HomeMy WebLinkAbout11-18-13 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF (�U/I'//��LA�10 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 forin:
Decedent's Information _ /
Name: TE�// m�E �%7��C� File No: �� ��'� ' ���3�
a/k/a: �'"�CAn /I'J�'lE LGn�G' �nAr /1��� (Assigned by Register)
a/k/a:
a/k/a: Social Security No: /��s 1�— �`/S 3�'
Date of Death: /� i2 �3 Age at death: ��
Decedent was domiciled at death in -�u���l/�iiU County, �� (Srure)with his/her last
principal residence at 3GC� o�KVrccF ,t?oa�/�PEnS�3t��Pr, ��a� ��Eu��/�, �m8G2CA�lv
Street address,Post Office and Zip Code /�r�57 City,Township or Borough County
/G3/ N•,�in�TST
Decedent died at ��`'���L--�z /�I�PTS�TiI,pG- f�A I�1'/�2 v,guj�i-�� �j.}
Street address,Post Office and Zip Code City,Township or Borough County State
Estimate of value of decedent's property at death:
If doniici[ed i�T Pennsylvania................... ......... All personal property $ /2� ����
!f not domiciled in Pennsylvania. ....................... Personal property in Pemisylvania $
If not domiciled in Pennsyh�ania. ....................... Personal property in County $
Value of rea[estate in Pennsylvania...... ................................................... $ / D�ccic�
TOTAL ESTIMATED VALUE. ... $ %�2, u�^�
Real estate in Pennsyivania situated at: ..�Ov �kKVr'GCE �0/it�� .$�r��S��I,F'C. �i9 /�'2 5 7� No.P77�/�/L�t1�/J Gj/y��ly�y}
(Attnch ndditional sheets,i/�necessary.) Street address,Post Office and Zip Code —� City,Township or Borough County
� A. Petition for Probate and Grant of Letters Testamentarv
� .�2c�'� and Codicil(s)
Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated ��
thereto dated �
State relevant circmnstances(e.g.renuncintion,rleaUa of executor,etc.) � '
�` �
Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was�dy�rced,was ot a p�t�pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. §3 (g"J?and did `p,�e'have�clfi�d born or
adopted;and Decedent was neither the vichm of a kdlmg nor ever adjudicated an incapacitated person. � � � � � 'n
T ._.{ [:�
�NO EXCEPTIONS ❑EXCEPTIONS __ � � rn �`'' n� r�i
� � � C3---�, C7
❑ B. Petition for Grant of Letters of Administration (If applicable) �`` � '� -� o �
c.t.u.,d.b.n., d.b.n.c.t.a.,pendente Iit��clu�DnE�qgbsexxEe ,durctalt ' 'noritute
If Administration,c.t.a. or d.b.n.c.t.a.,enter date of Will in Section A above and�om�ete list 6'�hei�s. m
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for�xorce had bee�tablished'�T defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
❑NO�XCEPTIONS �EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent lefr no Will and was survived by the following spouse(if any)and heirs(uttuch
aclditionulslaeets,i�necessary):
Name Relationshi Address
F�,-,�,aw-oz i•ev.10/11/20/I Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioner(s)Printed Address
`JE2Q �l/Irl �/�i9'/JGL� J`�/ ll� /�l�l,� S7c' I' /IIC�USC(� � /�Z�/
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 la�owledge and belief
of Petitioner(s)and tl�at,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 subscribed before — Date �� /� �-�
me t is ��day of ;�� � ��� � Date
By: � � � '��"}� Date
For the Re�ister Date
BOND Required:�YES 'O To the Register of Wills:
FEES: Please enter my appearance by my signature��ow: �
7 �� �5-� G'� �;�.,
Letters . . . . . . . . . . . . . . . . . . . . . . $ ��C!�•�v Attorney Signature: C � � n
--,. �
( � ) Sllort Certificate(s). . . . . . ��j�,f�j� � � v
( )Renunciation(s).. . . . . . . . rn � � � � C�
( ) Codicil(s). . . . . . . . . . . . . :U Za. r !--' 3"+"t t"Y�
( ) Affidavit(s).. . . . . . . . . . . � " � ��-'� �
.-,, Cf) ' � G:
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: "`- ' '�' -� -st ""+�
Conunission. . . . . . . . . . . . . . . . . . Supreme Court �� .�.. ' �- ---
C7
Othe}� . . . . . . . ID Number: �,�_�.� �--- r��
I t . l ,C L ` --�! �' C>
. .Y��• • � .�� Firm Name: � � � '�'i
• • • • • • • • LS.�v Address: �
. . . . . . . . Phoue:
Automation Fee. . . . . . . . . . . . . . . �j,� Fax:
JCS Fee. . . . . . . . . . . . . . . . . . . . . a7.�LJl� Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $ "�e�SO
DECREE OF THE REGISTER
Estate of f113✓! /1� ii��'� File No: �/������3�
a/k/a:
AND NOW, +�� � ��v���Q� , ��, in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters
are hereby granted to �'�
in the above te and(if applicable;that
the instrument(s) dated� �(�
described in the Petition be admitted to obate and filed of record as the last Will (and Codicil(s)) of Decedent.
��
Register of Will CY -1 � � �
Fo,�,�z n�v-nz ,��v. roiilizol� Page 2 of Z
H105.805 REV(9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee far this certificate, $6.00 �E�d���� ������ �� ��,,,,����" This is to certify that the information here given is
txt 1 ,,v�p�TH Of pE�;- correctly copied from an original Certificate of Death
RE�IST�� 0� P�i�LS ,�,,��y� _ y�,`_
; o - _ l�; duly filed with me as Local Registrar. The original
.� � � =`: z` certificate will be forwarded to the State Vital
t{;�� t��� 1� �� � ,� � a� Records Office for permanent filing.
;* , *,;
� 1 � 9 � 7 2 2 9 c��r��c o� �°�'� - �?'''� ��A.��.��a�-��- N0�1 1 4/2013
Certification Number ������$� ����T 99jMENT OF��`P
���''�
""""������ Local Registrar Date Issued
� Cl1MBER�AND G�., Pt�
Type/Pr{nt In COMMONWEAITH OF PENNSYLVANIA�DEPARTMENT OF HEALTH�VITAL RECORDS
PefTa"e"` CERTIFICATE OF �EATH
Black Ink State File Number:
1.Decede�t's Legal Name(First,Middle,last,Suffix) 2.Sex 3.Sociai Sec�rity Numbe� 4.Oate of Dea[h(MO/Day/Vr)(Spell Mo)
Jean Mae Shope emal 198-22-9537 0 �
Sa.Age-Last Birthday(Vrs) Sb.Under 1 Vear Sc.Under 1 Da 6.Oate of Birth(MO/Day/Vear)(Speil Month� 7a.Birthplace(City and State or Foreign Country)
g q Months oa�� No��s nn�„�ce� Ma y 2 , 1 9 2 9
7b.Birthplaca�co,,,;cY� e non
8a.Res�dencC(State or Foretg�Country) 96.ftesitlence(Street and N�mber-Include Apt No.) 8c.Oid OC<edent Live in a Township7 �
Penns lvania 300 OaKville Road �Ves,decedentlivedin North� Newton t,NP.
8d.Residence CounYy)
C.'UZR�be r 1 a nc3 ge.Residence(Zip Cotle) �No,decedent Iived wlthln Ilmits of city/boro.
9.Ever in VS Armed Forces? 10.Marital S�at�s at Time of Death � Mar�led Witlowed 11.Surviving Spouse's Name(If wife,give name prtor Lo flrs�ma�ri�6e)
�Ves ��No �Unknown � Divorcetl � Never Married 0 Unknow
12.Father's Name(Firs[,Middle,Last,Suffiz) 13.Mother's Name Prior So First Marriage(First,MlCtlle,Last) �
Montella K. Long Sda Warble
14a.Intormant's Name 146 Iationship to�DgcetlenT 14c.Informant's Mailing Address(Streef and N�mber,Cify,State,Zip Code)
o Jerry Ann Spangler 7�augriz t 57 West Main Street Newviiie
G � �. . � sCi�� _ _ _ _ _ _ _ i a.via�e o oeet c ec o e
_ IF Death Occ�rred�in a HosplCal . patient � �If Oeath Oc�urretl Somewhere Othe Than a Hospital ❑Hospice Facility �Decedent's Hom
° � Eme�gehcy Room/OUipatien[ . 0 oeaa on Arrival � Nursing Home/LOng-Term Care facility �Other(Specifyj ' � e
s 15b.Facility Name(If not irtsHtuUon,give streeC and number) ISC Cify ur Town,StaSe,ar�tl 2IG Cotle 15d_County t�f OeaSh
Harrisbur Hos it$1 Har
� 16a.Method of DlspoSition Burial Q Cremation 16b.Date of Dispositlon 16c.Place of DlSposi[ion(Name of cemetery,crematory,or other place)
p Remavalfromscece p oo,.ac�o., 11/15/2013 B1ue Rid�ge Memorial Gardens
- O Other(Specify)
.� 16d.Loca[ipn of pisposifion(City or Town,State,and 21p) i7a,Sig�ire o F ral ice Licensee or Person in Charge of Interment 1'16.license N�mber
_ Harrisburg PA 17101 '�_ /�-� � S L
E��17c.Name e�tl CompleCe Atldress of Funerai Facility
8 E er Funeral Home 2n 15 B ' r
� 18.De<edent's Education-Check the box Shat best describes the 19.Decetlent of Nispanic Orlgin-Check the 20.Decedent's Race-Check ONE OR MORE races fo indicate what
�- highest degree or level of school completed at the time of death. box that best describes wheLher the decetlent the de<edent considered himself or herself to be.
� Sth g�ade or less is Spanish/Hispanic/Latino. Check the"NO" �Whife � Korean
� No tliploma,9th-12in gratle box If tlecetlent is not Spanish/Hispanic/Latino. Black or African Amcrican Q Vietnamese
�High s<hool grad�ate or GED complefed �No,naf Spanish/Hispanic/Latino � American Indlan or Alaska Native
Some C011e � Other Asian
0 ge credit,but no degree O Yes,Mexican,Mexican American,Chicano O ns�an i..dian � O Native Hawailan
O Assoclate degree(e.g.AA,AS) 0 Yes,Puerio Rican �Chinese � Guamanian or Chamorro
� Bachelor's degree(e.g.BA,AB,BS) 0 Yes,Cuban '
O Master's tlegree(e.g.MA,M5,MEng,MEtl,MSW,MBA) � Yes,other 5 ish Hlspanic/Latino � Fillpino O Samoan
pan / 0 Japanes� � Other PactFic Islander
O Doctorafe(e.g.PhD,EdD)or Professional degree (Speclfy) � Other(Specify)
.MD,ODS DVM LL6 JD
21.Decedent's Single Race Self-Designation-Check ONLY ONE to Indicax�whaT the decetlent consideretl himself or herself to be. 22a.DecedEnt's Usual Occupation-Indicate type of work
�WhiLe O Japanese O Samoan done during most of working ItFe. DO NOT USE RETIRED.
� Black or AfMCan American � Korean ' � Ofher Pacitic Islander H O L7 S 2 W�f e
�American Indian or Alaska Native �Viefnamese � Don't Know/NOt Sure
O Asian Indtan � Othe�Asian � Refusetl 226.Kind of Business/Industry
v� � Chlnese � Native Hawallan 0 Other(Specify)
� O Fu�a��o O ��a�„a�rar.or cnamorro Homemaker �
ITEM523a�.-23A�MUSTHE COMPLE7ED. 23a.Date Pronounced Deatl(MO/Day/Vr) 236.Signatvre of Person Pronouncing Death(Only when applicable) 23c.License Number
BY PERSON WHO PRONOUMCES OR .
CERtIFtES DEATH
23d.�Date Signed(MO/Day/Vr) � 24:Time of Death
� � '.\ 25.Wes Medical Examine�or Coroner Confacted? � Yes No
� � � GAUSE OF DEATH ' � �
Approximate
26.Part 1. Enter the chaln of events-diseases,Inj�ries,or compllcations--that direcHy caused the de th. DO NOT enter terminal events such as cardiac arrest, � Interval:
respiratory arresi,or ventricular tibrlllation without showing ilie etiology. DO NOT ABBREV `.a/E nSer only one cause on a line. Adtl additlonal Iines if necessary. � Onset to Death
IMMEDIATE CAlJSE ------ --> � t/�jS'�{.r� / �
N .v� �1 �
(Ftr,ei ai:ease o�cona�e�on a o°� (� n:�q�e..ca of)-
resulting In death7 �� ,� 1
.. p. �'7h.1 � � �
Sequentf011y Ilst cor�dlCiorls, �!Y_ � D e to(a��onseq c� �� ~P� � 6
� 1
If any�leading to the�cause
1
Iisted on line�a.. Enterthe . �
UNDERIYiNG CAUSE �� D�e to(or as a conscqucnce of): � .
(disease or injury that �
1 '
� initiaietl the evenis res�icing tl. �
In death)LAST. Due to(o as a consequence of): . �
fj �26, rt�1. Enter oiher s�iftcant condlfions contributf�¢to death but�oY resulting in the underlying cause given in Part I. 27.Was an auCOpsy perto ed?
° �J� m1 !(�l O Yes L9�ivo
� � � �-Y ` " " � J ��� � C � 28.Were autopsy findings availablc
m �.� . to wmplete the causey f deathi
.-' � Yes C�3'No
a+ 29.If Felnale: 30.Did Tobacco Use Contribute to Death7 31.M�nner of Death
E F�NOtpregna�Swithinpastyear O Ves O ProbabW^ Q Natural � Homicitle
� � Pregnant at Sime ofi death � No �Unkno � Accident � Pe�ding Invesclgation
� Not pregnant,but prcgnanf wi[hin 42 days of death � Sulclde � Could not be determined
�-- � Not pregnant,but pregnant 43 days to 1 year before death 32.Date of InJury(MO/Day/Yr)(Spell Month)
� Unknown if pregnant within the past year 33.Time of InJury
� 34.Place of Injury(e.g.home;construcfion site;farm;school) 35.location of Injury(Street and N�mber,Gity,County,Staie,Zip Code)
d
Q 36.Injury at Work 37.If Transportatlon Injury,Specify: 38.pescribe How Injury Occurred:
0 Ves � Driver/Opera[or O Pedestrian
S O No O Passenger O Other(Specify)
V J 39�ertifier-physidary certlfied nurse practiiloner,medical examiner/coroner(Check only one):
Certifying only-To the best of my knowledge,death occurred due to the cause(s)antl m r stated.
� Pronouncing 8.Certifytng-To the best of my knowledge,death occurred at the tlme,date^and place,and due to the cause(s)and manner staYed.
J 0 Medical Examiner/COroner-On the basis of exa nation antl/ Investigation,In my opinion,death occurred at the time,dafe,and place,and due fo the cau�sc(s)and�m^a' 'r siated.
� Signature of certifier: w�-- Title of certifier: Yh\� Licertse Number�_M"���0�4�
� 39b.Nam¢,Address antl Zip Code of Person Complexing Ca of Death(Item 26) 39c.Date Signed(MO/Day/Y)
1 ls 3 �1- - � r-� f� 3
� 40.R¢gis[rar's District Number 41.Registrar's Signaiure 42_Reglstrar File Dafe(MO Day/Vr)
� al-�l� �y9�.�A_'���..ul..� ��.�- �c- N O 3
43.Amendments
0
�
6
Disposition Permit No. ��-L��/1�� H305-143
REV 07/2012
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I.AST WILL AND TESTAME �11��`"' :� o `y
�-� c-� �� � ,� "°`�
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. :l7 Z.J E-=' F.f�.
I, Jean M. Snope, presently residing at 300 Oakville Rc�d,-{Shippensbu�,�1orth
Newton Township, Cumberland County, Pennsylvania 17257, being of sound minc�, memory and
disposition, do hereby make, publish and declare this my Last Will and Testament, hereby
revoking and making void all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and
funeral expenses as soon as may be convenient after my decease.
SECOND. My son, James L. Shope, shall have the right to reside at my home iocateci
at 300 Oakville Road, Shippensburg, Pennsylvania 17257, for a period of two (2) years subsequent
to my death, rent free. In addition, my estate shall pay the real estate taxes for that time period.
THIRD. I give, devise and bequeath all my estate, real, personal and mixed,
whatsoever and wheresoever situate, to my children, in equal shares. However, if a child does not
survive me and leaves children who so survive me, such children shall receive, per stirpes (by
representation), the share my child would have received had he or she so survived me.
FOURTH. All federal, estate and other death taxes that may be assessed as a
consequence of my death, whether or not the assets pass under this Will, shall be paid from the
residuary estate of my probate estate just as if they were my debts, and none of those taxes shall be
charged against any beneficiary or joint owner.
FIFTH. I appoint my daughter, Jerry Ann Spangler, as Executrix of this my Last
Will and Testament; if she be unable to fulfill the duties of Executrix, I then nominate, constitute
and appoint Orrstown Bank, with offices located at 77 East King Street, Shippensburg,
Pennsylvania 17257, to be the Executor of this my Last Will and Testament.
SIXTH. I direct that neither my Executor nor any successor shall be required to give
bond ior ine faithful performance ot their duties in any jurisdiction.
SEVENTH. To the greatest extent permitted by law, before actual payment to a
beneficiary or to his or her account, no interest in income or principal shall be assignable by a
beneficiary or available to anyone having a claim against a beneficiary.
IN WITNESS WHEREOF, I, Jean M. Shope, have hereunto set my hand and seal to this
my Last Will and Testament, written on one (1)page, this 4th day of January, 2006.
� Y`'I (SEAL)
WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
� + �
This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to
be her Last Will and Testament, in our presence, who at her request and in the presence of each
other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed
our names as witnesses.
��
�
�.u� �� /C�P�.
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND :
I, Jean M. Shope, the person whose name is signed to the foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that I signed and executed the instrument
as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the
purposes therein expressed.
Sworn or affirmed to and acknowledged before
me by Jean M. Shope, the Testatrix,
this y� day of� , 2006.
������ �
NOTARIAL SEAL
= PA'RICIA L TOME
`� y} Notary P�blic
, ` . -"�' ,,, , SNfPPENSBURGBOROUGH�CUMIBERIANDCOUMY
`,, . My Commisslon Expires Jun 7,2008
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WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
. -
COMMONWEALTH OF PENNSYLVANIA .
: SS
COUNTY OF CUMBERLAND :
We, �/� �����—�/ � ��-�s���.. L, ��\-P _ ,
and L-/^�o►a x- ��L ��iv , the witnesses whose names are signed to the
foregoing instrument, being duly qualified according to law, do depose and say that we were
present and saw Jean M. Shope, the Testatrix, sign and execute the instrument as her Last Will;
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, sigiled the will as
witnesses; and that to the best of our knowledge the Testatrix was at the time eighteen (18) or
more years of age and of sound mind and under no constraint or undue influence.
` ,� �/
� �
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Sworn or af rmed to and subscribed before me by
/�,.�/� ,
�r�t�K.e__ L. �C� ��� �
ar.� �iND�+ I�_ ��LF in�
witnesses, this y��day of �t n u , 2006.
C!�-�n LC,c�x. �G'�
-�
,'.:., � NOTARIAL SEAL
` r`�` � . PA'RICIA l TOME
V� ' °�° E . ; Notary Publlc
l f± �` ' ��HIPPENSBURGBORp(K,�{,CUM18ERtANDCOUMY
_ , °- My Commission Explres Jun 7,2008
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WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17Z57-1397