HomeMy WebLinkAbout07-12-05
Register of Wills of Cumberland County, Pennsylvania
PE~ITION ~2R GRANT OF LETTERS
'SQ/e/le ft1 No. 21-05-tJ\s\C,
MiJ:le
Estate of Gail E. Sei8e-I
also known as
, Deceased
Social Security No. 162-36-9506
Gomer L. Stephenson III
Petitioner(s), who is/are 18 years of age or older, appl(ies) for:
(COMPLETE 'A' or 'B' BELOW)
[E] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the
the Decedent, dated 04/25/1973 and codicils dated
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
:-k leI'-' EIIl..,;..~tL.~' tt:.pk>-r--~()rv d, ec1.
FefJ. 1'1 /qqJ
o B. Grant of Letters of Administration
(c.t.a; d.b.n.c.t.a; pedente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs:
Name
Relationship
Residence
357.01d StageARoad339
Lewlsberry, P 17
Kelli Christine Williamson daughter
Jodi L. Seid/e.h &vt t5
daughter
1817 Green Street
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her family
or principal residence at 1014 E. Simpson Street,
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(list street, number, and municipality)
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years of age, died 06/27/2005
at
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Decedent, then 59
Decedent at death owned property with estimated values as follows: (Location)
(If domiciled in PAl All personal property $
(If not domiciled in PAl Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows: 1014 East Simpson Street, Mechanicsburg, Pennsylvania
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant
of tetters in the appropriate form to the undersigned:
50,000.00
20,000.00
yped or printed name and residence
Gomer L. Stephenson III 190 Ore Bank Road
Dillsburg, PA 17019
Prepared by the Pennsylvania Bar Association
Copyright (c) 2004 form softwere only The Lackner Group, Inc.
Form RW-1 (1991)
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 t as personal ntative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate . g to law.
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Sworn to or affirmed and subscribed
before me this. \ Z:+h- day of
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For the Register 4VJ T
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No.
21-05- Ol D jq
Estate of
Gail E. Sei4eI S e .'/j J-e
~'O
, Deceased
also known as
Social Security No: 162-36-9506
Date of Death:
06/27/2005
AND NOW,
, in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 00 Testamentary 0 of Administration
(c.I.a.; d.b,n.c.t.a.: pendente lite: durante absentia: durante minoritate)
are hereby granted to Gomer L. Stephenson III,
in the above estate and that the instrument(s) dated
4/25/1973
described in the Petition be admitted to probate and filled of record as the last Will of Decedent.
FEES
Letters.................................,..... ,$
\ 3500
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~n(G ~CU~;;:J;;"t~A ~
Attom" fl~t::'.ngs
(~u4:. J1.pUTj
Short Certificate(s).....................$
Renunciation...........,..........,....... $
Extra Pages (
)......,......,.....,.......$
)~~:....$ \5.co
J.D. No:
'1, ;), i'
Affidavits (
Address:
429 South 18th Street
Codicil..,.....,.,.............,.,............ .$
Camp Hill, PA 17011
JCP Fee.....................................$ \IJ,t'<b
Telephone1 717/730-7310
Inventory.................................... $
E-Mail:
OtherG,.j",.o\.,-~..o..t...;ll:-,.1:.~..$
5 .(X)
TOTAL............................$ ;2.05 ,Q)
Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner Group, Inc.
Form RW-1 (1991)
REGISTER OF WILLS OF ~ OUNTY
OA H OF SUBSCRIB WITNESS
-"~
~"
codicil
(each) a subscn' witness to the wilI presented herewith,
law, depose(s) and say s
.'., ,
ach) being duly qUalifi~Ording to
present~d saw
, ,
(Address) 80
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CUMBERLAND >:~(/)~
REGISTER OF WILLS OF COUNr~~
OATH OF NON-SUBSCRIBING WITNESS ':")~
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the testat
req of testat
other subscr .
Sworn to or affirmed an
me this
bscribed before
day of
19
Register
-,,-signed as a witness at the
d (in the presence of e.ach othe~ the presence of the
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(Name)
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KELLI CHRISTINE WILLIAMSON and GOMER L. STEPHENSON, III
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
they are familiar with the signature of Gail E. Seidel
~~JX
will
that
they
testatrix of ~x~~x~~~xwff~~~~ the
presented herewith and
~
believes the signature on the will is in the handwriting of
Gail E. 3-elJd Se.l ~ Le
to the best of their
Sworn to or affirmed and subscribed before
me this \Q-tL- day of
~ ' }(B; 2005
~W\() ~o..A.I"'\..1>A.~'\-A~L
~ n ' (\."..,.1-'1; Register
knowledge and belief.
~.C~~~.~~
LLI CHRISTIN ON
(Name) .
357 Old Stage Road, Lewlsberry,
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a e)
PA 17339
(Address)
190 Ore Bank Road, Dillsburg, PA 17019
Thi _, is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
LOt'al Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Fee for this certificate. $6.00
Local Registrar
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JUL 0 1 Z005
p
No.
Date
CERTIFICATE OF DEATH
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
,.....
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3 Rev, 2187
SEX
STATE. FILE NUMBER
SOCIAL SECURITY NUMBER
3, 162 36-
h ck nl n - Sa in truction
5.
COUNTY OF DEATH
59 Vrs.
2. Female
BIRTHPLACE (City and PLACE F E TH
State or Foreign Country) HOSPITAL
Harrisburg '.p.h.., D
7. 8a.
FACILITY' NAME (If not institution, give street and number)
ERfOutp8tienl 0
DOAD
Relidence 0 ~~:~iM 0
RACE - American Indian. Black, White, at .
(Specify)
1.
AGE (Lost Birthday)
8b,
Dau hin
DECEDENrS USUAL OCCUPATION
~usquehanna Twp
KIND OF BUSINESS / INDUSTRV
10,
Whi te
SURVIVING SPOUSE
(l~ w1~e, gIve maide1'\ nan'rft)
MARITAL STATUS - Married,
Never Married, Widowed,
Divorced (Specify)
14. Divorced
17a. State
Pa
1014 E.Simpson Street
16. Mechanicsbur Pa 17055
FATHER'S NAME (First, Middle, LasV
16, Gomer 1. Stephenson,Jr
INFORMANrS NAME (Type/Print)
20.. Kelli Williamson
METHOD OF DISPOSITION
Burial 0 Cremation ~emoval from State 0
Other (Specify)
Cumberland
Did
decedent
live in 8
township?
He. 0 Yes, decedent lived in
17d. ~ ~h~e~~~~?\i~i~ of
lwp.
11b. Countv
Mechanicsburg
city/bora.
o
MOTH~F'S.l'JAME (~st, fo.1igdle, l;1aiden,Sumame)
19. tielen t;. tiaWbeCKer
INFORWJ,N];'S MNLI/oIGloDDRESS (~reet, CjtylJown, ~tat~, Zip Code) P 17339
20b. j){ Uld ~tage Koad LeWlsDerry, a
PLACE OF O\SPOS\T\ON- Name of Cemetery, Crematory LOCATION - Cltyrrown, Slale, Zip Code
or Other Place
21cHollinger Crematory
NAME AND ADDRESS OF FACILITY
22cM ers-Harner Funeral
LICENSE NUMBER
26,
: Approximate
I interval between
: onset and deatl1
Otl1er significant conditions contributing to death. but
nol resulting in the undertying cause given in PART I
Items 24-26 must be completed by
person who pronounces deatl1
21. PART I: Enter the di......, inJurle1 or complication. which caused the death.
Lilt only on. caul. on ..c;h Iln8.
IMMEDIATE CAUSE (Final
disease or condition
resulting in death)-+
Sequentially list conditions
tf any, leading to immediate
cause. Enter UNDERLYING
CAUSE (Disease or injury
that ir.iliated e....ents
resulting on death) LAST
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
E
DUE TO (OR AS A CONSEQUENCE OF).
DUE TO (OR AS A CONSeQUENCE OF).
Ves D
MANNER OF DEATH
Natural !8' HomicIde 0
Accident 0 Pending Investigation 0
Suicide D Could nol be determined 0
DATE OF INJURV
(Month. Day, YfI8r)
TIME OF INJURV
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
280. 28b.
CERTIFIER (Check only one)
.~;~~F~~tGor~~~~~~~~hl.S~~:th cg~~~i~~~~UJ: t~ ~heea~a~:~(:r~~rJ>~x~i~~a~s h:t~r~~~~~~.~~.~. ~~~~~. ~~~ .~~.~~~~~~ .i~~.~ .~~).............
29.
300. 30b. M.
PLACE OF INJURY - At home, farm, street. factory, office
bUilding, etc. (Specify)
30e.
Ves 0 No D
30e.
Ves 0 No.8.
NoD
.PfOO~~:s~l~fGm~N~;;I~~e;l~e~t~~~~~c~:~ ~~~:i~l~e~d:t~~~~~I~~i,d:~~11 d~n: t;;~Zi~~~~~(~)~~~ d::~~er as stated........
....0
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.MEDICAL EXAMINER/CORONER
On the baal. of examInation and/or Investigation, In my opinion, death occurred at the tIme, date, and plcace, and due to the causes(s) and
manner as sUited....
31a.
REGISTRAR'S SIGN'Jrr~NO.NWM:rljJ
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MY LAST WILL AND TESTAMENT
I, Gail Stephenson Sedile, of the Borough of Mechanicsburg, Cumberland County,
Commonwealth of Pennsylvania, being of sound and disposing mind and memory, do
hereby declare this to be my last will and testament, revoking all former wills
by me at any time heretofore made.
FIRST, I direct my hereinafter named Executrix and Executor tOIRY all of
my just debts and funeral expenses as soon after my demise as it is practical
to do so,
SECOND, I give, devise and bequeath all of my personal property to my two
daughters, Kelli Christine and Jodi Lynn Seidle, to be disposed of amicably by
them, each to receive whatever they desire from the personal property and the
remaining personal property wheresoever situate to be sold or disposed of with
the benefits given to them,
THIRD, I give, devise and bequeath all real property to my two daughters,
above named, in equal shares; or in the case of their demise, their share to go
to their children in equal shares,
FOURTH, in the event of the demise of myself and my children, I give, devise
all of the personal and real properties to my mother, Helen Elizabeth Stephenson,
and my brother, Gomer Llewellyn Stephenson,IlI, in equal shares,
FIFTH, in the event of my demise, I appoint my brother, above named, as
the guardian of my two daughters, above named, and
3IXTH, I name, oonstitute and appoint my mother, above named, as Executrix
and my brother, above named, as Executor, without bond, of this my last will and
testament.
IN WITNESS WHEREOF: I hereunto set my hand to this my last will and
testament this ~=<,:;-:t;L day of April, 1976-.
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