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Home My WebLink About02-03-06 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Mary C. Thomas also known as No. 21-- ()~ - \J\\~ , Deceased Social Security No. 264-52-7100 John B. Thomas Petitioner(s), who is/are 18 years of age or older, appl(ies) for: (COMPLETE 'A' or 'B' BELOW) 00 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the Executor the Decedent, dated 02/26/2001 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: 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 (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 2011 Harvard Avenue, Camp Hill (list street, number, and municipality) Decedent, then 91 years of age, died 01/28/2006 at Holy Spirit Hospital, East Pennsboro Twp. (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania $ $ $ $ 250,000.00 100,000.00 situated as follows: 2011 Harvard Avenue, Camp Hill, PA 17011 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: John B. Thomas name and residence 19 Hillymede Road Hummelstown, PA 17036 ignature ~ \S C:::~ --------. .~, ~, .'.... >",1 ,J Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software 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 that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. x \.--:------ ""::C::- Sworn to or affirmed and subscribed r " '\ ~ John B. Thomas before me this ~~ day of c:;;..~\~~,<~ , <")..,'\:J\;~~ . ~ ~~~'ll-. ~~ "'~~, For the Regi~~, ~ \ ~, ~ .~.&~\ '~~S) ~ No. 21-- ~~ _ \'::) \ \ ~ Mary C. Thomas , Deceased Estate of also known as Social Security No: 264-52-7100 Date of Death: 01/28/2006 AND NOW, <::;: "'-.'-t).'{ ~~.:'I. u.. ~ ~ ~'0~~ , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [RJ Testamentary 0 of Administration (c.la.; d.b.n.c.la.; pendente lite: durante absentia; durante minoritate) are hereby granted to John B. Thomas, Executor in the above estate and that the instrument(s) dated 2/26/2001 described in the Petition be admitted to probate and filled of record as the last Will of Decedent. FEES Letters....................................... .$ Short Certificate(s).....................$ 16.00 ~~ ~~r\. 9....~~, ~~1) ~~ ~ ~ ')J~,...)~ . Register of Wills . , ~ ~" 360.00 Renunciation.............................. $ Attorney: James G. Morgan, Jr. ~ ~ ~\\I '-\ Affidavits ( )...........................$ Extra Pages ( )....................$ 15.00 1.0. No: 06897 Tucker Arensberg, P.C. Address: 111 North Front Street Codicil.............................. __........$ JCP Fee.....................................$ 10.00 Harrisburg, PA 17108-0889 Telephone1 717/234-4121 Inventory.................................... $ E-Mail: Other..........................................$ 5.00 ~ ~.. - '1 TOTAL............................ $ 406.00 Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner Group, Inc. Form RW-1 (1991) HIf1<'O, RFV 110< ~"\ _ \J~ _ ~~ '\ ^,3 This is to certify that the infOrfnation here given is correctly copied from an original certificate of death duly filed with me as Local 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. No. /J ~/1 t'l', A A ,~:;?' ~ /(1 /C~:./)~:/.'//" >~ Fee for this certificate. $6.00 Local Registrar p 12224969 JAN 3 0 2006 Date ,- , ) j '. y" COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NUMBER r' } Rev,Ol106 RINTIN \NENT KINK , Name 01 Decedent (First. middle, last) t~:::' 91 B. Birth lace C' andslaleorlore one o Residence 0 Other. 10. Race: American Indian, Black, Whfte. ale. (SpecifY) White Mary C. Thomas 5 Age (Last birthday) 3. Social Security Nurroer 7. Dale of Birth Monlh, de , ear 264 52 Cumberland East Pennsboro Other a ERiUut alienI 0 DOA 0 NurSfl Home 9. Was Decedent of Hispanic Origin? )Q{No 0 Yes (lfyes,specilyCuban. Mexican,Puer1.o Rican, elc./ Bb. County of Death 11. Decedent's UsualOcc alien Kind afwork done durin most 01 workin life; do nol slale relired HOUSe\J~r~Work Kind of Businessllndustry 16. Decedent's Mailing Address (Street. cilyflown. slale, Zip code) 14, Marital Slalus: Married, Never married. 15 Surviving Spouse (II wile. give maiden name) Vftdq,wed, Divmfad (SP8cif'll WldOwe(l 2011 Harvard Avenue Camp Hill, Pa 17011 17a. Slale Pa Did Decedent liveina Townsh~? 17c. 0 Yes, Decedent lived in Twp 17b. County Cumberland 17d, iX No, Decedent Lived within Actual Umils 01 Camp Hill CitylBoro 18. Father's Name (Firsl, middle,last) 19, Mother's Name (First, middle, maiden surname) John E. Landis 20a Inlormanl's Name (Typelprint) Nellie Hille as 2Qb, Inlormanl's Mailing ftDdress (Slreet. cifyflo~, slate, zip code) Kei th 'TIlOmas o Donalion 21b. Dale of Dispos~ion (Month, day, year) February 1,2006 22b. license Nurrber 21c. Place of Disposition (Name or cemelery, crematory or other place) 423 South Frederick Street Mechanicsbur Pa 17055 o AelTXlvalftomStale 21d. location (CilyJ1own, s18te, z~ code) 011654-L Rolling Green Cemetery Camp Hill, Pa 22c Name.ndAddrossofFacilily 1903 Market Street Myers-Harner Funeral Home IncCamp Hill, Pa 17011 23b. license Nurrber 23c. Dale Signed (Month, day, year) ervice Licensee (or person acting as such) o the best of my knowledge, death occurred althe time, date and place staled. (Signature and mte) 26. Was Case Referred 10 a Medical ExaminerlCoroner? Instructions IInd eumples) hem 27. Part l: Enler the ~ - diseases, jn~ries, or co"l'lIcalionS - thai directly caused the death. DO NOT enler lerminalevents such as cardiac arres!. respiratory arrest, o. r ven.tricUlar Ii:lrillation wrthout shoY(iog Ihe eA.. .00 NOT abbreviate. Enler only one cause on a line. .\ IMMEOIA TE CAUSE {Frnal disease or ! ' \ ( , ,- cond~ion resuhing In death) -7 a. DU~'ttr (or~s /cons9<luence o~: ~proximate inlerval' onset 10 dealh o Yas 1(. No Parlll: Enler olher sionificanl condrtions conlribulino 10 death, but nol resuhing in the undertying cause given in Part I 28. Did Tobacco Use Conlribute 10 Death? o W-. 0 Prob8b~ ~No 0 Unknown 30<1. Was an Aulopsy Performed? o Yes e(~~ d JOb. Were Aulopsy Findings Available Prior to Colfllletion of Cause 01 DeaJll? DYes uvNo 31 Man~r'orDeath Iir'NaturaJ 0 Homicide o Accident 0 Pending Investigation o Suicide 0 Could Not Be Delermined 32a. Dale 01 Injury (Month,day, year) 32b. Describe how Injury Occurred: 29. rfFemale: o Not pr9Ql1anl wrthin past year o Pregnant at lime 01 death o Not pregnanl, but pregnant within 42 days of death o Nol pregnant, but pregnant 43 days 10 1 year beloredeath o Unknown if pregnant within the past year 32c, Ptace 01 Injury: Home, Farm. Street, Faelory, Office Building, etc.($pecifyj Sequenlially list condrtions. il any, h leading 10 the cause ~sted on Une a Enler the UNDEAl YlNG CAUSE . (disease or injury thai in~iated the events resu~ingindeath) LAST Due 10 (or as a consequence o~: Due 10 (Of as a consequence o~ 32d. Time of Injury 32e,lnjuryatWork? DYes 0 No 34. NafJ'lE and Address 01 Per~ Who Cotfllleled Cause of D~ath (~B 7} TypeIPrinl '--I (,Ltt.t..;J{, /1 13",.. I c/Lt)U Ei'b~; ..~. {cL'1 CC1)._.v~t- 12J ~9, ZO{Jt.p 321. 32g. location (Street, cityl1own, slale) 331. Certifier (check only one) Certifying physician (Physician certifying cause 01 death.when another physician has pronounced death and COrfllleled !Iem 23) To the best of my knowledge, death occurred due to the cause(!) and manner as stated .... ............,.,................... Pronouncing IInd certifying physician (Physician both pronouncing death and certifying to cause 01 death) To the best of my knowledge, dellth occurred It the time, date, and place, and due 10 lhe ClIUSe(S) and manner as stated Medical examiner/coroner On the bllsls of examination andlor investigation, In my opinion, death occurred al the lime, dale, and place, and due to It\e cause(s) and manner as slated 35 Registrar's Signature and Disuict Nun1>er .// M. .............................................21 ..........0 ........0 /1) ~ /"<:1,,~~;r~"09 r l..ot I / l' (See instructions and examples on reverse) ~ l. LAST WILL AND TESTAMENT ~~ \. ~~; C.:.' \~~, .'.1\ ':5 BE IT REMEMBERED THAT I, MARY C. THOMAS, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am not married. My beloved husband, PAUL C. THOMAS, having predeceased me and that I have three (3) children, SANDRA J. MILLER, JOHN B. THOMAS, and KEITH L. THOMAS. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. IV I give and bequeath to my daughter, SANDRA, my personal items including jewelry (but excluding Aunt Beth's diamond ring). I direct that she divide these items among the fe~ale me~bers,ofmy family utilizing her discretion. . J', . .._ , ~U"<' :1l~.{j:{)~1../t.u .~. ~-c...( tv. v( d.-i~~dJ;.<- ~~.:7 (j/:....u.'d~}... J... .-'~/)~~,lA ~'~.j~?~-e__ , V .1- .1/J:L.-t!c.G ,)1;,:.1. ~.A..,-,) ~: '1 / U7 J l (, Ar(J..i.'t:'~,) t~ 7;.t,"c . All the rest, residue, and remainder of my property whether real or personal wherever situate, including any property over which I may have a power of appointment, I give, devise and bequeath to my daughter, SANDRA, my son, JOHN, and my son, KEITH, in equal shares, per stirpes. ,..'---'~ . . c.<) (.) \.D VI I nominate, constitute and appoint my son, JOHN B. THOMAS, as Executor of this LAST WILL, to serve without bond. If my son is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my daughter, SANDRA J. MILLER, as Executrix of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, MARY C. THOMAS, have set my hand to this LAST WILL this ~ It, day of ~1 ' 2001. MA~~';~~AS 1krZ4~/ Signed, sealed, published and declared by the above-name THOMAS, as and for her Last Will and Testament, in the p esence her request an~ in her presence, .and in the re~e c of e}. / hereunto subscnbed our names as WItnesses. / I /; ~1i/; j!'~~ , ~~ ) r~ MARY C. us, who, at other, have Cf4 Yr~ 2 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. I, MARY C. THOMAS, 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 as my free and voluntary act for the purposes therein expressed. m ~ (! ,-'j~-d4/ MARY C. T' MAS Sworn or affirmed to and acknowledged before me by MARY C. THOMAS, Testatrix, this 02'"'- day of F-i.l,rtA.iU")-_ ,200l. (l.~m .~ Notary Public Notarial Seal Diane M. Smith, Notary Public Mechanicsbul'Q Bore, Cumberland County My Commission Expires June 22, 2004 "-'~"'''--'''''-----'--''''--'~'''"'''''-''''-'-''''~' AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND We, fhurft./ R. 11JaI-f<rs, ill and .J V\ D't J14~tf ~- , 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 MARY C. THOMAS signed willingly and that she executed it as her free d voluntary act for the purposes therein expressed; that each of us in the he . g and sight of the Testatrix signed the Will as witnesses; and th t to th best 0 our knowledge, the Testatrix was at the time 18 years of age or ore".p soun mind and under no constraint or undue influence. ~?#. c~~ Sworn or affirmed to and acknowledged before me this cQ ('/I.. day of ;::- --e-.6 ru..aA d-- ' 2001. O~Jn.~ Notary Public 3 Notarial Seal Diane M. Smith, Notary Public Mechanlcsbul'Q Boro. Cumberland County My CommiSSion Expires June 22, 2004