HomeMy WebLinkAbout09-26-05
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
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COMMONWEAL TH OF PENNSYL VANIA
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COUNTY OF CUMBERLAND
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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) of the above
decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affIrmed and subscribed
Be~re m~ this :i l~) ~ of
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Estate of C;Jfbd fli'o'(;<' fV7rWi/J Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW 1 bel' 2IDS , in consideration of the petition on the reverse side
here f, satisfactory proof having bee presented before me, IT IS DECREED that the instrnment(s), dated
, described thereill be admitted to pro~te filed of record as the last will of
; and Letters are hereby granted to L"CI. (iMVf) F<. /~f)(~/
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FEES
Probate, Letters, Etc. ............. $
Will................................. $
Renunciation....................... $
Short Certificates ( )............ $
JCP.................................. $
Automation Fee................... $
Bond. ......... ......... .... ... ....... $
Total $
Attorney (Sup. Ct. LD. No.)
Address
Filed
20
Phone
Register of Wills of Cumberland County
Es/a/eo! tllf~(d. J. f/tILLuM
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
No.c:)/-f)c; -8~7
To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
, Deceased.
Social Security No. 15 &, - I'f. Lf 2.0 7:J
The petition of the undersigned respectfully represents that:
Your petitioner( s), who is/are 18 years of age or older, and the executfl..K... named in the last will of the
above decedent, dated 2-,..4v tyvsl- ,20 0 S-
and codicil( s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in {i U lVl. fg, {a f'Ld
Pennsylvania, with h~ last family or principal residence at
1& U ~ t20cu1 - U<'J(/~,h PA
(list street, number and municipality)
County,
Decedent, thennyears of age, died U ~t.em!x{, 20~, at &.df~U. Ibj'tnd fJ1..ltl.c.J.. uJ-cr
Except as follows, decedent did not marry, was not divorced and did not have a child liorn 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 ofreal estate in Pennsylvania
situated as follows:
(I'i( (JVi)
ere
,
$
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented
herewith and the grant of letters
(testamentary; administration c.I.a.; administration d.b.n.c.t.a.)
Residenci-S) ofPetitioner(s)
(C/O Au/,,-, d <./0 Si LP/ - r>u t 1. (p ,/?4 q(]l '3
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lhi, i" to certify that the information here given is correctly copied from all original certificate of death duly filed wiLl Ill( as
I.'.llll Registrar. The original certificate will be forwarded to the Slate Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. 56.00
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I "oc:" Registrar
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;:~ /; SEP 7 2005
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No. Dale
H10S.143 Rev.2J87
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TYPElPRINT
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PERMANENT
BLACK INK
CERTIFICATE OF DEATH
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
STATE FILE NUMBER
00
decedent
live In II
CllmMrlttlnn township? 17d.D ~~hl~~~a1~~fi:or
MOTHER'S NAME. (First, Middle, Maiden Surname)
1B. katherine' Welebir
INFORMANT'S MAILING ADDRESS (Strwt, CltvfTown. Slale. Zip COde)
2Ob. 140 1 edere St. Carlisle pa 17013
PLACE OF DISPOSITION- Name of Cemetery, Crumatory LOCATION ~ ClryfTown. Slate, Zip Gode
orOlherPlace
NAME OF DECeOENT (Fin;t, Middle, last)
,.
AGE (lasl Birthdayj
BIRTHPlACE (City and
Slate or Foreign Countryj
5.81 Yr$,
COUNTY OF DEATH
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8b
CUmberland
16 Clay Road
18. Carlisle, Pa 17013
PA
17b. County
23...
TIME OF DEATH OATE PRONOUNCED OEAD (Month, Day, Yaar)
24. lfv~ M 25. Oel () (..~ L...-;,..>'-;-
27. PART I: f:..t.r the diu...., l"JurI.. Or eomp"ctIUonl ..hlch ca.....rl tt.. de.-th. Do not .nt., tile mode 01 dyll'l", I..eh a. cardiac "" ...pi.-.,,,')' .....t, .hock or h....O.II"...
Uatonlyonlca"..on..ohllrltl.
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"'S..............l\ C,..t.t\ ",e--.J.'Q (.,.......avl;..~
DUE TO (OR AS A CON51"QUENCE OF)
SequentiaUylist cOrn;litions
ifany,leadlngtoimmediale
. cause. Enter UNDERLYING
CAUSE (Di$ease or injury
. a thatinlllaledeVltllls
resulting 00 death) LAST
WERE AUTOPSY FINDINGS
AVAIlABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
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DUE TO (OR AS A CONSEQUENC
DUE:. TO (OR AS A CGNSEQUENCI" OF)
MANNER OF CEOA TH
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DATE OF INJURY
(MOMlh,Day,Year)
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6 2005
f:'~,.,) 0
RACE" American Indlen, Blad<., White, et
(S~fy)
White
MARITAL STATUS - M8nied.
Naver Manied, Widowed.
Divon::ed(Speclty)
".Never Married
West
SURVIVING SPOUSE
(Kwife,lliVllrnaidlOnnamo)
11e. [!ves,decedentrivedin
Pennsboro
Iwp
citylboro
26.
: Appro:<im811ll
. Inlef\lal between
:on5etandd8i1lh
\)"", \......-t:..
c___
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURREO.
PendinglnvllsligaUon
o
o ~D~D
30a. 30b M JOe.
o PLACE OF INJURY At home, farm, street, laclOry. office
building, .t~. (Sp.rJ/y)
30e.
Natural
Homicide
Acddent
Suicide
YesD No
Y8SO
NOD
Could nOlbe delermined
28.. l8b.
CERTIFIER (Check ooly 01111)
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'PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing dealt, ..nd certifying 10 cause of dllath)
To tlla best of my knowledge, death occurred at the tlmo, datil, and place, and d"a to the causes(sj IInd manner as sial lid. ..
.MEDICAL EXAMINERlCORONER
On the bllsls of examination and/or Investigation, In my oplnJon, death O(:(;urred at the time, date. and place, and due to the causlllli(s) and
mannaraSSlaled ... ................ .... ............................................
31a.
REGISTRAR'S SIGNATURE AND NUMB~ _
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F: \FILES\DA T AFILE\Estate Planning\ 11756.1. will
11756.1/8/8/05/c1m
LAST WILL AND TESTAMENT
I, CLIFFORD JAMES McLAIN, of West Pennsboro Township, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils made
by me.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and
all death taxes (whether such taxes may be payable by my estate or by any recipient of any property)
shall be paid from my residuary estate as soon as practicable after my decease and as part of the
administration of my estate. My Executrix shall have no duty or obligation to obtain reimbursement
for any such tax so paid, even though on proceeds of insurance or other property not passing under
this Will.
2. ~~
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I give, devise and bequeath all of my estate, both real and personal property, unto myni,ece,-~;
CAROLYN R. HENRY, absolutely."
3.
1 nominate, constitute and appoint CAROLYN R. HENRY as Executrix of my estate.
4.
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I direct that my Executrix shall not be required to file a bond to secure the faithful
performance of her duties in any jurisdiction.
5.
I authorize and empower my Executrix, in her sole and absolute discretion, to purchase or
otherwise acquire and retain any investments of which I die seized or any real or personal property
of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in
regard to any or all property of any kind forming a part of my estate for such terms and such prices
as she may deem advisable; to borrow money for any purposes connected with the protection and
preservation of my estate; to mortgage or pledge any real or personal property forming a part of my
'41.1 L
[tnitials]
Page 1 of 3 Pages
estate or to join in or secure the partition of same; to compromise any claims or demands of my
estate against others or of others against my estate; to make distribution in kind and to cause any
share to be composed of cash, property or undivided fractional shares in property different in kind
from any other share; to employ agents, attorneys and proxies and to delegate to them such power
as my Executrix considers desirable and to pay reasonable compensation for such services as may
be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as
may be necessary to carry out any of these powers. In addition, I direct that my Executrix shall have
the power to conduct an inventory of any safe deposit box necessary to the administration of my
estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal this
I'h?JUs.-f ,;;Q00$'"
f'-L
~3 day of
c'~l1~~'-ffic~~~ L~0~ (SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testator, as and
for his Last Will and Testament, in the presence of us, who at his request, have hereunto subscribed
our names as witnesses thereto, in the presence of the said Testator and of each other.
U~ 5 (l
Page 2 of 3 Pages
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
We, Clifford James McLain, Christopher E. Rice, Esquire, and y) )ttf!J rtn n M. V~l LJ ...diM \ R, "lJ '.J
the Testator and witnesses, respectively, whose names are signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed
the instrument as his last Will and that the Testator has signed willingly, and that the Testator
executed it as his free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the
best of his /her knowledge the Testator was at that time eighteen years of age or older, of sound mind
and under no constraint or undue influence.
CL4 C;. fL-
Witness
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Subscribed, sworn to and acknowledged before me by Clifford James McLain, the Testator,
and subscribed and sworn to before me by Christopher E. Rice, Esquire and
~1 fh-"fi'L {tl-rl /)('ti.e^. (Q .tJ. , the witnesses, this d-31~ay of 1ho1AST, clfJtJ-5:.
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No at)' Public
NOTARIAL SEAL
CORRINE L. MYERS, NOTARY PUBLIC
CARLISLE BORO, COUNTY OF CUMBERLAND
MY COMMISSION EXPIRES MAY 27, 2007
Page 3 of 3 Pages
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