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Home My WebLink About02-10-05 ....,._"_.."---",..,.,"->._"--~._--""',"",.._~~...,,..,,,~- Register of Wills of Cumber land County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Samuel M. Sinunons Jr. also known as No. ~ \-~S - \~~ , Deceased Social Security No. 187 -16 -6004 Samuel M. Sinunons, III Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) [K] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 08/04/1997 and codicil(s) dated None N/A r""" na~ in the last a of ';:,0 ~ . ..p ,W'"j i:;;~;:2 ;~..: -;:~1 i~;':;, :t-j '.. .j State relevant circumstances, e.g., renunciation, death of executor, etc. ~ =::~ a /..1 /"..,... ,,....~"'\ U ,c;;"l -;.! Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution or~ne docu~ offered for probate; was not the victim of a killing and was never adjudicated incompetent: ~;~\ I">? None w D B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumber land County, Pennsylvania with hislher last family or principal residence at 1 South Locust Point Road, Monroe Township, Mechanicsburg, PA 17055 (list street, number, and municipality) Decedent,then~earsofage,died 02/02/2005 at Harrisburg Hospital, Harrisburg, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled inPA) Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania 137,000.00 $ $ $ $ 675,000.00 situated as follows: 1 South Locust Point Road, Mechanicsburg, Cumberland County, Pa. T ed or rinted name and residence Samuel M. Sinunons, III 72 South Locust Point Road, Mechanicsbur , PA 17055 s Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) ~ \-~S - \:S~ 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 ~~~~ffl Samuel M. Simmons, IiI ~ before me this~ day of i.~S ~~,,~~, "I. r......., ~:~ {~~~:-,:) :::n ~~~~\ ~Register ~~. ~~\ '}. ~\) ~~ No. c). , - ~ S - \ ~ ~ n . ::(J . ....y? c) : . :~-. F~~1 /;1 :)~~ , r"~:""~ C~;~J ... '-~ ~f~:~ ; i '..~..,..'" <::) ._... ;'_::~:::'::-J ; ("-'1:~"1 "j \"'::,_"~J ,'----" ""'. ..,- '.,.""j '......t i I \)' -n (:.'''~ ~ J rT.1 c::> ~''''''i'''l ....,.e:""" '.1 ,............ f:::-3 .. .~~~ .......~ Deceased .r:- Estate of Samuel M. Simmons Jr. w Social Security No: 187 -16 - 6004 Date of Death: 02/02/2005 AND NOW, ,~'(~~'{'\ \\J , ':)..~~S, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [!] Testamentary D Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Samuel M. Simmons, III in the above estate and that the instrument(s) dated 08/04/1997 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters. . . . . . . $ <.o\~ ~"-\ \S <:<,~ <;;:~ ~ "'" ~.'l..~~~~",\)~ ' Attorney: James D. Bogar Short Certificate(s). $ \))\\..\... Ref\WRtiatKaR $ Affidavits ( $ 1.0. No: 19475 Extra Pages ( ) . $ One West Main Street Address: Codicil. . $ Shiremanstown, PA 17011 JCP Fee. . . . . . . ~~~~~ ~ ~ $ \~ ~ Telephone: 717/737-8761 Inventory. $ Other . . $ TOTAL. . . . . . . .. $ ~\ol\ Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) H105.805 REV 1105 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanen\ filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. if~ ~.l4- Local Registrar Fee for this certificate, $6.00 p 11336250 ~e ~J-' if lL ~V If & ~ooS nJ.e r--.:l 2:5 c.n -0 o -.i!'~ i"c' .. r w H105.143 Rev. 2/87 C~L TH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH ITATI. fU........ SOCIAL SECURITY Nl*ER 'IYPEIPR*T IN - BLACkIlOK \' BIRTHPlACE (CIlr one! _ or ForoIgil CClurWy) . -ID 17. FP.... FACIU1Y _ (llnol--'lIMl_one!~ White SURllMNG sPousE ........, 11M ...... fNlMe) 1L 11~. Farmi ...... 1 South Locust Eoint Road t Mecbanicsburg, EA 17055 F"'_ -(Fnt. -.lMl) tl. Samuel M. Sinmons ,po/PItnI) _ Samuel. M. Sinmons III _IXI~G-__D 0IIlIl' (SpodIy) ... - AI<. F v-D No v-D NoD - .. ClIm'IElI (0-. onIr"') ~~~:::"'..::=:r=r~~.~.~.~.~.~~~................. =OF~ -.. D - D HamIcIdo Pondir1g -- DATE OF INJURY _...,.v.-) D D_ _. M. D PtACEOF/NJURY-...._.__-,._ 1luMlQ....(SpotGI'r) 100. TIME OF INJURY INJURY...T WORK? DESCRIBE HOWIIIJURY OCCURRED. Could not be dIIInNned - l.DC4T1ON~.CltyII'_._) :sot. 21. !E. ~ ~ ~ I 12I.l.I~ll~ M. JJ ~"oS" LAST WILL AND TESTAMENT I, SAMUEL M. S~, JR., of the Township of Monroe, County of Cumberland and State of Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my Last will and Testament, hereby revoking and making void all former wills, codicils and other testamentary dispositions by me at any time heretofore made. 1. I direct my Executor, hereinafter named, to pay my legally enforceable debts and the expenses of my last illness and burial. 2. I give, devise and bequeath all the rest, residue and remainder of my Estate, whatsoever and wheresoever situate, unto my son, Samuel M. Simnons, III, providing he survives me by sixty (60) days. 3. Should my son, Samuel M. Simnons, III, predecease me or die on or before the sixtieth (60th) day following the date of my death, then and in that event, I give, devise and bequeath all the rest, residue and remainder of my Estate unto my daughter-in-law, Suzanne K. Simnons. 4. 0 c:;o I nominate, constitute and appoint my son, Samuel M. s~s, "'.. r.'-...... ,'r"'n III, Executor of this my Last Will. Should my son fail to qualify or.':(:~se Q ~::' C) to act as Executor, then and in his stead, I nominate, constitg1;E(I~nd :..,:::::j N appoint my daughter-in-law, Suzanne K. Simnons, Executrix of thisrtJy Last.;;" w will and Testament. 5. I direct that my Executor and his successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN Wl'DmSS WBBRIIlF, I, SAMUEL M. S~, JR., the Testator, have hereunto set my hand and seal to this my Last will and Testament on this '1tJi. day of /I ~lfa.s'7" , 1997. :J;~"p$~;"~'&Y ' samuel M. Sinmons, Jr. . Signed, sealed, published and declared by the above named SAMUEL M. SIMMQfS, JR., as and for his Last will and Testament in the presence of us, who, at his request and in his presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto COMMONWEALTH OF PENNSYLVANIA . . . . COUNTY OF CUMBERLAND . . I, SAMUEL M. S~, JR., Testator, whose name is signed to the attached or 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 to ~~OWledged the Testator, this. day of by SAMUEL M. SDK:H;, JR., , 1997. N al Seal Charlyn . Guerriero, Notary Public Mechanicsburl} Bere, Cumberland County My CommiSSion Expires May 18, 1998 Member, Pennsylvania Association of Notaries COMMONWEALTH OF PENNSYLVANIA . . . . SSe COUNTY OF CUMBERLAND . . We, 'KAJ.1'''' G. vlEH.H"U .;~ .If.vP lftl,.VA;14 L ",PdP~fII>' ~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator, SAMUEL M. S~, JR., sign and execute the instrument as his Last will: that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed: that each of us in the hearing and sight of the Testator, signed the Will as witnesses: and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me by ,~q.H I.r. JI/KH'A~.v... dx. 1tlJ day odr",r and ~/4~/~ ~. ~~HP~Y , witnesses, this 1997. ~~/I zt'L~ ~tnes ~ P Ii Nota Seal Charryn Y. Guernero, Notary Public MechanlcsburQ Boro, Cumberland County My CommissIon Expires May 18, 1998 Member, Pennsylvania Association of Notaries