HomeMy WebLinkAbout04-12-13 Kesel
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 2-1 - 0- o41�
Name: hize-htf-O-) C—, SX01e-v File No:
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 182-22-6659
Date of Death:A r)ri 18,2013 Age at death:83
Decedent was domiciled at death in Cumberland County,Pennsylvania (State)with his/her last
principal residence at 63 West Vine Street, 17011 Shiremanstown Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at50_3 North 2iq Street i7oil Camp Hill _Cuoler�nd
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 2.Jr, 600, Of
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. ... 00 6 0
Real estate in Pennsylvania situated at:
(Attach additional sheets,4'necessarj%) 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 September 19,2006 and Codicil(s)
thereto dated
State relevant circumstances(e.g.renunciation,death of executor,eta)
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.
t"WNO EXCEPTIONS 0 EXCEPTIONS
1-ta
rl 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.ta.,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(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
0 NO EXCEPTIONS 0 EXCEPTIONS
Petitioner(s),after proper search has/have ascertained that Decedent left no Will and was survived by the following spou§e(if any)and heirs(attach
additional sheets, if necessary): C�
C!> rrT
_T)
Name Relationship CO 4ress
= C>
J�. r- 1--A
r
C_)
Form R W-02 rev. 10//11`2011 Page I of 2
Oath of Personal Representative official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND }
Petitioner(s)Printed Name Petitioner(s)Printed Address
Gary A. Staley 1188 Warm Spring Road,Chambersbur , PA 17202
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 Petitioner(s)will well and truly administer the estate according to law.
Sworn to or affirmed and subscr'bed.before 7t ��_, -� Date q-12 –13
me )11 y of _52Q2) Date
By: Date
For the Register Date
BOND Required: 0 YES , To the Register of Wilts:
FEES: Please enter my appearance by my signature below:
Letters. . . . . . . . . . . . . . . . . . . . . . S W,0 } _ Attorney S' nature:
( S ) Short Certificate(s). . . . . . C�
( )Renunciation(s).. . . . . . . .
( )Codicil(s). . . . . . . . . . . . .
( )Affidavit(s).. . . . , . . . . . .
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: Andrew C. Sheely,Esquire
Commission, . . . . . . . . . . . Supreme Court
Othe�r� . . . . . . . . ID Number: 62469
tl 16.DD Firm Name: Andrew C. Sheely,Attorney at Law
Address: 127 South Market Street
— P.U. Box 95
Mechanicsburg,PA 17055
• . • . . . . Phone: 717-697-7050
Automation Fee. . . . . . . . . . . . . . �',►.t� Fax: 717-697-7065
JCS Fee, . . . . . . . . . . . . . . . . . . . . 'L3• Email: andrewc.sheet ywerizon.net
TOTAL. . . . . . . . . . . . . . . . . . . . . $. t FiB.5D 0
DECREE OF THE REGISTER
Estate of lj Z /;--7, �e y File No:
alkla:
AND NOW, Avri , oD-0 I ': _, in consideration of the foregoing f
satisfactory proof having been prese ted before me, IT IS DECREED that Letters Testamentary
are hereby granted to Gary A. Staley
in the above estate and(if appliez
the instrument(s)dated September 19,2006
described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s))of Decedent
r
Register of Wills
H105.805 REV(9/11) -
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
RECORDED OFFICE 0 F This is to certify that the information here given is
�""""'---
REGIS
T ER OF V I L L S ,fi1,ll�l�\TH OF pFNy correctly copied from an original Certificate of Death
14- duly filed with me as Local Registrar. The original
1013 APR 1 � 29 C= Zz certificate will be forwarded to the State Vital
iv � n� Records Office for permanent filing.
P 1939983%pILE11a =°�,q = a�,`��� APR 2 �3
ANS COURT 9lMENTO ��
Certification Number CUMBERLAND 0 0 11 1pp��✓✓r* Local Regis rar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH•VITAL RECORDS
Permanent CERTIFICATE OF DEATH
Black Ink State File Number:
1.Decedent's Legal Name(First,Middle,Last,Suffix) 2.Sex 3.Soclal Security Number 4.Date of Death(MO/Day/Yr)(Spell Mo)
Elizabeth G. S t a l e y Female 182 - 22 - 6659 April 8, 2013
Sa.Age-Last Birthday(Yrs) 15b.UnderlYe,r Sc.Vnder 1 Da 6.Date of Birth(MO/Day/Year)(Spell Month) 7a.Birthplace(City and State—Foreign Country)
Months Days Hours Minutes
�/ 83 October 17, 1929 7b.Birthplace(County) Perry
8a.Residence(State or Foreign Country) 8b.Residence(Street and Number-Include Apt No.) 8c.Did Decedent Live Ina Township?
Penn lvania
se.Residence(County) 63 West Vine Street 0 Yes,decedent lived in twp,
CQuin3berland 8e.Residence(Zip Code) 17011 In No,decedent lived within limits of Shir"""""^tOWn city/bor..
9.Ever in US Armed Forces? 10.Marital Status at Time of Death 0 Married W Widowed 11.Surviving Spouse's Name(If wife,give name prior to first marriage)
D Yes M No 0 Vnknown 0 Divorced 0 Never Married 0 Vnknow
12.Father's Name(First,Middle,Last,Suffix) 13.Mother's Name Prior to First Marriage(First,Middle,Last)
John Killick Gertrude Brandt
34a.Informant's Name 14b.Relationship to Decedent 14c.Informant's Mailing Address(Street and Number,City,State,Zip Code)
ffi Gary A. Staley Son 1188 Warm Spring Road Chambersburg, PA 17202
Ci _ _ - _ _ _ _ _ _ _ _ -- 15a.P ace o eat (Check on gone _ _ _ _ _ _ _
¢_ If De th Occurred in a Hospital ❑Inpatient If Death Occurred Somewhere Other Than a Hospital Hospice Facility []Decedent's Home
Emergency Room/Outpatient 0 Dead on Arrival 0 Nursing Home/Long-Term Care Facility 0 Other(Specify)
15b.Facility Name(If not Institution,give street and number) '15c.City or Town,State,and Zip Code 15d-County of Death
Holy Spirit Hospital Camp Hill, PA 17011 CL=berland
16a.Method of Disposition $] Burial O Cremation 16b.Date of Disposition 16c.Place of Disposition(Name of cemetery,crematory,or other place)
It E3 Removal from State 0 Donation
(�7� O Other(Specify) April 12, 2013. East Harrisburg Cemetery
/ Z 16d.Location of Disposition(City or Town,State,and Zip) 17a.Signature of Funeral a Licensee or Person in Charge of erment 17b.License Number
Harrisburg, PA 17103 FD 012774-1-
E 17c.Name and Complete Address of Funeral Facility
8 Richardson FLlneral Home 29 South Enola Drive Enola PA 17025
.°id' 1H.Decedent's Education-Check the box that best tlescribes 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 completed at the time of death. box that best tlescribes whether the decedent the decedent considered himself or herself to be.
0 8th grade or less is Spanish/Hispanic/Latino. Check the"No" M White 0 Korean
0 No diploma,9th-12th grade box if decedent is not Spanish/Hispanic/Latino. 0 Black or African American 0 Vietnamese
EX High school graduate or GED completed M No,not Spanish/H(span lc/Latino. 0 American Indian or Alaska Native 0 Other Asian
0 Some college credit,but no degree E3 Yes,Mexican,Mexican American,Chicano 0 Asian Indian 0 Native Hawaiian
0 Associate degree(e.g.AA,AS) 0 Yes,Puerto Rican 0 Chinese
0 Guamanian or Cha Morro
0 Bachelor's degree(e.g.BA,AB,BS) 0 Yes,Cuban 0 Filipino 0 sampan
0 Master's degree(e.g.MA,MS,MEng,MEd,MSW,MBA) 0 Yes,other Spanish/Hispanic/Latino 0 Japanese 0 Other Pacific Islander
0 Doctorate(e.g.PhD,Ed D)or Professional degree (Specify) 0 Other(Specify)
I.
.MD DDS DVM LLB JD
21.Decedent's Single Race Self-Designation-Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22 a.Decedent's Usual Occupation-Indicate type of work
0 White 0 Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED.
0 Black or African American 0 Korean 0 Other Pacific Islander
8 0 American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure Contract Adrm±T±strator
0 Asian Indian 0 Other Asian 0 Refused 22b.Kind of Business/industry
0 Chinese 0 Native Hawaiian 0 Other(Specify)
p Filipino 0 Guamanan qr Cham.rr. Mechanicsburg Naval Depot
ITEMS 23a-23d MUST BE COMPLETED 23a.Date Pronounced Dead(MO Day/Yr) 23b.Signature of Person Pronouncing Death(Only when applicable) 231.License Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH
23d.Date Signed(MO/Day/Yr) 24.Time of Death
25.Was Medical Examiner or Coroner Contacted? 0 Yes Er No
1 CAUSE OF DEATH 1
Approximate
26.Part 1. Enter She chain of a ants--diseases,Injuries,o co --that directly..used the death. DO NOT enter terminal events such a cardiac a est, I Interval:
respiratory arrest,or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only only one cause on aline. Add additional lines ifrnece ssa ry. 1 Onset to Death
IMMEDIATE CAUSE ---------------> a. �C M nli ILL t--C` �(u C 1C
(Final disease or condition Due to(or as a cq nsequence of):
resulting In death) I
b.
o to
Sequentially list conditions, Due (or as a consequence of): ,
If any,leading to the cause ,
I fisted on line a. Enter the c. ,
UNDERLYING CAUSE Due to(or as a consequence of):
(disease or Injury that ,
initiated the events resulting d.
in death)LAST. Due to(or as a consequence of):
26.P--..- Enter other i fl-ar t condi I n Contributing to death but not resulting in the underlying cause given in Part I. 27.Was an autopsy perf ed7
0 Yes No
2H.Were autopsy findings available
m to complete the caus �aLrath?
t- d qO vas eO�Nq
29.If Fem 30.Did Tobacco Use Contribute to Death? 31.Mai per of Death
of pregnant within past year 0 Yes OB yn L�'N atural 0 Homicide
0 Pregnant at time of death 0 No
0 Not pregnant,but pregnant within 42 days of death 0 Suicide Accident - 0 Pending t be deter Investigation
\ 0 Not pregnant,but pregnant 43 days to 1 year before death 32.Date of In Mo D 0 Suicide D Could not be determined
f-- O Unknown if pregnant within the t Jury( / ay/Yr)(Spell Month)
pas year 33.Time of Injury
34.Place of Injury(e.g.home,construction site;farm;school) 35.Location of Injury(Street and Number,City,County,State,Zip Code)
36.Injury at Work 37.If Transportation Injury,Specify: 36.Describe How Injury Occurred:
-V 0 Yes 0 Driver/Operator 0 Pedestrian
-� 0 No 0 Passeng.r 0 Other(Specify)
39a.C -physician,certified nurse prac[i�deff I e miner/co r(Check only one):
-'�- Certifying only-To the best of my knowlretl due to the c se(s)and m stated.
\ 0 Pronouncing&Certifying-To the best of e,death occurred at the time,Z.,and place,and due to the cause(,)antl manner stated.
0 Medical Examiner/Coroner-On the basin and/or(nvestigatlo n,In my opinion,death occurred at the time,date,and place,and due to the c se(s)and manner stated.
Signature of certifier: Title of certifier: to CJ License Number: <-
396.�1 Address and Zip Code of Person Completing Cause o Death(Item 26) n 39c.Date Signetl(MO/Day/Vr)
alam��o eC.� A'Z t2(c'(-.w T2 D.. r )A t- C \k�..f l( It crL/.3 C/l�'� 14-1(1' AA 17 Ir `t /cam (3
40.Registrar's District Number 41.Registrar's Signature 42,Registrar File Date(MO/Day r)
43.Amendments
o_
ITEM# lG /3 % o 13 a �"
:y
n 4.a M CCi
c
�- 2m N ;
LAST WILL AND TEST Mt9t �
o ~ � c*'
v
m
0 F -v CAI v'
a
ELIZABETH G. STALEY
I, ELIZABETH G. STALEY, of Shiremanstown, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory, and understanding, do hereby make, publish, and
declare this to be my Last Will and Testament and hereby revoke all other Wills and Codicils
that I have made, including the Will dated December 18, 1974.
FIRST: I give, devise, and bequeath all of my Estate, of whatever nature and
wherever situate, to my son, GARY A. STALEY, of Chambersburg, Pennsylvania, so long as
he shall survive me by thirty (30) days.
SECOND: Should my son fail to survive me by thirty (30) days or should he for any
reason fail to take under this, my Last Will and Testament, then I give, devise, and bequeath
all of my Estate, of whatever nature and wherever situate, to my brother, HENRY G.
r�
KILLICK, of Mechanicsburg, Pennsylvania, so long as he shall survive me by thirty (30) days.
THIRD: All interests of any beneficiary in the income or principal of this Estate,
while undistributed and in the possession of my Executor, even though vested and
distributable, shall not be subject to attachment, execution or sequestration for any debt,
contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to
pledge, assignment, conveyance, or anticipation.
FOURTH: All inheritance, estate, and succession taxes (including interest and any
penalties thereon) payable by reason of my death shall be paid out of and be charged generally
against the principal of my residuary estate, without apportionment or right of reimbursement
from any person. In the event that a substantial portion, as determined in the sole and absolute
judgment and discretion of my Executor, of the non-probate assets such as an annuity or
mutual funds are directed to be paid to a beneficiary or beneficiaries, so that the taxes referred
to herein would be paid out of the probate residue passing to the beneficiary or beneficiaries of
this will (whether or not the same as the beneficiary or beneficiaries under the non-probate
assets), my Executor, in the Executor's sole and absolute judgment and discretion, shall have
the right to allocate the full or partial payment of the taxes to the beneficiary or beneficiaries of
the non-probate assets.
FIFTH: In addition to all rights and powers conferred by law, I authorize and
empower my Executor and his successors, in his absolute discretion and without necessity of
obtaining court approval:
A. To buy investments at a premium or discount.
B. To hold property unregistered or in the name of a nominee.
C. To give proxies, both ministerial and discretionary.
D. To compromise claims.
E. To join any merger, consolidation, reorganization, voting trust
plan, or any other concerted action of security holders and to delegate discretionary duties with
respect thereto.
F. To lend to, and buy from, my estate.
G. To borrow and to pledge real and personal property as security therefor.
H. To sell at public or private sale for cash or credit or partly for each, to
exchange, or to lease for any period of time, any real or personal property, and to give options
for sales, exchanges, or leases.
I. To exercise any option permitted by law which he believes to be
advantageous from the viewpoint of overall tax reductions, including, without limitation of the
foregoing, power and authority to claim administration or other expenses either as income tax
deductions or inheritance or estate tax deductions, without regard to whether they were paid
from principal or income and without requiring adjustments between principal and income for
any resulting effect on income or estate taxes, and a deduction of such expenses for income tax
purposes shall be given effect in computing the respective shares of all persons interested in
my estate set forth herein, even though the effect is to increase the share of one beneficiary or
class of beneficiaries hereunder at the expense of another; and to make such adjustments, if
any, between beneficiaries with respect thereto as he shall deem appropriate in view of the
nature of the transaction and the amounts involved.
J. To distribute in cash or in kind or partly in each.
The powers granted hereunder shall be exercisable with respect to all real and personal
property, including, but not limited to, income and principal held for minors or disabled
beneficiaries at any time, until the actual distribution of all property. All powers, authorities
and discretion granted here shall be in addition to those granted by law and shall be exercisable
without leave of court. However, nothing herein shall be interpreted or construed to
encourage, authorize, empower, or permit the Executor to act or cause anyone to act in a
manner contrary to or inconsistent with accepted standards of portfolio diversification and risk
management.
SIXTH: I nominate, constitute, and appoint my son, GARY A. STALEY, as
Executor of this, my Last Will and Testament. In the event of the renunciation, death,
resignation, or inability of my son to act for whatever reason in this capacity, then I nominate,
constitute, and appoint my brother, HENRY G. KILLICK, as Executor of this, my Last Will
and Testament.
I direct that no representative named above shall be required to post security for the
faithful performance of his duties in any jurisdiction insofar as I am able by law to relieve him
of such obligation. Any of my representatives shall be entitled to reasonable compensation for
the performance of the duties set forth here.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of
-Stir fc.wbcr , 2406, on this, the fourth of four typewritten pages. I have also signed the
left-hand margin of the first three of these pages for purposes of identification only.
ELIZXMTH G. STALE
SIGNED, PUBLISHED, and DECLARED by the Testatrix, ELIZABETH G.
STALEY, as 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 hereunto subscribed our names as witnesses.
ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of Cumberland
I, ELIZABETH G. STALEY, Testatrix, whose name is signed to the attached
instrument, having been duly qualified according to 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.
ELIZA BETH G. S ALE
Sworn or affirmed to and subscribed before me by ELIZABETH G. STALEY, the
Testatrix, this 101 ' day of M64 C 2006.
Notary Pub dc
COMMONWEALTH OF PENNSYLVANIA
Notarial seal
Mary M.Loper,Notary Public
Camp Kin Boro,Cumberland County
My Commission Expires Oct.27,2007
Member,Pennsylvania Association Of Notaries
AFFIDAVIT
Commonwealth of Pennsylvania
County of Cumberland
We, Debra K. Wallet and the witnesses whose names
are signed to the attached instrument, being duly qualified according to law, depose and say
that we were present and saw the Testatrix, ELIZABETH G. STALEY, sign and execute the
instrument as her Last Will and Testament; 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 that
time 18 years of age or older, of sound mind, and under no constraint or undue influence.
Sworn or affirmed to and subscribed before me by - , k-. j �_� and
�nnL L&i- j,, )mn witnesses, this 10J41 day of 'Sip b�r 12006.
Notary Pub 0c
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Mary M.Loper,Notary Public
Camp Hill Boro,Cumberland County
My Commission Expires Oct 27,2007
Member,Pennsylvania Association of Notaries