HomeMy WebLinkAbout02-10-15 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:
David B.Nesmith
Decedent's Information
Name: Miriam R.Stone File No: 21
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: 01/21/2015 Age at Death: 77
Decedent was domiciled at death in Cumberland County, PA (State)with his/her last
principal residence at 5401-20 Oxford Drive,Mechanicsburg 17055 Lower Allen Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Holy Spirit Hospital,Camp Hill 17011 Camp Hill Cumberland PA
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 $ 5,000.00
If not domiciled in Pennsylvania................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania................ Personal property in County $
Value of real estate in Pennsylvania................................................................... $ 95,000.00
TOTAL ESTIMATED VALUE $ 100,000.00
Real estate in Pennsylvania situated at 5401-20 Oxford Drive,Camp Hill 17011 Lower Allen Cumberland
(Attach additional sheets,if necessary.)
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)that he/she/they is/are the Executor(s)named in the Last Will of the Decedent,dated 03/02/2005 and Codicil(s)
thereto dated
State relevant circumstances(e.g.,renunciation,death of executor,etc.)
Except as follows:after the execution of the instrument(s)offered for probate,Decedent did not mar 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.
®NO EXCEPTIONS ❑ EXCEPTIONS
❑ B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b.n.,d.b.n.c.t.a.,pedente lite,durante absentia.durante minoritate
If Administration,c.t.a or d.b.n.c.t.a.,enter date of Will in Section A above and complete list of heirs.
Except as follows:Decedent was not a party to pending divorce proceedingwherein 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 adudicated an incapacitated person.
❑NO EXCEPTIONS ❑ EXCEPTIONS v
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the follo_voinNpouse("ny)am Fpgtrs(attach
additional sheets,if necessary): - , rf c�•
E 7 J
Name Relationship Address
C.D
Form RW-02 rev.1 o-11-2011 Copyright(c)2011 form software only The Lackner Group,Inc. Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Petitioner(s)Printed Name Petitioner(s)Printed Address
David B.Nesmith 31 Bourbon Red Drive
Mechanicsburg,PA 17050
717-691-9199
The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoi g Ipetition are true and correct to the best of the knowledge and
belief of Petitioner(s)and that,as Personal Representative(s)of the Decedent,P 'lone s) it ell truly administer the estate according o la
Sworn tVri'rmed and b cribedbefor )/ Date to z'
met 's y Date
By. I Date
to Date
BOND Required? FIYES ff/NO To the Register of Wills:
FEES:
Please enter my appearance by my signature below:
/l 60
Letters.......................................... $ v Attorney Signature:
( � )Short Certificate(s)......... �, D
( )Renunciation(s)..............
( )Codicil(s)........................
( )Affidavit(s)...................... Printed Name: Lauren E. ays
Bond............................................. Supreme Court
Commission........ ........................ ID Number: 205966
Other
G> C=:)
Firm Name: Bogar&Hipp Law Offices rn
5` a Address: One West Main Stret2 rn
5.( r.n cn
Shiremanstown,PA.17.071 rr
wi
Cf rt
Phone: 717-737-8761
Automation Fee............................ Fax: t--► t_ �_�
7 N t tl
JCS Fee....................................... V S
E-mail: Ikays@bogarlaw.colm crt U7
CD
TOTAL......................................... $ ?D, - -n
DECREE OF THE REGISTER
Date of Death: 01/21/2015
Social Security No:
Estate of Miriam R.Stone File No: 21--
a/k/a:
AND NOW, in consideration of the foregoing Petition,
satisfactory proof having been presented tuore me, IT IS DECREED that Letters Testamentary
are hereby granted to David B.Nesmith
in the above estate and(if applicable)that the instrument(s)dated 03/02/2005
described in the Petition be admitted to probate and filed of record as th last Will(a�n�d/Codicil of Decedent.
ister of Wills
Copyright(c)2011 form software only The Lackner Group,Inc. Page 2 of 2
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 ...... --- This is to certify that the information here given is
correctly copied from an original Certificate of Death
c duly filed with me as Local Registrar. The original
D 0� A
REG0 ttu=' y certificate will be forwarded to the State Vital
REGIS "� " :-v yam' a Records Office for permanent filing.
*
P 21402557 ? FEB 10 " __ M � E�`;�~
L
Certification Number �" ,ENT�O , Local Registrar Date Issued
s/Pr 11 COM ONWEALTH O11pENNSYLVANIA C EPARTMENT OF HEALTH•VITAL RECORDS
'`nt CERTIFICATE OF DEATH
ack Ink �~ State Fill Number:
1. a denCs Legal Name sl Itltll "IT { ` - 2. x 3.ocial S.unity u Det a. ate of Death(Mo/OaY rj ISpell Mo)
_. k/ lilt J GNr 5
51.Age-tact Birthday(111) 5b.Under Y a .Udder l0a 6. ate of Blrt w Day/Yev)((5spell Monthj 2. rt place CltY dStataor Forel n" ntr/I
n( M iDa�_Hours Minutes I I�i {_{ I7 76VBirthPlace(County)
ga. {y.IyJ ce(State or Foreign Country) 86.Residence(Street and Number-Include AV,No.,)J 8c.Dlid Decedent Live Ina 7 hip2 L/�
5 len fl/� �'Ves,decedent llvedln My!A- twp.
We eCon IO&j u
CIBe.Residence(Zip Code) J ❑No,decedent lived within limits of clty/bOco.
9.Ever In US Armed Forces, 10.Mahal Status at Time of Death ❑Marrletl ❑widowee 11.SurvWing Spoae's Nam.(If wife,glue name prior to first marriage)
0 Yes eNo 0 Unknown ();Divorced D Never Marrletl 0 U, :wn
1. T r' a Ifs Itldle t,5 jHlx) 13. othefs Name Prl o7 MarHaB(first,Mlldle.last)
Cr
.In(Or Na b. elatlonship to Deceden� .I o ant's Mall ngsire, [reef an ulgber,Clry,State,Zip Code) Dory,
G ____________ _ rmd ,e, ecko rThe _
Il Death Occurred ina Hospital: �Inpatlent df Death Occ„rretl5omewhere OtherThanaHOspital [J Hospice Facility L]DeceOent's Home
S ❑Emerge flooMOufpa[len[ D Daadon A,dval I D Nursing HomrJLong-Term Care Facility O Other(Specify)
z i -fa lily Na II(notl sti t n,givestreetandnumber, i5ffor Town tab and de VII p,�p yof cath
y ,fide Meth o10 position ❑B ria) 0 Cremation 16b.Da e;2;,,. 1 .Placeo Dispositjon(N me of cemetery,Crematory,or other place)
E VfV
C3Rem0yal from State _13 Donation
/
❑other Ispadly) OC
Z .Location of olipositbn(Ciry or 7-Stale,and Zip) 17d"Sig fFun al IS, kcUohroe rPars Charlie onnterment tensa ryum
17UxptiA t7 UI l.:L
ete111
m
]B. eceden['s Educal Check the box that best describes the 19.Deco nt of His panic Origin-Check the ZO,Decedent's Race-Chl ONE OR MORE races to Indicate what
highest degree or level olischal completedat the time of deathbox that best de scribes whether the decadent the decedent considered himsel(or herself to be.
0 81h grade or less IS Sp.M,,/HI,,,mc/Latina.Check Ile"No' []Korean
❑No diploma,9th-12th grade box,(decedent is not Spanish/Hisamc/Latino. 0 Black or African American D Vietnamese
�Hlgh sch..I gr,d,,Mo,GEOcompletad Q-No,not Spanbh/Hisaric/Latino []American Indian or Alaska Native 001her Asian
[]Some college credit,but no degree []Yes,Mexkan,Mexican American,Chicano D Asian Indian 0 Native Hawaiian
D Associate degree(e.g.AA,AS) ❑Yes,Puerto Rican []Chines. []Gua anian or Chamorro
0 Bachatnes degree(e.g.BA,AB,BS) D Yes,Cuban []Filipino 0 Samoan
0 Atasteh degree(e.g.MA,MS,MEng,MEd,MSW,M8A) O Yes,other Sanish/H anlc/UHno 0Japanese O Other Pacific Islander
0 Doctorata(e.g.PhD,EdD)or ,Pra/essbnal degree (Specify)_ D other(specify)
e..MD,DOS DVM,LLS 10
21.Decedent []
's Single Race Sell-Designation-Check ONLY ONE to Indicate what the d.cede,,considered himself or herself t0 be. 22a.Decedent's Usual Occupation-Indicate type o/work
White Japanese 0 Samoan dane)Kidp mail Of working If DONOTUSERETIRED.
[]Blackor A(nican American 0 Korean D Other Pacific Islander //II I /lZ/I"IIV�.•
0 American Indian or Alaska Native [I Vietnamese 0 Don't Know/Ncr Sure
D Asian lnalan []Other Asian 0Refused 22bNd Or Busln s/Industry
C]Chinese 0 Name Hawaiian 0 Other(Saciry)
[]Filipino 0 Gamanlanor Chamorro }.--
aTEMS23a.23dMUSTBECOMPLETED 23a.Dat.Pronp 7,Dead(MO/Day/Yf) 23b. gator Person Pronouncl gDea[M1(Ooh when apPlicablej 23c.License Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH U I ZI /JA,
23E.Date Signed(Ma/Day/Y,) 2a.rime ar Doom .�1nn L. MD4�0"751 .
\ 2-1 /7-0)5 1(7�-fV Pm25.s ns Medical Examiner or Coroner ntactad, [] Yes No '
CAUSE OF f.•ATH Approximate
26.Part 1.Enter the chain ofevonts-diseases,injuries,orcompIk,t;,m--that directly cau ,the death.DO NOT enter terminal events such as cardiac arrest, I Interval:
resplratory arrest,or ventrlcular fibrillation without showing the
tk,l,gy.DO NOT ABI E11^V'IATE.Enter only on,cause on line.Add addItI,n,1 lines if necessary. I Onset to Death
IMMEDIATE CAUSE > a.��f"�j21 vL� \��s(�i r(J\/fy(y �01 t�W-e
.tion....... b. , m,1, 1
rFsultindisks.Inar Condition u.to(or consequence of): I
resulting in death) CIO? oe(�'tm
t� L lig 1 1
Sequentlagy list conditions, Due to(or As consequence o(l: 1
Ifany,is.fin,.En1. er the Pr PU C'O/9'�IG
fisted on gne a.Enter the
UNDERLYING CAUSE Due to(ar as consequence 00: I
(disease or Injury that I -
W initiated the events resuRing d.
f5 In death)AS
LT. Due to(0r as a consequence of): ;
26.Part ll.Enter other significant conditions conal to death but not resulting In the underlying cause given in Part 1, 27.Was an autopsy performed,
❑
Yes "
No
Were autopsy findings seallable
to complete the cause of death,
13Yes ®No
•' 29.If Female: 30.Did Tobacco Use Contribute W Beath, 31...Manner,f Death
[fNpt pregnant within past Year D Yes 13Probably Ly Nature
C]Homicide
0 Pregnant at time of death UL No 0 Unknown 0 Acddem 0 Pending lnvestigatI,n
[]Notp.egnant,but pregnant wlNin A2 days of Death []Suicide []Could not be determined
❑Notpregant,butpregnant43d,y tolyear before death 32.Date of Injury(Mo/Day/Yr)(Spell Month)
0 Unknown if pregnant within the past 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.Infuryat Work 137.1(Trantpo-ton Injury,Specify: 38.Describe How Injury Occurred:
[]Yes 0 Orlver/Operator []Pedestrian
0 No D Passenger 0 Other(Sadty)
39e2.Caitiff,,-physician,certlfed mune practitioner,medical examiner/coroner(Check only one):
'p Card ngonly-Tothe best of my knowledge,death occurred due to the cause(,,and manner stated.
D Pronouncing 6 Certifying To the st of my knowledge,death occurred at the time,date,and piece,and due to the cause(,)and manner staled.
❑Medical Examiner/Coroner-
D basis of ex min and/or lnvestigatlon,In my gp'nion,death occurred at the time, and place,and due to the causels)and manner,toted.
Signature 0f certifier: TR1.er.ertlner. IIID License Numbero M 13 75 _
39b.Name,Address and Zip Code of P rson Completing Caus (Death Iteym 26 39c.Date Signed(Mo/O,Y/Y,) -
a0.Registnafs Distrkl Number a1.Registrar's Signature 41.Registrar FIN,Oat.(Mo/Day
A,L a l x W o c 33 1s
a3.Amendments
IZ�I
HtTS-143
Dlipasl[lon Permit No. ` I lJ REV 07/2012
LAST WILL AND TESTAMENT
y-
71CD
r i
OF
C, 3 t
MIRIAM R. STONE
Cn Cn
I, MIRIAM R. STONE, of 5401 - 20 Oxford Drive, M
Mechanicsburg, (Lower Allen Township), Cuanberlan.d County,
Pennsylvania, make, publish and declare this as and for my Last Will and
Testament, hereby revolting all other Wills and Codicils heretofore made
by me.
FIRST: I direct that all inheritance, estate, transfer, succession
and death taxes, as well as my just debts and funeral expenses, of any kind
whatsoever, which play be payable by reason of my death, shall be paid
out of the principal of my estate as the same can conveniently be done.
SECOND: I give, devise and bequeath all the rest, residue and
ren-iainder of my estate of.whatever nature and wherever situate, including
any property over which I hold power of appointment and together with
any insurance policies thereon, unto to my nephew, DAVID B.
NESMITH, SR., of 31 Bourbon Red Road, Mechanicsburg, (Silver
Spring Towship),Cumberland County, Pennsylvania, provided that
should he predecease me, I give, devise and bequeath his share unto his
issue per stir
� es.P P
THIRD: In addition to all powers.granted to thein by law and
by other provisions of this Will, Lgive the fiduciaries acting hereunder the
following powers, applicable to all property, exercisable without court
approval and effective until actual distribution of all property:
(A) To sell at public or private sale, or to lease, for any period
of time, any real or personal property and to give options for sales, ex-
changes or leases, for such prices and upon such terns (including credit,
NNdth or without security) or conditions as are deemed proper. This
includes the power to give legally sufficient instruments for transfer of the
property and to receive the proceeds of any disposition.
(B) To partition, subdivide, or improve real estate and to
enter into agreements concerning the partition, subdivision, improvement,
zoning or management of real estate and to impose or extinguish restric-
tions on real estate.
(C) To compromise any claim or controversy and to abandon
any property which is of little or no value.
(D) To invest in all forms of property, including stocks,
common trust funds,and.mortgage investmentfunds, without restriction to
investments authorized for Pennsylvania fiduciaries, as are deemed proper,
without regard to any principle of diversification, risk or productivity.
(E) To exercise any option, right or privilege granted in
insurance policies or in other investments.
(F) To exercise any election or privilege given by the Federal
and other tax laws, including, but not necessarily being limited to, per-
sonal income, gift and. estate or inheritance tax laws.
2
(G) To make distributions to my herein named beneficiaries
in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order to
pay debts, taxes, or estate or trust administration expenses, to protect or
improve any property held under my will, and for investment purposes.
(I) To select a mode of payment under any qualified retire-
ment plan (pension plan, profit sharing plan, employee stock ownership
plan, or any other type of qualified plan) to the extent the plan or the law.
FOURTH: I nominate and appoint my nephew, DAVID B.
NESMITH, SR., of Mechanicsburg, Pennsylvania, Executor, of this my
Last Will and Testament. I direct that my Executor and his successors
shall not be required to post security or a bond for the performance of
their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
Np
this, my Last Will and Testament, this a day of March , 2005.
-(SEAL)
MIRIAM R. STONE
3
Signed, sealed, published and declared by the above-named
Testatrix as and for her Last Will and Testament in our presence, who, at
her request, in her presence and in the presence of each other, have
hereunto subscribed our names as attesting witnesses.
Address Name
Address 1-70 S Nr e
4
RECC:RCEO CFFICE OF
R WCISTER F `INIL LS
OATH OF SUBSCRIBING WITNESS(E§}S FEB 10 QM 1.2 59
CL.Er 0
REGISTER OF WILLS 0 R R H/11 r;' C 0`_`:t
CUMBERLAND COUNTY, PENNSYLVANIA C U M D E R-� € 'i
Estate of MIRIAM R. STONE , Deceased
Andrew C. Sheely and Becky M. Knisely , (each) a subscribing witness to
(Print Name/s)
the D Will El Codicil(s)presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she/he/they was/were present and saw the above Testator/Testatrix sign the same
and that she/he/they signed the same and that she/he/they signed as a witness at the request of
the Testator/Testatrix in her/his presence and in the presence of each other.
ignature) (Signature)
(Street Address) (Street Address)
/i��= "
(City.State.Zip) (City,State,Zip)
Executed in Register's Office Executed out of Register's Office ..
Sworn to or affirmed and subscribed Sworn to or affirmed h�and'subscribed'-
before me this day before me this day
of of klrt ii' o7G
Deputy for Register of Wills Notary Public U _
My Commission Expires: IQ Il a//6
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s)at time of notarization.
Form RW-03 rev. 10.13.06 COMMONWEALTH Of PENNSYLVANIA
NOTARIAL SEAL
BETH B.LEN GEL,NOTARY PUBLIC
SHIREMANSTOWN BORO,CUMBERLAND COUNTY
MY COMMISSION EXPIRES DECEMBER 12,2015
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
CU -
R
No. 2015- 00153 PA No. 21- 15- 0153
J 9 Estate Of: MIRIAM R STONE
(First,Middle,Last)
V Q
Late Of: LOWER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
1750 Social Security No:
WHEREAS, on the 10th day of February 2015 an instrument dated
March 2nd 2005 was admitted to probate as the last will of
MIRIAM R STONE
(First,Middle,Last)
late of LOWER ALLEN TOWNSHIP, CUMBERLAND County,
who died on the 21st day of January 2015 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, LISA M. GRAYSON, ESQ. , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
DA VID B NESMI TH
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 10th day of February 2015.
Lz- 00
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**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
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