HomeMy WebLinkAbout01-0105
PETITION FOR PROBATE and GRANT OF LETTERS
,M. V-t:J\JIS No. ~I-OI- 0 105
~To:
.~~ Register of Wills for the
, Dec.epsed. ~ _. County of C lA ....l..:..tl ~~ in the
Social Security No. :; j;,r _ ~ - :2.3.:J . 03- 21Qj::ommonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execute f!....
in the last will of the above ~~denh...dated'~ AJ-I 3/, I '1 ~ 1
and codicil(s) dated -'f1/If I tV r :.J"'-.
Estate of r'\e f, 1\4 tJ
also known as
named
,19_
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in c........ b4'tI~~
h 4. i. residence at a , v,.... J( I ~
loll W
(list street, number and muncipality) l _ z.oo ( . ~ '
Decendent, then X 4- ~ears of age, died ( (11j" ~ , 19 ,
at C A"""'f H. 1\, "V.a . .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: N '" H1;:
Decendent 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 of real estate in Pennsylvania
situated as follows:
$ 20 t>()O
I
$ NIp..
$ ""IA.
$ ,vb'" E'
WHEREFORE, petitioner(s) respectfully ~quest(s) th probate of the last will and codicil(s)
presented herewith and the grant of letters . -ll..:;.1-o...... ~
(testamentary; ad inistration c.t.a.; administration d.b.n.c.t.a.)
theron.
~
"
u
C
"
~3
" ...
00:"
c
-00
='Z
(lj';:
~"
~o..
,,'-
30
~
c
Oil
Vi
~J~ &~,J)
~~tD G- t?}TPI\-~O\ W
.3\ \q SJlJT+-\ ~\f\ptOl-3 CT -# On
(),tc..l+riIOI-JD C~ C\A.~O~)
\
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYL VANIA I ss
COUNTY OF c.u..NII3 eF\ LAND J
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 represen-
tative(s) of the above deced. ent petitione,(s) will well and trulSi:\nt€t3cconling to law.
Swom to m affi'~ -il'ld subsccibed 61\\l:Q J '"
b~fore me thO ~ ~d of ~
...Ji " ~
.....
s::
~
~
llc -tX)5 - ~
No. ~l-O J - 0 J 05
Estate of (Y)~j PrN m, DA:VI S
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
2DOl
AND NOW JPrN. IS ...w-, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 1-0/- I cr9'l
described therein be admitted to probate and filed of record as the last will of
TYleRl A:N M. DfYVl S
and Letters -rr::5 TA1Y\r2NTA1<'.'1
are hereby granted to FReD G. -5TIYPPo1<J)
FEES
Probate, Letters, Etc. ......... $ 5D. (1)
Short ertificates(S).......... $ 15.00
'/..-. ~ ... .. . .. .. .. .... $ lP . 0 D
SC~p $ 5 ' 00
TOTAL _ $ ll.p,OD
Filed ..... -' .-l~ .'.Q. i. . . . . . . . . . . . . . . . . . . .
ATTORNEY (Sup. Ct. l.D. No.)
ADDRESS
PHONE
).. "
'..,;
;1
~ .
'1,\',.,
, D.
H10'UW<) RFY l)!H(l
Tim is to certify thac the informacion here given is carrecd)' copied from an original certificate of death duly tlled with me as
local Registrar. The original certificate will be forwarded to the State Vital Records OHlce for permanent tlling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~,;
~,i,i~'~\.1LOF. pi;;-,-,.,.
"~,I ~'\. ~ ~'4' <.
l~ ~"':.
.,' s:s_~;.
I!!~~ '" . ~~
~ <<=i ,- ~". i~~
~ (.,.)~_...iY, .:b.~
\*'f:=:J....~.. ,/*!
;. ~\. ". I~l
-;..,.~~ A'~'"
~-....W1MfNl i\ 't-~'I"'\'
'''''''''/''UIIIIIJJJIIIJ
~ /7Z~-
Local Registrar
Fee For this certificate, $2.00
P 7175036
I " ~ I 2 C'\ 2001
\.J'\'~ ;(,
Date
'iTEfvr # 3
SHUULD 1.:EAD AS FOLLOWS:
o? 3.3 ... tJ.:/. ~...< 0 r-
a ~ --{_.,..-
/" (- {~<=2..{'~'. f.
:A/~"..A::/ C.
....-
5.'43_.211I7
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
ttAME OF DECEDENT (hll. Midc.e. LUll
..
sex
ST~I '11.( NUMBER
SOCIAL SECUAtTV NUMOER
DAlE OF DEATH ,MCftlh. o.~. .....f)
Cumberland
... E. Pennsboro
SIRTHl'lACE (c..,_
StIi.. Of Fa'e.gn COUnIfy)
.. Female So 251 - 79 2806 ..January 18, 2001
P\...ACE OF OEATW fO\errck 0f'Ity"". - .. lfIIWuctoOnt on 0fMt 'tide)
OO~_: ~~~
_....0 ~ =...10
AOE{l"'_Yl
UNDER , YVdl
........ o.yo
Merian M. Davis
UNPER, OM
HourI ! t.IInuI..
,
.
84
Y...
..
COUNTY OF DEAl'H
..
llECEDaIT'S USUAl OCCUAVlON
.i-=:~~':::L:'l'
. .... Branch Mana r t1~ Comn. of PA
MCEOf.NT'S WAll._ _sa ISh.... CiIy'-'. _. Z"'~I
10 House Road
Camp Hill, PA 17011
.1.
MnlEA'S HAME IF... M_. L"l
SUflV1Y1NO SPOUSE
," WIle. ~ I'nIlIden rwne)
llECEllENT'S
ACTUAl
RESlCOICE
cs.._
on__
,..,
Cumberland.
No,__
. ____
MOTHER'S _lfW.. _. ......Sut_
lIl<l
-
......
_1
_.
II.
_OAMAHrS_(f~
Unknown
Fred G. Stafford
IlETMOO OF OISPOlllTlOH
O _1Rl c.........o _......_.0
~ au...
. 2'"
_UAE OF FUN
~ Hill, PA 17011
:I,d.
17011
PAin' .: ou...llgni/IconI_ CO<llIll!odng" do.......
... .._.....___"'-'..IWlTI.
Pf\ev~or\1 C4
DUE 10 lOll AS A CONSEOUENCE OF):
4.(~
....-..--
'_-.v..-
_._---
-~........
......--
_.._L.UT
lb.
c.
d.
DUE 10 lOA AS A CONSEOUENCE 0Fl:
DUE 10 lOll AS A CONSEOUENCE OF):
-..
~
DATE OF INJURY
(Monlt Dlv. -'81)
TIMe Of INJURY
o
o
Coutdnot ~ ".nntnifd 0 PlACE OF INJURY. AI home, tvm, ........ tactorY, offtee AI.
..-.... .... I~"'}
... 211t. 21. 30..
~C::~"==M (PhySC.an cetWytng cause oJ drath wh.., aoorh.. phYSIC"" he, Pfonounced de8lh ana comiPleled Item 23,
T....beetot"'y~...thocc\ln'ed...to...cau..t.).nd....nn.,.....tlId.. .......... ....-............... ........-............
weRE AU10PSY FINDINGS
--..aE PAIOll1O
COMPLETION OF CAuSE
OF llERM1
MANNER Of DEAlN
.....iddo
-
"'_-'90"""
...t)/
....0
NoD
-
o
-PROHOONClNG AND caRllFYINQ PMVStCIAN t~ both ;>fonounc"'O ddfh -'CI c:tMytnQ to cause 01 dtattll
To....bMto.my.no~.d.."'occu'rH.t....Ime.d.... aMpt"_, .nd1l....,oth.c."..'.).nctm.nn.'...I.led "... '............... '...
o
fr(~^
~I ~/1/1
, .
OATEFILEOI_h" ~
,.. I. Z~ oj
( /
SAIDIS, GUIDO,
SHUFF &
MASLAND
2109 Market Street
Camp Hill, PA
'I
I-
i
LAST WILL AND TESTAMENT
OF
MERIAN M. DAVIS
I, MERIAN M. DAVIS of Camp Hill, Cumberland County, pennsyl-
vania, declare this to be my Last will and Testament, hereby
revoking any will previously made by me.
I - I direct the payment of all my just debts and
funeral expenses out of my estate as soon as may be practical
after my death.
II - I devise and bequeath all of my estate of what-
ever nature and wherever situate unto my son, Fred G. Stafford.
III - Should my said son predecease me, then I direct
that all of my estate of whatever nature and wherever situate be
divided into three equal shares and distributed as follows:
A. One said share shall be paid to my great
niece, Sally Solomon, 951 Hearthside Court, Jacksonville, FL.
B. One said share shall be paid to my stepniece,
Martha Marconi, Hinsdale, N.Y.
C. One said share shall be paid to my stepnephew,
William Renwick, 1325 Brownstown Road, Apollo, PA.
I~ -
) J,7\..
L
Page 1
SAIDIS, GUIDO,
SHUFF &
MASLAND
2109 Market Street
Camp Hill, PA
If any of the foregoing beneficiaries are deceased, his
or her share shall be divided between the remaining beneficia-
ries.
IV - I appoint my son, Fred G. Stafford, Executor of
this, my Last will and Testament. Neither of my personal repre-
sentatives shall be required to post bond in this or any juris-
diction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on
this, the
""
-; I
:....{,./~ r:.~.. ,.-<1__'~ .:._',-__,,":, &..,:. .
, 1997.
Jr--,
I '
I
<..,,-",J"
, /
day of
/ .
~/
Ii
/ I'
,. ")-7 ,,,~~,. .<.. 'Cd-/?7 Iv) !'~f~-<':-\&EAL)
./ Merian M. Davis
Signed, sealed, published and declared by MERIAN M. DAVIS,
Testatrix therein named, on this and one (1) other sheet of paper
as and for her Last Will and Testament, in our presence, who, in
her presence, at her request, and in the presence of each other,
hav hereunto subscribed our names as attesting witnesses.
8/4(Yl PA
Address
p
{I~JI(JJ,
.' Address'
."'1
IJ
L ~'.~
Name
Page 2
SAllIS, GUIDO,
SHUFF &
MASLAND
2109 Market Street
Camp HilI. PA
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY
CUMBERLAND)
OF
WE, the undersigned, the testatrix and the witnesses,
respectively, whose names are signed to the foregoing instru-
ment, being first duly sworn, do hereby declare to the under-
signed authority that the testatrix signed and executed the
instrument as her Last Will and Testament and that she signed
willingly (or willingly directed another to sign for her), and
that she executed it as her free will and voluntary act for the
purposes therein expressed, and 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.
'i: ;-..
, /
;\
~)--,// ,1,,' \ ~"'f'-C~./.
fJ
Witness
Subscribed, sworn to and
testatrix, and su~scribed and sw
nesses, this ~l~-- day of
before me by the
me by both wit-
_' 1997.
~nuJ ,) c(;fL_J~
Notary Public
NOTARIAL SEAL
THELMA S. McCAUSLIN, Notary Public
Camp Hill, Cumberland County
~ COmml~~!.?~.~xPires July 3, 2000
E:
--
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: ~t:"~ \ AN M 0 ~ \l \ S
\ \\810\
Will No. :J.(:Jj \ - ~ \ C .6
Date of Death:
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the
served on or mailed to the following beneficiaries of the above-captioned estate on
Name Address
(~€D ~ 5\~f"~aRD 3\ \'1 S,UTH-N-I1P\t)J0 C--r- ~~L
~\~Htt\C~b c.~ C\4gc~
( ~o Lf.: ~t:lJ€1="('\~")
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
4\~\~\
S;gnatu" ~~.1 ~
Name fQt:'D G- S \f.\~f'a RO
Address '3 \ \" ~ ~ p... ~.pm 1--J \:;, it;21
~ l~\-1-rAC lJO C ~ q 4zo <a
Telephone 6iC)
l.'Z "2.. \ a '2.. \
Capacity: ~rsonal Representative
_Counsel for personal representative
-.
...
IJ OK
v~.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: M(R\~N
Date of Death: \\\~\~OOl
\ I
t'-I\. Ul\~\5
('3\~ - .Q\ ~ J 00 \ - \ 0 5
Admin. No. G:J~ K~OvJ
Will No. \JJ\J\ 't(~O\0
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1.
State wpether administration of the estate is complete:
Yes v No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: \ \~ \\J3
\
~\\.~ 1 ~Q (~\J\){ SC~)
Signature
f~tG ~ (~r\\\~~O~D
Name (Please type or print)
~\ \~ ~\j\1A~"'~0 ~~,Ql \Z\C-\4MONf) CA
Address C\1'%OCO
(5\()) ~'12. \ \:) 1..\
Te 1. No.
Capacity: ~personal
Representative
Counsel for personal
representative
(MAH:rmf/AM3)