HomeMy WebLinkAbout12-05-06
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of RICHARD D. SHAFFER No.:J-J -()liJ - / D7 3
also known as To:
Register of Wills for the
, Deceased. County of <=-u(),~...tM..o in the
Social Security No. 204-03-7039 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older and the execut ORS named
in the last will of the above decedent, dated OCTOBER 5. 2006
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with
h IS last family or principal residence at 214 CUMBERLAND DRIVE. CAMP HILL. LOWER
ALLEN TOWNSHIP. CUMBERLAND COUNTY. PENNSYLVANIA 17011
(list street, number and municipality)
Decedent, then 93 years of age, died 11 /25/2006
at HOLY SPIRIT HOSPITAL. EAST PENNSBORO TOWNSHIP. CUMBERLAND COUNTY. PA
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: NONE
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(lfnot 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:
$
$
$
$
2.578.000.00
0.00
0.00
0.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant ofIetters TESTAMENTARY
thereon. (testamentary; administration c.I.a.; administration d.b.n.c.t.a.)
3 ANDES DRIVE
MECHANICSBURG
414 BRIDGE STREET
NEW CUMBERLAND
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OATH OF PERSONAL REPRESENTATIVE
COMMO. NWEAL TH OF PENNSYL VANIA} ss
COUNTY OF C'v()-,~'" ~L'>
The petitiGner(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 decedent petitioner(s) will well and truly inis r the tate Qrdi to law.
Sworn 10 0' affi"lloo aod ,ub"';b,d ~
b~'J, m, tb;, 'JHt day of
~r;l:J/~~:Jrg2~:f)_~~
fPJL ~ 1J:Ljf&~ Register
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No. dl-00J-(D73
Estate of RICHARD D. SHAFFER
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~p.ln h.e.'\. ? ".Q 00 Co , 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 10/5/2006
described therein be admitted to probate and filed of record as the last will of RICHARD D. SHAFFER
and Letters TESTAMENTARY
are hereby granted to
LINDA J. MICKEY AND DAVID H. STONE
FEES
Probate, Letters, Etc.. . . . . . . . $ 1t..fIoO. DO
Short Certificates (/5 ) . . . . . . $ l.1JO .CO
R1mtlh"icnttm .U,.;~ l.\. . . . . . . . $ 1'5.00
('5. DO
{c:l5 D. DO
#39785
ATTORNEY (Sup. Ct. 1.0. No.)
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TOTAL _ $
Filed. . . . . . . . . . . . . . . . . . . . . . . .
414 BRIDGE STREET
NEW CUMBERLAND PA 1707
ADDRESS
717-774-7435
PHONE
HI05.R05 REV 1105
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Lncal 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.
Fee for this certificate, $6.00
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Date
Local Registrar
p
12841729
NOV 2 8 2006
No.
'REV.02I2OO6
: fPRINT IN
~~~T 1130-389
1, Name of Decedent (Fi'S~ middIe,last sllflixl
Richard
s. Aoe(UlsIBrildayl
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH (CORONER)
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Shaffer
6. Date 01 Birth Mon~, , ..
STATE FILE NUMBER
4. Dale of Oealh (Mon~, day, year)
November 25, 2006
93
14. MarItal SIatus: Married, Never Married,
Widowed, Dlvorc8d (Speciy)
Single
17c.t] Yes,Oeceder/U"',hn Lower Allen
17d 0 ~~~U~W;1f1in
y"
Nov. 8, 1913
eb. Coun~ of Death
Cumberland
Holy Spirit Hospital
12 W"_""mll1e 13. Oeceden,.,Educalion(SgedfyonlyhigheslQl>decompletedl
U.S.A_Forces? EOmenI"YfSeoond.ry(1).121 CofOgel14 or 5+1
DYes 19No 12
o Resklance 0 Qtha,. Spec;fy
10. Ria: American Indian, B1ac:11, WhIle. elc.
(Specify)
White
11. Oecedenrs Usual Occu
Kind of Work
Farmer
mosl of wcni lie. Do not state retired
IOnd of Busi'oss J InllosOy
Agriculture
. 16. DecedenrsMallingAddress(S1reet,city/lown.slale,~code)
214 Cumberland Drive
Camp 'Hill , Pennsylvania 17011
18. Falhe(s Name (First. mktdle. last, suflhf)
Oecedenl'.
AduaI Residence 17a. Slate
P~nn!C:.ylv;:lni;1
Cumberland
17b. Coun~
('to 19. Mothers Name (First middle, maiden surrurne)
Rosie May Donovan
200. ~formanr.Maiing_(SIreat,cltyl_,_,~_)
3 Andes Drive', Mechanicsburg, Pennsylvania 17055
Wesley D. Shaffer
2Oa. Informanfs Name (Type/Print)
21.. Meflod 0' Dispos;t;on
o Buri~ 0 Remov~ from 51...
21c. P1aceol.Disposffion (Nameo'ceme~.cntmatoryOf'olt1erpla::e)
21d. LOCSIion(Cily/lown,state,lipcode)
Twp.
City J Boro
29, 200 Cremation Spciety of PA Harrisburg, PA 17109
22<:. Name,"",Addres'OfFd~Auer MemO~ia.J Home & Cremation SeIYises, Inc.
100 Jonestown Road, Harr1~burg, Pennsylvania I Y
23a. To !he best ofmy kllCJ\lAedge, dealtl 0CCtJn'ed allhe time, date and place staed. (SignalLQ and tille) 23b. Licenll&Number 23c. Dale Signed (Month. day. year)
26. Was Case Referred 10 Medical Examiner I Coroner for a Reason Other Ihan Cremation Of' Donation?
. Yas 0 NO
: Approximate interval: PII1Il: Enter other sianiIicMl c.mdili'rio; ari'Dltioolodslllh 28. Did Tobacco Use Contribute to Death?
; 0nseI1o Oea~ but nol resu~ng ~ II1e undel1ying cause g...." Part I 0 Yes 0 Proba~y
o No 0 Unknown
29 ~Ftlm....
o Notpregnanlwilhinpaslyear
o P'"9flanI~limao'daa~
o Not pregnant bul pregnant within 42 days
ofdealh
o Not pregnant, but pregnanl43 days 10 1 year
afdeath
o Unknown if pregnanl within the pasl yea-
32c. Place of InjLfy: Home. Fann, Street Famry,
Office BuiOng, ... (Spec;fy)
Com IoI_2Ja.t:o<Iy_cet1IIying
phy.. is nolavcilable at time of death 10
certify cause of death
iiams 2"26 musl be com_ by """""
~ WOO pronounces dealt1
24. Time of Death
25. D... Pronounced Dead 1_, day, ye"l
P. M November 25, 2006
2:15
CAUSE OF DEATH (See InstnJctions and aump"_'
Item 'Zl PART t: Enter the ~- ciseases, injuries, or compficabons -lhat dncUy caused !he death. 00 NOT entef Ierminal events such as cardiac arrest
respiratory arrest, Of \'enlricula- fibrilalion wiIt100l showIlg the etiology. Lisl only one cause on each Ifle.
=:~US:J:~~
Sepsis
Due 10 (or.. a COl'Illtquence of)
Leukocytosis
Oue to (or 85 it consequence of)
~'alylisl conditions, if any,
Ie 10 cause IisIed on Wne a
En'" UNOERL YING CAUSE
(disease 01 injury Ihal inillaled lhe
8Y8f'Its resu'ting In death) LAST.
DUI! 10 (or .. a consequence of)
JOa, Was an Autopsy
Pe<formad?
3Ob. Were Autopsy Rndings
Avatable Prior 10 Completion
of Cause of Dealh?
31. Manner of Death
~N''"'" 0 Homme
o Acddanl 0 Pending Investigation
o SuM:ide 0 Cou~ Nol be Delennilad
M
Dyes JSi(No
Dyes DNo
3211. Time of Injury
33a. Cettlfler (check only one)
CettifyIng phpk:l.ln (Physician certifying cause of deitlh when another physicia(1 has pronounced death and compleled Ilem 23)
Tothlbntofmy know\edgt,dHlhoecurrtd due 10 the elUH(., and InInntfa,.tltl!l__ __ ___.. __........ _ _.. _.. __.. _.... _.... _ _ _......0
ProncHmclng .nd certlfylng physiciln (Physician both pronouncing death and certlfyllg 10 cause of death)
To the bell of my knowledge, de.th occurred It the time, date,.nd pIKe, .nd du. to the eI"'e(I' and ""nner II atMteL... _ _.. ........ _ _.. _ _ .. _.... ...D
Medlcll Ex.nwner 1 COfOner
On th. bail of 'xarNn.oon and' or inYHtig.llon, in my opinion, death occumtd Illhe time, dill, .nd placl, .nd due to the elUIe(I) and manner llltatfct ..
33d. Da~ Signed (Mon~. day, _l
November 27,
34 Nm~~I"r':'~Com~C"",o{.Dealh(llem27) Typal"""
36. Data Fo (Mon~ d yeat) C ae . orr s, (;oroner
Io?/ /~ I /' I.... 1 //QcF'~ 6' ~~~~a~t~~~~~g, R~~dI7~~bte 111
(See Instructions and examples on reverse)
Coroner
2006
--
ep\wills\SHAFFER,RICHARD
...
LAST WILL AND TESTAMENT
OF
RICHARD D. SHAFFER
I, RICHARD D. SHAFFER, of Lower Allen Township, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any
will previously made by me.
ITEM I:
I devise and bequeath all of my estate of every nature
and wherever situate to as follows:
A. One-fourth (1/4) thereof to my nephew, DAVID W. MICKEY.
B. One-fourth (1/4) thereof to my nephew, MICHAEL HOFF.
C. One-fourth (1/4) thereof to my nephew's wife, SUSIE
HOFF.
D. One-fourth (1/4) thereof to my nephew's wife, LINDA J.
MICKEY.
ITEM II: I appoint DAVID H. STONE, Esquire and LINDA J. MICKEY,
Co-Executors of this my last will.
ITEM III: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his or her
duties in any jurisdiction.
IN WITNESS WHEREOF, I, RICHARD D. SHAFFER, have hereunto set my
hand and seal this
-.S
day of
~C~ \...,..~
, 2006.
Page 1 of 3
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RICHARD D. Sij. R ~
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SIGNED, SEALED, PUBLISHED and DECLARED by RICHARD D. SHAFFER, the
Testator above named, as and for his Last Will and Testament, and in
the presence of us, who at his request, in his presence and in the
presence of each other,
~~. "-~~
Witness
have subscribed our names as witnesses.
414 Bridoe St., New Cumberland, PA
Address
~m~
Witness
414 Bridoe St., New Cumberland, PA
Address
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND
I, RICHARD D. SHAFFER, the Testator 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 this instru-
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
~15.~
RICHARD D. 'SH R ER
Sworn to or affirmed to :n~,~:k~now. 1.0 edg711)~lr~obY RICHARD D.
SHAFFER, the Testator, this ~L ~~ ,2006.
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL Notary Public
DANIEL M. HARTMAN, Notary Public
New Cumb~rland Bora., Cumberland Co.
My Commission Expires Jan. 21, 2009
Page 2 of 3
...
. .
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
we,(" ~~ ~,~~
and
!frJ,^ Yil13Ur~
the attached or oregoing
the witnesses whose names are signed to
instrument, being duly qualified according to law, depose and say that
we were present and saw Testator sign and execute the instrument as
his last will; that Testator signed willingly and that he executed it
as his free and voluntary act for the purposes therein expressed; that
each of us in the hearing and sight of the Testator signed the will as
witnesses; that to the best of our knowledge, the Testator was at that
time eighteen or more years of age, of sound mind and under no con-
straint or undue influence.
~~~-Q~
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Witness
to and
before me by
witnesses,
, 2
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL .
DANIEL M. HARTMAN, Notary Public
New Cumberland Bor~.. Cumberland Co.
My CommissIon Expires Jan. 21,2009
Notary Public
Page 3 of 3