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Home My WebLink About01-04-05 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estateof Agnes K. Smith No. /~/ --DS--~7 also known as - ' ' , Deceased Social Security No. i32 - i6- 3326 Kathleen S. Jordan and Barbara A. Smith Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) -'-{ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut named in the last Will of the Decedent, dated and codicil(s) dated State relevant c~rcumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: ~ B. Grant of Letters of Administration -d. b _ _,',_. c. t. c~. ~ (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence Dorothy P Smith I Daughter · 13223 Mulberry Drive, Clearwater, FL 33761 Kathleen S. Jordan IDaughter 12 Mayflower Ave., Hull, MA 02045 Barbara A. Smith IDaughter I101 Oneida Road, Camp Hill, PA 17011 William P. Smith, Jr. ISon ~140 Hunter Lake Drive, Unit "F" ~ Oldsmar, FL 34677 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumber[and County, Pennsylvania with his/her last family or principal residence at 4833 East Trindle Road, Hampden Township, Mechanicsburg, PA 17055 (list street, number, and municipality) Decedent, then 79 years of age, died 12/10/2004 at M.S. Hershey Medical Center, Hershey, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ~ ~ 368,0_.~0 C~O (If not domiciled in PA) Personal property in Pennsylvania :~;~'~-Z~_ (If not domiciled in PA) Personal property in County ;~ ~ ? Value of real estate in Pennsylvania -~ m situated as follows: , _> ?~_' ~ ~,, ~ ~1 ~ r-- r~ Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition an(~he.~ .... grant of" letters in the appropriate form to the undersigned: C.o _.;.~ I Si~lnature Typed or printed name and residence ~.'.~~ ~.~ Kathleen S. Jordan 2 Mayflower Avenue, Hull, MA 02045 Barbara A. Smith 101 Oneida Road, Camp Hill, PA Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that 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, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed '/~_~¢.~ j~_.~ ~. ~--~._~ Kathleen S. Jor~a before me this L~ day of ,..~q0~r~ , C~'--" Barbara A. Smith Estate of A~nes K. Smith Deceased Social Security No: 132-16- 3326 Date of Death: 12/10/2004 AND NOW, q''lt~ ~Z~/. ~_ J~'r'lo~f/ ,~,~ , inconsideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~] Testamentary ~] Of Administration,~. ~.,.,,.,~-' ' L. ~. (c.ta.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Kathleen S. Jordan and Barbara A. Smith in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s) ..... $ Renunciation ........ $ t lJ. t./l,.j Attorney: Ja..rfles D. Bo~ar Affidavits ( ) .... $ I.D. No: 19475 E-x~e~ ( ) .... $ 5'~'~0 Address: One West Main Street Codicil ........... $ Shiremanstown, PA 17011 .......... $ \0'0D Telephone: 717/737-8761 JCP Fee ......... $ ,ff--OD Other ........... $ TOTAL ......... $ Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) This is to certify dmt lhe inlbrmation here gixcn is correcllv copied from an original certificate of death duty filed with me as Local Regislmr. The original certificate will bc forwarded 11) l[~c Stme Vital Records Office lbr permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. F~"~ ~_* ~ Local Registrar N 143 Rev. 2187 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH [ NAME OF DECEDENT (First. Middle. La~I) STATE FILE NUMBER ..... -- SEX [ SOCIAL SECURITY NUMBER DATE OF DEAT ~. Agnes r,. bmLtn Femal .......... J H(Mon~h. Day. Year} Iz e J3 IJZ -- lb -- 33Zb J4 December 10,2004 AGE (Last Bidhday) [ UNDER I YEAR UNDER 1 DAY DATE OF BIRTH BIRTHPLACE (City and PLACE OF DEATH Ch ck Chi one - ' [M~ths ] Days, Houm IMinutes, (Monlh. Day. Year, State or Foreign Coun,~) I.~ ...... · ' ; y , ..... t~ct,on, onoth~rside, W OF DEATH I C W BORO ~p OF D~TH I FACILI~ NAME 'If ........ ~ ' J ~ ~ R.,~..~. U (Sp.~) U .. Dauphin I. De.yTwp I M S Hershey Medical Center lu~.~..~ .... '.,~' ' ' . .Yes~ NO~ Elamen~lSe~a~I C~e~ Oiv~ (Specie) ,,. Teacher ~Carlisle Schools ~. ~o-,~ O~CEOENT'S ~ILING ADDRESS (Street. Citron. S{~l~. Zi~ O~e) [ DEC,DENT'S ' ACTUAL Did 17c. ~ Yes. dec~ent lived in Ham~en 4833 East Tnnd[e Road ~ ,7..sm,. Pa RESIDENCE ' dec~ent ' ~ (See ins~uctions live in a ~ Hechanlcsburg,pa 17055 Cumberland tow.,,~,? ~7,.~ I MOTHER'S NAME (First. MiddY. MaVen Sumac) ,. Terrence Kelly I,~ Nora Carney METHOD OF DISPOSITION [10b. ayr lower Avenue Hull, Mass 02045 Donation D Burial ~ Cremation ~ ..... ..om State O l( .............., Io. Other Place ' DATEOFDSPOSITION P~CEOFDSPOSITION Na~olCeme/e~ Cremalo LOCATION 22a ~ '~ ~~ ~:~: uN ~/ING AS SUCH LICENSE N~[R. ~. NAME AND ADDRESS OF FACILIW ' "" - bom~msz~n~i~ i. __ , ' [azc ' ' I [(~th Day Year) ~ ...... hop ....... death ~ ,ME OF D~TH ' DATE PRONOUNCE~ D~D tMo~th Da~ y I ......... [23c. ems 24-26 must be ~pleted by T 23b. ' ' 24 ~ ~ I ~ , . -. ~ [ w~ ~A~ REFERRED TO A MEDICAL E~MINER/CORONER? IMMEDIATE CAUSE (Final . inte~al be~n not resulting in the unde~ying ~use given in PART I. '. onsel and death disease or ~diti~ ~ e % 'i ~ ~E TO (OR AS A CONSEQUENCE OF): cause. Enter UNDERLYING CAUSE (Disease or inju~ c. WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF D~TH DATE OF INJURY TIME OF INJURY INJURYAT WORK3 DESCRIBE HOW iNJURY OCCURRED ~ COMPLETION OF CAUSE J Na{ural ~ Homicide On the basis ofex~lnatlon andl~ investigation, in my opinion, death ~curred at the time date and p ace and due to the causes s and ~ 3~-~' Hershey Medical Center Hershey, PA 17033 REGISTER' IGNATURE ND NU B Register of Wills of Cumberland County, Pennsylvania RENUNCIATION also known as , Deceased The undersigned, Children of (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to Kathleen S. Jordan & Barbara A. Smith WITNESS ~ hand this Q, 6~ dayo~ .j~f.(~~, ~ (Signature) Dorothy P. Smith 3223 Mulberry Drive Clearwater, FL 33761 (Address) (Signature) William ~5-. Smith, Jr.v 140 Hunter Lake Drive, Unit "F" Oldsmar, FL 34677 (Address) (Signature) (Address)