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Home My WebLink About01-16-07 (2) PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of MERRILL F. SIMPSON also known as File Number ~/-07-txJS/ , Deceased Social Security Number 716-09-6646 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the EXECUTRIX last Will of the Decedent dated OCTOBER 12,2004 and codicil(s) dated named in the (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 instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: NONE D B. Grant of Letters of Administration (If applicable. enter: c.t.a.; d.b.n.c.t.a.; pendente 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: (If Administration. c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of 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 last principal residence at CAMP HILL CARE CENTER - 46 ERFORD ROAD. CAMP HILL. EAST PENNSBORO TWP.. CUMBERLAND COUNTY, PA 17011 (List street address, town/city, township, county. state. zip code) Decedent, then 91 years of age, died on DECEMBER 31, 2006 TOWNSHIP. CUMBERLAND COUNTY. PENNSYL VANIA at CAMP HILL CARE CENTER - EAST PENNSBORO Decedent at death owned property with estimated values as follows: (If domiciled in P A) 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 $ $ $ $ 305,000.00 0.00 0.00 0.00 situated as follows: r-..:> Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant ofl;~ers in the app~iate form the undersigned: So -..J , ". ~"r. T ed or rinted name and residence :' ::'lJ ,;:po 0,._. I D. JOANNE KROUT - 126 GLENDALE DRIVE, MECHANICSBUltq:{'~ 1705~ C/ -' o.?_ O"'l :-~J Form RW-02 rev. 10.13.06 1.0 Page 1 of2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF ClUYl ber-l(),n& 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 SS 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. Sworn to or affirmed and subscribed x 4!~~~.~ Signature of l)If{sonal Representative before me the ~ lo +--M day of Signature of Personal Representative Signature of Personal Representative File Number: ~1-07-(){)51 Estate of MERRILL F. SIMPSON , Deceased Social Security Number: 716-09-6646 Date of Death: DECEMBER 31, 2006 AND NOW, , :2007, in consideration of the foregoing Petition, satisfactory proof that Letters TESTAMENTARY in the above estate and that the instrument(s) dated OCTOBER 12,2004 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. tL (j Letters ............... $ Short Certificate(s) . . . ~. . . $ 8foO.00 020. CO FEES Attorney Signature: Renunciation(s) .......... $ illUl $ utP $ AutDYfla..tlCJY\.... $ $ $ $ $ $ $ $ Itl.OO ID.OO ~. ()() Attorney Name: DAVID H. STONE, ESQUIRE Supreme Court I.D. No.: 39785 Address: 414 BRIDGE STREET NEW CUMBERLAND, P A 17070 Telephone: 717-774-7435 c-) :-:::;0 -.. l. J ~::10 " -:~- .,_.,,,~ .'"t' 1 ,....",."'\ c::> <= .......J -u L.. ::a:"" TOTAL 1-10.00 . ') -; - 0"\ .~ --j Form RW-02 rev. 10.13.06 +"" \.0 Page 2 of2 P'0~.~0~ R>-:V 1/0':; This is to certify that the information here given is correctly copied from an original certificate of death dulr filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fIlmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~I?~ Local Registrar Fee for this certificate, $6.00 JAN 04 2007 Date r--..:l = (:.:;::) "-' <....... -0 ::""l:~. 0') -!:"" \.0 OS.143RSY.01106 rYPElPRINT IN PERMANENT aLACK INK 1. Name olDececlenl (Fits!. middle, 1a51) COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NUMBER 3/9/1915 3. Social Security Nuntlef 4. .Date 01 Dealh (Monlh, day, year) Merrill F. Simpson VIS 1]6 - 09 Decenber 31, 2006 5 Age (Lasl birthday) 91 7. Dala 01 Biflh Monlh, da . Bb. County of Dealh o ERIOu one .Qher: lienl 0 DOA .lJ NUr$1l Horne 0 Residence 0 OIhet. S 9. Was Decedent 01 Hispanc Origin? 10. Race: Amaran Indian. BlaCk, WMe, elc. Xi No 0 Ves("yes.speci~C""n. (Specify! Mexican. Puerto Rican. &Ie.) Wli te 14. Manal SIalus: Married. Never married, 15. Surviving Spouse (If wife, give maiden name) WodoWlld,Oivorced(Specify) Widowed Clmberlarx:l East Pennsboro 'lWp. 12. Canp Hill Care Center 13. Decedenrs Educalion eel Elemeo1,rylSei2ndary (0-12) on h' hast de co fed Colege (1'" or 5+) 16 17b, Coonly York ~,Din~oIenl 17e. ~ Ves.OacadenlLivadin Newberry 'lWp. T ownsh~? Twp. 1300 York Haven &1. ~~6iken, PA 17370 18. Falher's Name (First. rriddle,lasl) 17a. Slale PA 17d. 0 No. Decedent LHed wilhin AcIuaJ UrriIs 01 ClylBo.. <~ 19. Mother's Nama (Fnt. middle. maiden surname) Reed M. Simpson 203. Jnlormanrs Name (fypelprint) Frances E. Gordon 2Ob. Informanl's Mailing Mdress~Slreet. cilyllown. s!ale, zip code) D. Joanne Krout 21a. Method of Disposition .Hi Burial 0 Cremalion 0 Rem:wal from Slate o Othet.S - 228. Signature 01 Funeral Service licensee (or person acling as such) } 21b. Dale of Dispos~ion (Monlh, day. year) 126 Glendale Dr. H=d1anicsburg, 21c. Place of Disposil~ (N8~ 01 cemele ,crematofy or other place) lobodlawn &mriill. Gardens 22c. Name and Address of Fac~ity PA 17050 21d. location (Cilyllown. slale. 4t code) o Donation Lower Paxton . PA 17109 unced Dead (Month, day. year) 12-/31 /0 Co CAUSE OF DEATH (See Instructions and examples) hem 27. Pal'll: Enter the ~ - diseases, injuries, or COrTllJlcalions -that directly caused !he death. DO NOT enler terminal evenls such as cardiac arrest. respiratory arrest. or venlricular fibrillation without Showing the etiology: DO NOT abbrevlale. Emer only one cause on a line. :::~~~S;J~:~dls~ a. IJw.ev~~u4 Due to (pf.,ps a consequence 01): Sequer4ialylistconddions,ilany. ~'"T7~ . :..1~0 ~:D~~~C~nu~ a. Due to (or as a consequence 01): . (disease or jn~ry that in.ialed Ihe evenls resulting in death) LAST. /2.-/3)) C,j ~,~ o Ves.P"flO Approxinlille inlervat onset 10 death Part II: Enter other sianiflcanl condiIions conlrtmlino 10 death, but not resullingin the underlying cause given in Part t. 28. Did Tobacco Use Conlrilute 10 Death? DYes 0 Probably o No jJAJnknown 29. I'Female: o Nol pregnanl within past year o Ptegnant allime 01 death o Not pregnant. but pragnanl wilhin 42 days ofdealh o Not ptegnant, bul pregoanl43 days 10 1 year before death o Unknown ~ pregnant within the past year 32c. Place 01 Injury: Home, Farm. Street FacioI)'. Office Building, elc. {Spacitn Due to (or as a consequence o~: o Yes o....Nlr d, 3(t). We,eAuIopsyFindings Avalable Poor kl CompieIion of Cause 01 Dealh? o Yes a-No 31. MannerofDealh 32&. Dale 01 Injury (Month. day, yeer) 32b. Describe how Injury Occurred: 3Oa. Was an Autopsy Performed? --e- Natural o Accident o Suicide o HoMcitle o Pending kwestigation o Cook! Nol Be Delertnined 32d. Tme of Injury 32e.lnjuryaIWort? o Vas 0 No 321. IfTransportationlnjlry{SpeciM o Driv<<lOperaklr 0 Passenger o Pedeslrian .0 Other - Specify: 33b. Signature and nle 01 Certifier 32g, locatk>n (Street. cilyllown. stale) 338. Certifier (check only 01'18) CertltylnQ physk:lan (Physician certifying cause of death when another physician his pronounced death and cofllJleled lIem 23) To the best of my knowledge. death oeeumtcl due 10 the cause(11 and manner as stated ._M._._..___.._.._....._....MM.M______.___._......_._._......__......_M......_..-;O Pronouncing and eerUtylng phylk:ian (Physkian both pronouncing dealh and cerlifying locause of death) To the best of my knowledge. death occurred at the time. date, and place, and due 10 the cause(s) and manner al statecL..........M.........._._............_....M......_....._....,p.--- Med exaninerlcoroner . On Mofeo 35 ReQis M. ~f'L 33c. license Nurroer 33d. Dale Signed (Month. day. year) PA I ;2..1 II ~ /1 II 17070#,0~Cl~ 74 (j? (See instructions and examples on reverse) oSoc.S""'1- 7f--<-. / - 4- -0 7 34. NameandAddr...o1~~~~l=r."tr.O. 87'0 """",,k"'V"~ /i..J #4/ w.. ts+ L.J\ST'WILL.J\ND T'TST'.Jl:M.TNI' of :MT~R,'RILL :F. SI:MPSO:N I, Merrill F. Simpson, of 1300 York Haven Road, Lot 65, York Haven, Pennsylvania, York County, Pennsylvania, this J1 day of October, 2004, do herby make this my Last Will and Testament, REVOKING ANY FORMER Wills and Codicils made by me. ITEM I: I direct that all of my just debts, the expenses of my last illness and funeral expenses, shall be paid from my estate as soon as practicable after my death and as part of the expense of the administration of my estate. It is my desire that my remains be interred and that I be buried in the cemetery plot by my wife Thelma at Woodlawn Gardens Cemetery in Harrisburg, Pennsylvania. ITEM II: All taxes and interest, including any penalties thereon, payable by reason of my death with respect to property comprising my gross taxable estate, whether or not passing under this Will, shall be paid from the principal of my residuary estate. N (-) :f0 cU-:;: :.~ _-J :1 '- ITEM ID: I give, devise and bequeath all the following specific items'tQ}he _ __ C"l r) -u I following persons: a. my automobile to my friend and companion Ellna B. O'Connor~? b. my mobile home located at 1300 York Haven Road, Lot 65, York Haven, to my friend and companion Ellna B. O'Connor; c. my remaining cemetery plot at Woodlawn Gardens Cemetery to my friend and companion Ellna B. O'Conner so that she can be buried beside me. _t:'" 1.0 ITEM IV: I further direct that I hereby give, devise and bequeath all the rest, residue any remainder of my estate, whether real, personal, or otherwise, in the following percentage amounts to the following persons: a. Twenty percent (20%) to my beloved friend and companion Ellna B. O'Connor. In the event she fails to survive me, then her share shall be equally divided among the survivors named in Item IV subparagraphs b though g. b. Twenty percent (20%) to my dear step-granddaughter Donna L. Martin. In the event she fails to survive me, then her share shall be equally divided among the survivors named in Item IV subparagraphs a through g. c. Twenty percent (20%) to my dear niece D. Joanne Krout. In the event she fails to survive me, then her share shall be bequeathed to her husband Elmer E. Krout. d. Ten percent (10%) to my dear great niece Delores J. Derick. In the event she fails to survive me, then her share shall be bequeathed to her son, Jesse B. Derick. e. Ten percent (10%) to my dear great niece Patricia A. Barrick. In the event she fails to survive me, then her share shall be equally divided between her two sons, Boe D. Barrick and Jake D. Barrick. f Ten percent (10%) to my dear great nephew Ricky A. Krout. In the event he fails to survive me, then his share shall be bequeathed to his son Tommy E. Krout. g. Ten percent (10%) to my dear great nephew Elmer E. Krout III per stirpes. In the event he fails to survive me and has no issue, then his share shall be 2 equally divided among the survivors named in Item IV subparagraphs a though g. ITEM V: If any beneficiary under ITEM IV is under twenty-five (25) years of age, I direct that his or her interest be held in trust by D. Joanne Krout, hereinafter called Trustee and referred to in the singular neuter gender, until such beneficiary reaches twenty-five (25) years of age. My Trustee shall apply such amounts of income and principal as it, in its sole discretion, deems proper for the support, education and welfare of such beneficiary, and may accumulate any unexpended balance of income to the extent permitted by law. Some amounts may be applied directly or may be paid to the beneficiary or to the person with whom such beneficiary resides or who has the care and control of such beneficiary, without the intervention of a guardian. My Trustee shall not be obliged to supervise or inquire into the application of such amounts by such person, and the receipt of such person shall be a complete release of my Trustee. Should the share of a beneficiary, in the sole opinion of my Trustee, be or become too small to warrant continuing such fund in trust, or should its administration be or become impractical for any other reason, my Trustee, in its sole discretion, may pay such share, absolutely, to the beneficiary, or may deposit such share in the beneficiary's name in a savings account at a savings institution of its choosing, payable to the beneficiary after he or she attains the age of twenty five (25) years. In the event D. Joanne Krout predeceases me or is otherwise unable to serve as my trustee, then I appoint Donna L. Martin as my alternate trustee. 3 ITEM VI: I appoint D. Joanne Krout, as my Executrix of my estate. If she predeceases me or is otherwise unable to serve as my executrix, then I appoint Donna L. Martin as my Executrix. I direct that my Executrix or Executor serve without bond in any jurisdiction in which called upon to act. ITEM Vll: I give to any Executor or Executrix and to any Trustee or Trustees named in this Will or any Codicil hereto all of the powers now applicable by law to fiduciaries in the Commonwealth of Pennsylvania and in particular, through the Probate, Estates and Fiduciaries Code, as effective and as in effect on the date hereof, during the administration and until the completion of the distribution of my estate, and until the termination of all trusts created in this Will or any Codicil hereto and until the completion of the distribution of the assets of such trusts. ITEM vm: I direct that this Last Will and Testament control the distribution of my property irrespective of whether there are children born to me or adopted by me subsequent to the execution of this Last Will and Testament. ITEM IX: The words "issue" and "children" whenever used in this Last Will and Testament shall include adopted children. ITEM X: No interest of any beneficiary under this Will or any Codicil hereto shall be subject to anticipation or to voluntary or involuntary alienation. ITEM XI: All estate, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all 4 property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the residue of my estate, as if such taxes were expenses of administration, without apportionment or right of reimbursement. I authorize my Executrix and Trustee to pay all such taxes at such time or times as deemed advisable. IN WITNESS WHEREOF, I have set my hand and seal on this my Last Will and Testament consisting of k~ pages this l~ay of Oct::2004. ~~.:~~ r: ~..... Merrill F. Simpson F 5 SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OFCVIh ber land WE, Merrill F. Simpson, and T ~ f Lt,lJrL, and jY\tl...:y,t Q.. c.. '1-1<, the (' Testator and the witnesses, respectively, whose names are signed to the attached or SS. 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 he had signed willingly (or willingly directed another to sign for him) and that he 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 witness and to the best of his or her knowledge the Testator was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. ~...-~l ~ ~~~ ~ ~ (z~or ness ~~ 0.4<>4- WitnesS- C. 6 . . Subscribed, sworn to, and acknowledged before me by' Merrill F. Simpson, Testator, and subscribed and sworn to before me by T~Ct. f'\ J:: J.... fG { , (nG r; u... C. \./0 ( k. , and witnesses, this -1 d day of ~ 2004. ~s~ Notary Public My Commission Expires. NOrMW.IEAL Mia.... =,NIIo r.:'tu~J~,.,.. w,:.=- 7