HomeMy WebLinkAbout06-02-15 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:
Decedent's Information
Name: Betsy R. Williams File No:
a/k/a: Betsy Ross Williams (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 176-16-9105
Date of Death: May 24, 2015 Age at death: 93
Decedent was domiciled at death in Cumberland County, Pennsylvania (State)with his/her last
principal residence at 308 Bethany Drive, Mechanicsburg, PA 17055 Lower Allen Township Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Bethany village,5225 Wilson Lane,Mechanicsburg Lower Allen Township 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 $ 120,000.00
If not domiciled in Pennsylvania. . ... ....... .... . . .... .. Personal property in Pennsylvania $
If not domiciled in Pennsylvania. . ... ....... ..... ... .... Personal property in County $
Value of real estate in Pennsylvania........ ..... ... ............ .... .......... .............. . $
TOTAL ESTIMATED VALUE. ... $ 120.000.00
Real estate in Pennsylvania situated at: N/A
(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)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated November 24, 2009 and Codicil(s)
thereto dated N/A.
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 marry,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.,pendente 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 a pending divorce proceeding wherein 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 adjudicated an incapacitated person.
❑NO EXCEPTIONS ❑EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse(if ai��nd heirs(attach
additional sheets,if necessary): n ::0
G R1 M
Name Relationship Address U
M
r. a C�
Form RW-02 rev. 1011112011 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA } RECORZ ED C1 FICL 6�
} SS: REGISTER CF WILTS'
COUNTY OF Cumberland }
Petitioner(s)Printed Name Petitioner(s)Printed Address
Richard E. Williams 3 Parkside Drive, Hummelstown, PA 17036 CL.EF.,+ OF'
Aho a
U9'
r �
i.E ..-., ._ PA,
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 knowledge and belief
of Petitionerks),and that,as Personal Representative(s)of the Deced etitione i wel d truly administer the estate according to law.
Sworn to or affirriied an subscribed before Date e r�^20/5,
me tlii '-day of. , old Date
By:_ Date
For the Rgki9 er - Date
BOND Required:AYES W]NO To the Register of Wills:.
FEES: Please enter my appearance by my signature below:
Letters . . . . . . . . . . . . . . . . . . . . . . $ 260.00 Attorney Signature:
( --g Lj) Short Certificate(s). . . . . . 7C� `15-68
1
( )Renunciation(s).. . . . . . . .
( ) Codicil(s). . . . . . . . . . . . .
( )Affidavit(s).. . . . . . . . . . .
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: Yan D. SeibertEsquire
Commission. . . . . . . . . . . . . . . . . . Supreme Court
Other . . . . . . . . ID Number: 41713
Inh. Tax Return . . . . . . . . 15.00
Inventory . . . . I . . . 15.00 Firm Name: Caldwell & Kearns, PC
Uli I� . . . . . . . . a-tip Address: 3631 North Front Street
. . . . . . . . Harrisburg, PA 17110
. . . . . . Phone: (717)232-7661
Automation Fee. . . . . . . . . . . . . . . 5.00 Fax: (717)232-2766
JCS Fee. . . . . . . . . . . . . . . . . . . . . 35.50 Email: JSeibert(cDcklegal.net
TOTAL. . . . . . . . . . . . . . . . . . . . . $ -334'5-5a
DECREE OF THE REGISTER
Estate of Betsy R. Williams File No: n2 - If —�Q 1y
a/k/a: Betsy Ross Williams
AND NOW, clm.c C� _,in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters Igma
are hereby granted to
in the above estate and(if applicable)that
the instrument(s) dated - 2e:{ M03
described in the Petition be admitted to probate and filed of record as the last Wil (and Codicil(s)) of Decedent.
Kegis4r of Wills P?r
Form RW-o2 rev. 1011112011 Page 2 of 2
11105.805 REV(9111)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
qa��+1 G: It is illegal to duplicate this copy by photos at or photograph.
R C L,L CFFiCE 0
Fee for this"Certificate, $6.00 lf rffrm„„ii,rr' 'his is to certify.that the information here given is
Il `�N OF p
2015 JUN 2 CM 9 � ,,a'�k�`� { fN,y= dorrectly copied from an original Certificate of Death
9 duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
CL EF.'t; C F
Rec rds Office for permanent filing.
Certification Number -,,,,,,,nruf'} Local Registrar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH•VITAL RECORDS
Permanent CERTIFICATE OF DEATH
Black ink State Vile Numbor:
1.Decedent's Legal Name(First,Middle,Lost,Suffix) 2.Sex 3.Social Security Number 4.Dat@ 4f Death(Mo/Oay/Yr)(Spell Mo)
Betsy .R. Williams Female 176-16-9105 May 24 2015
So,Age-Las%Birthday(Y[s) E.Under 1 veer Sc.Under Da 5.Dat¢of Birth(Mo/Day/year)(Spell Month) 7a.Birthplace(City and State or Fa reign Country)
93 Months oat's Hours Minutes Shenandoah Hei hta Penns lvania
June 14, 1421 7b.Birthplace(County) _ Schu lklll
86,Residence(State or Foreign Country) Bb.REsidence(Street and Number-I"chid*Apt No-) 8c.Old Decedent Live in a To-, to7
Penns lvania 408 Be Chan Drive C3 Yas,decedent lived In twp.
8d.Residence(County) -- Y
Ctunberland Be.Rasiaenca(Zip Code) 17085 tffi No,decadent need within limit.of 'Mechanicsburg .<Ity/bora-
9,Ever in US Armetl Formes? 1D,Marital Status at Time Of Dsath Married E3 we 11.S.-tying Spouse.Name(If wife,give name prior to first marriage)
O Yes pal No Ca Unknown O Divorced O Never Marrled 0 unknow
Robert Buxton
12.Fath.e.Name(First,Mitldle,Last,Suffix) 13.Mother's Noma Prior to First Marriage(First,Mlddte,Last)
Grant S. Dattre Cecelia F. Dillenan der
144-Informorvt's Nam@ 14b.Relationship to O.cedent 14c-Informant's Mailing Address(Street and Number,City,State,Zip Cods)
Richard Williams Son 3 Parkside Drive, hummelatow , Pennsylvania 17036
�i _ - - _ - _ _ __ _-, __ _ i a. ice o eat (Checkonlyon. _ _ _ _ ..; _ ...
If Death Occurred in a Hospital: - Inpatl a nt IIf Death OCGurc.d.5omewhere Other Tttan a Nosp lta l: �[�HGSPI a Facility -� T3 De-cid e_.t's Home»
a C1 ErtiM envy ROOM/Outpatient n Dead on Arrival t t$Nursing Home/Long-Term Care Facility Q Other(Specify)
i
1gb.Faciitry Nam¢to not i"atiiution,give s%r¢et and number) 15..City ar Town,5t#tt,and Zip Coda 15tl-County.f Death
Bethany Village Mechanicsburg, Penns lvania 17055 or
lea.Method of Disposition Q B-1.1 W Cremation 16b.Date of Dlspositlon 16c.Place of Disposition(Name of Cemetery,crematory,or other place)
Removal
ther{Specify) lW
Sp.State p Donatlan P7A PS o _ Cremation SOCiety O£ Pennslvania
O Oy
led,Location of 01,Ppsition(City or Town,State,and Zip) 17e.Signature of Fun@rel S Ice Uce se n in Charge of interment 17b.License Number
Harrisburg, Pennsylvania 17109 FD-138948
E 17c.Name and Complete Address of Funeral Facility
=✓e Cremes n c et £ v 100 a v
�' 18.OecadEnt's Etlucotlon-Check the box a best describes the 19.Decadent of HlsV Origin-Ch...the 20.O.CedenV.Race-ch.ck ONE OR MORE[aC.s to Indicate-hot
highest degree.r level of school completed at the time of death, box that best describes whether the decadent the decadent considered himself or herself to be.
Cx 8th grade or less Is Spa mish/Hlspe nlc/Latino. Check the"No" ®Whit. C3 Korean
C3 No dlplo me,9th-12th gr#do box if decedent Is not Spamish/Hispanic/Latino. 0 Black or African American 0 VI"name..
pay H)IIh school graduate or GEO ea-Plated JW No,not Spanish/Hispanic/Latino C3 American Indian or Alaska Native C3 Other Asian
C] Sem.College credit,but no degree O Yes,Mexico",Mexican Am.rlcan,Chicano O Asian Indian C3 Native Hawaiian
Q Associate degree(e.a.AA,AS) O Vas,PuIn.Rican O Chines. O Guamanlan or Cham.rr'O
Q Bachelor's degree(e.g.BA,AB,BS) O Yes,Cuban E3 Filipino 0 Samoan
C.7 Mastoes degree(e.g.MA,MS,MEng,MEd,MSW,MBA) O Vas,other Spanish/Hispanic/Lett.. O Japanese C3 Other Pacific Islander
C3 Ooct4rotE{cage PhD,£d0)4r Professional degree (Specify) [3 Other(Specify)
ODS OYM LLB JD
21.Decedent's Single Race Sell-Dosignatlorl-Check ONLY ONE to Indicate what the decedent Considered himself.r herself to be. 22 a.Decedent's Usual Occupation-Indicate type of work
0 Whits C3 Japanese 0 Samoan done during most of working life. 00 NOT USE RETIRED.
0 Black or African American 0 Korean 0 Other Pacific Islander
Q American Indian or Alaska Native Cx Vietnamese C3 Don't Know/Not Sure Executive Secretary
0 Asian Indian 0 Other Asien E3 Refused 22b.Kind of 8.0o.s./industry
E3 Chinas. C3 Nativaws Ilan 0 Other(Specify)
O Filipino O Guemaniene Hor Chamorro American Water Works Co.
ITEMS 28.-23d MUST BE COMPLETED 23..Date Pronouncap Dead M./Day r) 23b.Signature of Person Pronouncing Death Only wham applicable 23c.License Number
8Y PERSOOR N WHO PRONOUNCES -
CERTIFIES DEATHIZ57
23d.Data SlIInad(Mo/Day/Yr 24.TImfof Death .� '•`• �`-
t5elD No
CAUSE OF DEATH t Apprextmata
26.Part I. Enter the chain.f.vents-dl.......injuries,a[compil.-Ions--that directly caused the d@oth. 00 NOT enter terminal events such as cardiac arrest, lot.- I:
respiratory arr43t,or ventricular fibritiatj:� ithoput�s¢h.�o 1wSng iThE.,N'Oi}ogy. QO NOT ABSR EVIATE. Enter only one cause on a line. Add additional iin@s if necessary. t Onset to Death
IMMEDIATE CAUSE -------•»--_> a. 1•�( f-T
(Final disease or condition Due to(or as a consequence oh: t
resulting in death) -
Sequ@nti.ity,list conditions, Due to(or as a consequence of); I "
If any,leading to the cause
),too on lines. Enter the c. I
UNDERLYING CAUSE Due to(4r as♦consequence of):
(disease or injury that
(nitiattd<he..ants resulting d. i
in death)LAST. Due to(.r as•e0"aaquence an:
1
alt Part it.�Enter esus a w v��/a�mrib-Ing,to death but not resulting In the u /lyi�ng/C fuse at,"InPartPeart 1.V 27.Was an autopsy performed?
.. a T it{S" jlt_ - I j�,� r T,.,/` Y+4aYL\J,i � of 1� Yes IM No
?N-4 £ 1,4 t�7 i�/9-tW � 28,Were autopsy findings satiable
$ .�-.1 - to complete the cause of death?
O Y.s W No
g 29.If Female: 30.Did Tobacco Use Contribute to Death? 31.Monner of Death
Not pregnant within past year 'O Yes 0 Probably jilt Natural 0 Homicide
Pregnant at time of death C3 No 'IR Unknown Q Accident 0 P.ndIoX invest+gatl.o
C3 Not pregnane,but pregnant within 42 days of death Cx Suicide Cx Could not be determined
3 Not pregnant,but pregnant 43 days to 1 year before death 32.Date of Injury(Mo/Day/Yr)(Spell Month)
^4 C3 Unknown If pregnant within the past year 33.Time of Inj.ry
34.Place of Injury(a.g.home;construction site;farm;school) 35.Location of Injury(Street and Numbar,City,County,State.ZIP Code)
36.Injury It Work 37.If Tro"sportatioo Injury,Specify: 38.Describe How Injury O...-.d;17 Yee Dr_'_Boer.,_ [] P.d.strion '-
C3 No C3 P....nger M Other(Specify)
39a.Certifier-phys iclon,certified nurse practitioner,medical examiner/coronor(Check only one):
IS C@rtifying only-To the best of my knowledge,death occurred due to the cause(s)and manner stated.
i O Pronouncing&Certifying-To the best of my knowledge,death occurred at tho tim.,dot.,and Plae.,and due to the couse(s)and manner st.t.d.
Cl medicate I /C -On the bests of.-rolo-I.n and/or Investigation,In my opinion,death occurred at he time,date,and place,and due to the causa(s)and manner stated.
j M(.')A Z_4)?i33
Signature Of "V4
lReTitle of c.rtiR¢r: Uc¢nsa Number:
39b.Name;Address and Zip Cod of P sq C plating Cause of Death(Item 26 t'j_ )'3j-+'.L,E�V)^ may �.}�J` 39c.Da Signed O/Day/Yr) .
✓vi�f �/Ura�urG n(1Y) /V \ �J ��J 3l0
" 40.Registrar's OIs Ct tuber 41.Registrar's SlIInature , 42.REII)C[ar fie bte
n
j7endro.nts -
' DlsposlUOn P.rmiC No.
/0"113 fY3 REV07/24012
LAST WILL AND TESTAMENT
C7 c�
C, cri
OF
BETSY R. WILLIAMS
I,BETSY R.WILLIAMS,declare this to be my Last Will and Testament andrh-ereby,
GO <D
revoke all prior wills and codicils made by me.
FIRST: My Executor shall pay from the residue of my estate all my debts, funeral
and administrationexpenses and all estate,inheritance,succession and transfer taxes imposed
by the United States or any state, territory or possession which shall become payable by
reason of my death. It shall not be necessary to file any claims therefor, nor to have them
allowed by any court.
SECOND: Except as otherwise provided herein, I give all of my tangible personal
property to my husband, ROBERT I. BUXTON, if he survives me. If ROBERT I.
BUXTON fails to survive me, then I give such of my tangible personal property as is set
forth in a separate,dated and unsigned letter of instruction,which I shall place with my Will,
to the persons therein designated. If I have not left a letter of instruction or for those articles
not distributed under this letter of instruction, I direct that such items be distributed among
my children living at the time of my death as they may select in as nearly equal shares as is
practical. If there is any disagreement as to distribution, I direct my Executor to make such
distribution. The decision of my Executor shall be final and binding. I direct my Executor
to sell,or otherwise dispose of in his discretion,any such property not specifically distributed
LAST WILL AND TESTAMENT
OF
BETSY R. WILLIAMS
by my letter of instruction or selected by my beneficiaries and to add the net proceeds from
their sale to the residue of my estate.
THIRD: I give and bequeath my antique marbletop table to my son, RICHARD E.
WILLIAMS, and express the wish that the table be kept in the family.
FOURTH: I give, devise and bequeath the residue of my estate, real, personal and
mixed;of whatever kind and nature, and wherever situate at the time of my death,including
any property over which I now have or hereafter acquire a power of appointment,as follows: .
a. I give, devise and bequeath ten (10%) percent to my husband, ROBERT I.
BUXTON, if he survives me.
b. I give,devise and bequeath five(5%)percent to my sister,ANNE JANE YOUNG,
her heirs and assigns.
c. I give, devise and bequeath five(5%)percent to my niece,EARLENE Y.FORD,
if she survives me.
d. I give, devise and bequeath the residue to my sons, RICHARD E. WILLIAMS
and JEFFREY L. WILLIAMS, in equal shares, their heirs and assigns forever.
FIFTH: I nominate, constitute and appoint RICHARD E. WILLIAMS, Executor
of this my Last Will and Testament, to serve without bond or security, and to make
2
LAST WILL AND TESTAMENT
OF
BETSY R. WILLIAMS
distribution of my estate in cash or in kind, or partly in cash and partly in kind, and in such
manner as he may determine. I authorize, empower and direct him to sell and convey, by
good and sufficient deed, in fee simple estate, any and all of my real estate, at public or
private sale, for such price or prices,upon such terms.and conditions, as in his judgment is
best for my estate, and to that end to sign, seal, execute, acknowledge and deliver all deeds
or other instruments necessary therefor, as effectively as. I could do if I were personally
present.
In the event such person does not survive me,or refuses to act as Executor or does not
complete the duties of Executor, then I nominate, constitute and appoint ROBERT I.
BUXTON, as the alternate Executor, to serve without bond or security. My alternate
Executor shall have all of the powers, privileges, duties and immunities granted to my
Executor as provided herein.
IN Vv-ITNESS WHEREOF, I, BETSY R. WILLIAMS, the Testatrix,have to this
my Last Will and Testament, set my hand and seal this -` day of November, 2009.
F
(SEAL)
BETSY*. WILLIAMS
3
LAST WILL AND TESTAMENT
OF
BETSY R. WILLIAMS
Signed, sealed,published and declared by the above named Testatrix, as and for her
Last Will and Testament, in the presence of us,who have hereunto subscribed our names at
her request,as witnesses hereto,in the presence of the said Testatrix,and of each other. The
preceding document consists of this and three(3)other consecutively numbered typewritten
pages.
�..
residing.at 1
VY t P�9- 6"7L9
_ residing at )0
4
a
LAST WILL AND TESTAMENT
OF
BETSY R. WILLIAMS
ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
ss..
COUNTY OF DAUPHIN )
The Testatrix and the witnesses whose names are subscribed to the foregoing
instrument, being first duly sworn and qualified according to law, do hereby acknowledge
and declare to the undersigned authority that the Testatrix signed and executed the instrument
..as her Last Will in the .presence of the witnesses, that she signed willingly or willingly
directed another to sign for her, that she executed it as her free and voluntary act for the
purposes therein expressed, that each-of the witnesses, in the presence.and hearing of the
Testatrix, signed the Will as witnesses, and that to the best of their knowledge the Testatrix
was at that time eighteen years of age or older, of sound mind and under no constraint or
undue.influence.
Te tri
4
Wltn SS
Witness
Sworn to, subscribed and acknowledged before. me by the above named Testatrix and
witnesses this 7 day of November, 2009.
INV
COMMOMVEALTHOPPENNSYLVANIA _: Notary'Public
' ",WTARIAL SEAL k r
DA L.TANG,Notary Public
Cttyd1Wspu'ng.Dauphin County
W' Commission Expires August 9,2_b�2
5