HomeMy WebLinkAbout04-12-05
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Register of Wills of Cumberland County
; (~ ' .. ~ 1. 2.
Estate of Clarissa B. Clark
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
No. .21 - () 5 - -;;>., 3"'\
To:
, Deceased.
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Social Security No. 508-07-6693
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, and the execut~ named in the last will of the
above decedent, dated September 11 , 20 03
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Carlisle, Cumberland
Pennsylvania, with hlClast family or principal residence at
2A Todd Circle, Carlilse, Cumberland County, Pennsylvania
(list street, number and municipality)
County,
Decedent, then ~ years of age, died April 3 , 20~, at Carlisle, Cumberland Co., Pennsylvania
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after
execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent:
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$ 365,000.00
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented
herewith and the grant of letters testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
thereon.
Signature(s) of Petitioner(s)
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-<( J i' riA ~ ( -. 'tUui /......
Residence(s) of Petitioner(s)
300 West Willow Street, Carlisle, PA 17013
.
Register of Wills of Cumberland County
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENN8YL VANIA
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88:
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 ofpetitioner(s) and that as personal representative(s) ofthe above
decedent petitioner(s) will well and truly administer the estate accordi~g to la~, _ 'I /
Sworn to or affirmed a~~bscribed {?( [tIN! fA . c: !ill clLt'.t ~
Before me this ) a. ~'!Y of
n.p~;L ,20 CP
~n:\o..':tru."o" ,'1+rm\r.n\n~
~'-" CCr~~gister I
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No.dl-05' 2,3~
Estate of CLARISSA B, CLARK
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~ I;:).. 2oQ;i, in consideration of the petition on the reverse side
hereof, satisfactory proofhavin~ been presented before me, IT IS DECREED that the instrument(s), dated
200 , described therein be admitted to probate filed of record as the last will of
CLARISSA B, CLARK ; and Letters are hereby granted to
CORNELIA C, MIDDLETON
Short Certificates ( ).,
JCP"." """"."
........" $
$
Renunciation........ ............. $
$
$
$
.........., $
$
20..J.:2
L:11R 0 ~n ~ tM..Y\ "^ ~ h:::u...w,\--
Register of Wills i?l'^'t! ~' ~
,~(oO . 0'0 James D. Flower, Jr, #27742
1:5 ,00 Attorney (Sup. Ct LD, No,)
26 West High Street
Carlisle, PA 17013
Address
'6,00
\0,00
C:;.oO
FEES
Probate, Letters, Etc.
Will"""""",.".
Automation Fee.....
Bond..",
Filed April
Total
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717-243-6222
Phone
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This is to certify that the information here given is correctly copied from an original ccrr.ificate of death duly' filed with me as
Local Registrar. The original certificate will bc forwarded to the Statc Vital Records Olllce for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fec I'Jr this certificate. $6.00
p
115
No.
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Local Registrar
APR 0 5 2005
pate
rlt05143Rev.2187
021 - oS - 33V\
COMMONWEALTH OF PENNSYLVANIA. DEPARnliENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
NO
.,
"
NAME OF DECEDENT (Fnl. Middle, LUll
1. Clarissa B. Clark
AGE (ual BWthday)
SEX
2.Female
t. 88 Yf1,
COUNTY OF DEATH
BIRTHPLACE (Cilyel'ld
SllIle or Foreign COl.fllry) H .
fawnee City,NB ;:-0
FACILITY NAME (II roollnlli\ution. give slreelend number)
lb. Cumberland Ie, Carlisle
DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS I INDUSTRY
( _al _
of-'Ong...:do""'.... ..t)
11.. Teacher
DE EDENT' MAILING
11b. Schools
own, talll,ZipO::tQe.} DECEDENT'S
ACTUAL
2A RESIDENCE
($et1I01truclitlnS
oootl'lsllldr.)
17l:Jo.CtI\l1"ItII
Cumberland
ESS(S~lty
~d
"",d."
livelne
ItHln&h\p'!
1000 West South St.
1&, Carlisle, FA 17013
fATHER'S NAME (Flral, Mk:k'!e, lasl)
".
''''OR
srATEFILENlJMBER
SOCIAL SECURITY NUMBER
,.508 07
DATE OF DEATH (Monlh, ~y, year)
.. A rll 3 2005
6693
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4 (f-4CO'G')
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ElVOuli>d<lnlO
~D
R.I_B"'" =MO
RACE - AmenClllllndian, B1ack, Wlite, el
(Sf*tlIy)
".
White
SURVIVING SPOUSE
(Ifwlhl, ijI..",.lden n....l
MARITAL STATUS _ MllTlIId,
Ne~~~rr:ts=red,
14, Widowed
17C.O YU,decedet1I~vedln
17d,~~hi=~~I=oI
Carlisle
C.[yIMro
MOTHER'S NAME (Fin\, Middle, Malderl SumlIme)
".
INFORMANT'S MAILING ADDRESS (Slreet, Ci!yfTown. S\ete, Zip Code)
''''.
PlACli. OF DlSPOSITION- NIIIlllI of cemele!)', CremelO()' tOCA TION City own. Stale, Zip Code
orO\herPlece Cremation Society
aid.
NAME AND ADDRESS OF FAClllTYAuer Memorial
,...
30.. 30b. M
PLACE OF INJURY - Al home, fam\ slleet, factof"\', oM<:B
IxHng,lie.(Sp.cifVl
....
a7,PARTI; E........'II_.Inju......._
LlltOftIy..........Oft__.
LICENSE
Ub,
best of my krlOYlIledgso, d..1h OCCI.I:Tedatthelimll,dal' llnd plll<:B silled
{S\~eoeT~\
231,
TIME OF DEATH . 0
" C/:0
......""c.._"'. dulh, Po _..we.. ........of'ylnll. """~..Clrdlocor..lp"*ory....I~ Ibock.,,"'."I.U....,
Sequen1iePy"steondilions b
i1eny, leadin" 10 immedlelll
. <:BUM. Enler UNDERl YlNG
CAUSE (Olaeele or irjury { ,
that inltiewdeventl
I1lQlingon deatl1) LAST d.
WAS AN A\JTOPS~ 'WERE AUTOPSY FINDINGS
PERFORMED'l AVAILABLE PRIOR TO
COMPlETION OF CAUSE
OF DEATH?
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0'
Horrndde
o
o
o
OATE OF INJURY
(Monlh,Doy,YIIr)
MANNER OF DEA~
Natural B'
Ao;;cldent 0
o
P8ndlfl!illn~estigalion
Couldnolbe delermll"OKl
No EJ"
vesO No vesD
28e. 28b.
CERTIFIER (Check only one)
.~:7Jcltb':,0J'~~~~'~~~~~:=:\:~~r~~~r~.h~r,~~~.~.~.~~~~.~..~.~,~~~.~.I~~.~~,l...
Suicide
D.
.PRDNOUNCING AND CERTIFYING PHYSICIAN (Physldllll bofh pronouncing dlIlllh end certifying 10 CilUlie 01 dolelh)
To tI'Ie but of my krlowIed"e, d<I.th OCtllrnd et Ille 11m" dete, end pi"., and due to the tlll"'(ll end lI\&lU\er" stated,,,.
\0{ /~J/~ I
Home and
LICENSE NUMBER
Ub, 2:k:.
WAS CASE' REFERRED TO ~DICAl EXAMINER /CORONER'!
aI. Yea E:1t No 0
'Approxlmllle PART II: OIhefsignificer1lcondilionaconllibullngtodeath,bul
:~nl.eNal~ flll\1fl~\n\heuntltf1yingCllusegl~lIt1inPARll
:onMI deeth
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
o
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LAST WILL AND TESTAMENT
OF
CLARISSA B. CLARK
I, CLARISSA B. CLARK, of 2A Todd Circle, Carlisle, Cumberland County,
:~ennsylvania, being of sound and disposing mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament, hereby revoking and
making void any and all former Wills, Codicils, or writings in the nature thereof, by me at
any time heretofore made.
FIRST: I hereby order and direct my Executrix or Executor,
hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses
and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be
conveniently done after my death, out of my residuary estate.
SECOND: I hereby give all the rest, residue and remainder of my estate
to my daughter, CORNELIA C. MIDDLETON, of 300 West Willow Street, Carlisle,
Pennsylvania.
THIRD: In the event that my daughter, CORNELIA C. MIDDLETON,
shall predecease me or fails to survive me by thirty (30) days, I hereby give my residuary
estate to my granddaughters, LEE MARRIOT and LAURA ELIZABETH RUSSELL, both
of Carlisle, Pennsylvania, in equal shares per stirpes.
LASTLY: I nominate, constitute and appoint my daughter, CORNELIA
C. MIDDLETON, to be the Executrix of this my Last Will and Testament. In the event that
my daughter, CORNELIA C. MIDDLETON, shall be unable to serve as Executrix for any
reason, I appoint my granddaughter, LEE MARRIOT, as Executrix. In the event that my
said granddaughter, LEE MARRIOT, shall be unable to serve as Executrix for any
reason, I appoint my granddaughter, LAURA ELIZABETH RUSSELL, as Executrix. No
Executor or Executrix shall be required to file bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
/ ol -Ii
day of
~/~jA~-
(;(J~;:3. ~~
Clarissa B. Clark
,2003.
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
~
2
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, CLARISSA B. CLARK, Testatrix, 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 or affirmed)} and
CLARK, the Testatrix, this IP~ day of
by CLARISSA B.
,2003.
~13.~~
Clarissa B. Clark, Testatrix
NOTARIAL SEA',
RENEE L. MURRAY, NCli\f', """","
Ca~isle 80m, Cumberlal":! '
My Comm"SS!'on E"'-' ,>- "c,'-',>,'
"f""1::~,:.:,:~;~:', .<J ,':I;::;.j
3
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We, James D. Flower. ,Jr _ and 'I'"ny" To W"rp ,
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
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 signed the Will as witnesses; and that
to the best of our knowledge the Testatrix was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by . James D. Flower, Jr.
and
Tanya L. Ware
this
11th
day of
September
2003.
NOTARiAl SEAL
RENEE L. MURRAY, Notary Public
Cartisle Born, Cumbertand County, PA
My CommiSSion Expires Dec. 13, 2005
4