the c.
UNDERLYING CAUSE Due to o as a consequence
f5b (disease or Injury that ( of): {
Initiated the events resulting d. i
In death) LAST. Due to (or as a consequence of):
26. Part 11. Enter other I c nt condition, contrib.tin, to th but not resulting in the underlying cause given In Part I 2.. Was an autop.:y pe paned.
O Yes No
I 2H. Were autopsy find.... available
m to -mplete the case of death.
Yes No
t~ a 29. If Female: 30. Did Tobacco Use Contribute to Death. 31. Manner of Death
E Not pregnant within past year 0 Yes 0 Probably M Natural 0 Homicide
S 0 Pregnant at time of death C No 0 Unknown 0 Accident 0 Pending InYestigation
m 0 Not pregnant, but pregnant within 42 days of death 0 Suicide 0 Could not be determined
0 Not pregnant, but pregnant 43 days be 1 year before death 32. Da ie 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:
(-U 0 Yes 0 Driver/Operator 0 Pedestrian
0 No 0 Passenger 0 Other (Specify)
1 39a. er (Check only one):
Certifying physician -To the best of my knowledge, death occurred due to the cause(s) and m r stated
0 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
0 Medical Examiner/Coroner - On sis of examination, and/or InvestigatiC--t, in my opinion, dea t OccurreO - d at the time, data, and place, and due to the cause(s) and m anner stated
Signature of certifier: Title of certifier: IT License Number: CX~r D
V 39b. Name, Address and 21R Code on Completing Cause of Death (Item 26) rflr/\ 39c. Date Slg nod (MO/Day/Vr)
~ cur \ 6 w.~. A Si_ CB~~.~L~ pre 13 z frf f~
40. Registrar, District Number 41. Registrar's ature 42. Regist ar 111, Date (MO Day Yr)
a~ A / - s X / -5-
43. Amendments
o J a
0
Disposition Permit Nc REV C1 O 2-~ \.9' J 077/20
/20
I 11
RECORDED OFF ICE OF
LAST WILL AND TESTAMENT REGISTER OF WILLS
;'a13 FEB 26 P! ! 12 58
CLERK OF
KNOW ALL MEN BY THESE PRESENTS, that I, CATHERINE V.OI "A)WrZQ)VRT
CUMBERLAND CO., PA
Pennsylvania being of sound and disposing mind, memory and understanding, do
make, publish and declare this my Last Will and Testament hereby revoking all prior
wills and codicils by me at any time heretofore made.
FIRST: I direct the payment of all my legal debts, funeral expenses including
my grave marker and all expenses of my last illness, state, federal estate and
inheritance taxes and administration costs shall be paid as soon as may be
conveniently done following my decease leaving all specific bequests free of tax to
the legatee.
SECOND: I give, devise and bequeath all my property be it real, mixed or
personal, to my spouse, James W. Davidson.
THIRD: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events, I give, devise and bequeath
all of my estate, be it real mixed or personal in four equal shares, as follows:
a. One share to Lawrence James Davidson, per stirpes.
b. One share to Robert Allen Davidson, per stirpes.
C. One share to Diane Louise Free, per stirpes
d. One share to Tyler Hockenberry and Stacy Pattillo, the children of
Linda Marie Hockenberry, in equal shares, share and share alike, per
stirpes.
FOURTH: I nominate and appoint my spouse, James W. Davidson as
Executor of this my Last Will and Testament. If he should fail to serve or be unable
to serve, then in either of those said events! I nominate and appoint my children,
Lawrence James Davidson, Robert Allen Davidson and Diane Louise Free as the
Executors of this my Last Will and Testament. I direct that no executor named
herein shall be required to post bond in this or any jurisdiction.
IN WITNESS WHEREOF, I, CATHERINE V. DAVIDSON to this my Last Will
and Testament set my hand and official seal, this day of .
2003.
(SEAL)
Catherine V. Davidson
Sworn to and subscribed, declared and
Published by Catherine V. Davidson as
Her Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at her request,
And in her presence, and in the presence
Of each other.
% Ad z'
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND :
I, Catherine V. Davidson, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed it
willingly; and that I signed it as my free and voluntary act for the purpose therein
expressed.
Catherine V. Davidson
Sworn to and acknowledged, before me,
By Catherine V. Davidson, the Testatrix,
This r~ day of 2003.
Notarial Seal
H. Anthony Adams, Notary Public
Shippensburg Boro, Cumberland County
My Commission Expires May 15, 2006
Member Penn.,vWir.iaAssctiat:"®nOINOtaOeS
Notary Public
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we saw the Testatrix sign and execute the instrument
as her Last Will and Testament; 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 and belief the Testatrix was at the time at least eighteen
(18) or more years of age and of sound mind and under no constraint or undue
influence.
r
..a / J'
Sworn to and subscribed before me by,
Darlene M. Bigler and Sharon Coleman Adams
The witnesses, this )c1' day of 4k" 2003.
Notary Public
Notarial Seal
H. Anthony Adams, Notary Public
Shippensburg Boro, Cumberland County
My Commission Expires May 15, 2006
Member, Ugnn$vi~iar!i<ikgsoona'voncf "!'j'j iES
REGORGED OFFICE OF
REGISTER OF WILLS
RENUNCIATION
10113 FEB 2b Phi 12 58
REGISTER OF WILLS CLERK OF
CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT
CUMBERLAND CO., PA
Estate of CATHERINE V. DAVIDSON , Deceased
1, Lawrence James Davidson , in my capacity/relationship as
(Print Name)
son of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Robert Allen Davidson
February 21, 2013 > fig,
(Date) (Sig ature)
' -3r1 w CSV o. 8,-,, '7r
(Street Address)` 9L U)3 In A- _:)o40 m G. t~a(A.
(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
purposes stated within on this 21 s' day
of 2-J t `3
01
Deputy for Register of Wills Notary Publi
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
SY A ZUKAUCIUS
Form RW-06 rev. /0./3.06 No" PYbk
FfAly=Commlsslon OTARIAL SEAL
Tff.., CtOKK AND COUNTY
Exp1 m Mu 20, 2016
RECORDED OFFICE OF
RENUNCIATION REGISTER OF' ILLS
"Q FEB 2b FM 12 58
REGISTER OF WILLS CLERK OF
CUMBERLAND COUNTY, PENNSYLVANIt R P H A N S' C O U RT
CUMBERLAND CO., PA
Estate of CATHERINE V. DAVIDSON , Deceased
I, Diane Louise Free , in my capacity/relationship as
(Print Name)
daughter of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Robert Allen Davidson
February 21, 2013
(Date) (Signature)
i
(Street Address) j
(City, State, ' )
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
purposes stated within on this __A 5 rn day
of -2 L2 1 22
Deputy for Register of Wills Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
SY A ZUKAUCKAS
FSOUXTHAMPTONIff. OTARIAL SEAL
otary Plubk
Form Rw-06 rev. 10. 13.06 CUMKRLAND COUNTY
ion Expires Mar 20.2016