HomeMy WebLinkAbout06-14-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYL VANIA
Estate of
also known as
Ravmond E. Divelbiss
File Number
d \ 0 '1 0 ~e-P
, Deceased
Social Security Number 3 7 6 -14 -7 572
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE '.4 'or 'B' BELOW:)
IXI A. Probate and Grant of Letters. Testamentary an~ ~er that Petitioner(s) is / are the Execu tr ix
last Will of the Decedent dated Apr1l 11, 19 an11 codicil(s) dated
Filed herew1th 1S the Renunciation of Patrice Ann W111ey to serve as
co - ex e cut r i x . (State relevant circumstances, e.g., renunciation, death of executor, etc.)
named in the
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:
o 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 ~use (if any) atui heirs: (If
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list ofheirs.)-~ .-__ .
-, -~ :::...-::::
,~-.:;:
Name
Relationship
Residence' (-')
. -.1___-
- .,/-',
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Cl
Decedent was domiciled at death in Cumberland. County, Pennsylvania with his / her last'principal residence at-,
1112 Cocklin street, Borough ot Mecnanicsburg (1705~)
(List street address, town/city, township, county, state, zip code)
---J
r,.)
Decedent, then 86 yearsofage,diedon May 31, 2007 at Holy Spirit Hospital, East
Pp.nnsboro Township. Cumberland County. Pennsylvania
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
ValueofrealestateinPennsylvania (per County R/E Assessment)
$ 5,000
$
$
$ 127,510
situated as follows: 1112 Cocklin Street, Borough of Mechanicsburg, Cumberland County.
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:
T ed or rinted name and residence
Susan Jane Rodqers
310 Lafa ette Drive New Cumberland PA 17070
Form RW-02 rev. 10./3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
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 ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
'4
/ I
day of
Rodgers
Sworn to or affirmed and subscribed
Signature of Personal Representative
t')
Signature of Personal Representative
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File Number:
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;-:~:~)
Estate of
RAYMOND E. DIVELBISS
, Deceased
Social Security Number: 37 6 -14 -7 5 7 2
Date of Death: May 31, 2007
AND NOW, June 1'--\ , ? 0 0 7 , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters Te stamen tary
are hereby granted to Susan Jane Rodqers
in the above estate
and that the instrument(s) dated Apr ill 1 J 1 q q t)
described in the Petition be admitted to probate and filed of record as the last Will
Letters ............... $
Short Certificate(s) . t. i.). . $
Renunciation( s) ...,( '.). . . $
Will . .. $
.JeJ) ...$
A v...-k .. . $
.. . $
.. . $
.. . $
.. . $
.. . $
.. . $
TOTAL .............. $ ~~ \ \ 00
~wt>'"
{ (0 0<>
cot>
(5 DO
,.... cc.,
lv
[;;<:JO
Attorney Signature:
FEES
Attorney Name:
Supreme Court I.D. No.: # 0 6 355
Address: 44 West Main Street
Mechanicsburq, PA 17055
Telephone: (717) 697-8528
~
Form RW-02 rev. 10.13.06
Page 2 of2
H105.80S REV (01/071
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
p
13670293
Certification Number
This is to certify that the information 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.
(j ~ e ~1<cL Cr, / 1 / tJ 1
Local Registrar
Date Issued
,
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.......
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a
Hl05-143 REV 1112006
TWE r PRINT IN
PERMANENT
BlACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
-..i
Other:
lient 0 EA I Outpatient DooA 0 Nursing Home 0 ResIdence Oather. Specify
&J';~OName\("nolil'lslltuS- lion,give~treet,and~f~\~ -+r.\ 9.~~~~~~0rigin? ~No DYes 10,~~1nliaIi,8Iaca.Wtuleelc
" Y \ \ \ \~pl \A Me,<an,PuertO""""O.1 White
12. Was Oecedenl ever in the 13. Oeceden1's Education (Specify only htghest grade compteled) 14. Marital SIaIus: Married. Ne,wlr Married, 15. Sulvlvtng Spouse tit WIfe, ~V. maiden namei
U.S. "'mod F"""'51 EI&memaIy I Secondeiy (()'12) Co4Iege 11-4 or..) W_ed, Di"""'" (Specif)l
Ji(lY05 oNo Unknown Widowed
::nr~ lla.Stale PA ~e~ 17c.Dves,Oecedentlivedin
Cumberland T0WllShijl1 17d. [jC,." _lNed_
ActuaIliniIsol
1. Name 01 Decedent (FlfSI, middle, last, suffix)
Raymond E. Divelbiss
5. Age (lall Birthday)
86
6. Date of Birth (Month, day, year)
Y"
June 11,1920
most 01
lite. Do not 5late retired
Ca"rp~t"Oveaver KWa~~~ing
. 16. ~S2~C1>dii:rSt~~~t' stale, z~code)
Mechanicsburg, PA 17055
17b.Coonty
19. Mother's Name (Firsl, midcIe, maiden surname)
Unknown
18. Falher's Name (Filsl, middle, 1asI, sullix)
Charles Divelbiss
Mechanlcsburg
TWI'
Cily/Boro
2Oa. InformanC's Name (Type I Print)
Susan J. Rodgers
Mary
2Ob. tnJormant's MairIg M:lress jSlreel, ~ floWn, state, zip code)
310 Layfayette Drive New Cumberland, PA 17070
21c. PIace~ 0isp0&iIi0n (Namt of cemetery,ClIlMIOty or oller place)
Conolite Crematory
f;l
<g
'"
:S
:;/
214. Location ICily I klWn, stalf, zipcodt)
Schaefferstown, Pa. 17088
22c. Name and Address of Facility
Myers Funeral Home, Inc. 37 East Main Street Mechanlcsburg, PA 17055
23<. Dote &gned IMontIt,...., "'''I
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, ApprOJ:imaleinterval.
I Onset 10 Death
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-"'-,'any,
!eadinglollecause IisIed 00 line a,
E""'" UNDEllLYIHG CAUSE
=.:;.t;t. ':.,,~r
b.
c.
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C:
d.
301. Was an ~y n. Wefe Auiopsy FIl'Ilings
Par1onned? A~ai&abIe Prior 10 Completion
of Cause of Death?
DYes RNa Dyes DNa
lii(Na,",~ 0-'"
D-t oP"""'Il""esligation 32d.Toneollnjwy
080""" DCoutdNotbeDelem>ined
M.
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33a Centfioll""'" tt01ly one)
CerUtyfng physidlK'l (Physician cer1dying cause of death when anoIher ph)'SlCian I'Ias prooouoced deaItl and compIeled lIem 23)
To Iht btst 01 my knowAecIgI, 'deIth occurred dull to 1M cause(l) and manner u I&Ited- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
~;=~:~::=n~~:'~~~::'1oto~:~:a:'manner alllated_ _ _ __ _ _ _ __ _ __ _ _ _ _ _ 0
. := ~~~ and I Of WlllestiQUion, in my opinion, death occurred at the time, datil, and place, iN'ld due to the cause(1) Md maMeI al staled.. 0
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, ,''J6.~FiIed(Montll,day,year)
I'" Ii I~ 1.1 I~ I "fut1'V: l ~IY(
..."""'~"/Gi\,
23b. Licen&e Number
28. Did Tobacco USe ec.wit:w.,~?
o Yes 0 "'-
DNa
2i..F~:
o Not P'agnant...... past_
0"'_"....01.....
0...1"_,...1"_........."
ol_
D "'P'_,"'_'3days~l_
boIole_
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32t. PIIce 01""': Hon'lI, Farm, ~, FacQy,
0Iit:0_,"'(~1
329. LocaIion 01 Injury (SIAMtI, ciIy 1Iown, stale)
~.t. \1 l\
LAST WILL AND TESTAMENT OF RA~10ND E. DIVELBISS
I, RAYl10ND E. DIVELBISS, of the Borough of Mechanicsburg,
County of Cumberland and State of Pennsylvania, being of sound
and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and
making void any and all prior Wills by me at any time heretofore
made.
1.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can be conveniently
done.
2.
I give and bequeath the sum of One Thousand ($1,000.00)
Dollars to my granddaughter, JENNIFER L. DITONNO.
3.
I give and bequeath the sum of One Thousand ($1,000.00)
Dollars to my grandson, JOSHUA D. LUSK.
\ ~. _. I "
\ -:_J' I '~'.:,.- ',._ !-'--',--/'l
I give and bequeath :1tihe-s.'W1l of One Thousand ($1,000.00)
Dollars to GRACE UNIt~I?:)~1E,'~HGJ?+$;~ LbiWRcH, of Hechanicsburg,
L U "v ' '.J
Pennsylvania.
-1-
5.
I direct that the Inheritance Tax on all of the above
bequests, be paid out of my residuary estate.
6.
I give, devise and bequeath all the rest, residue and
remainder of my estate, real, personal and mixed, whatsoever
and wheresoever the same may be situate, to my two (2) daughters,
to wit, SUSAN JANE RODGERS and PATRICE ANN WILLEY, share and
share alike, per stirpes.
LASTLY, I nominate, constitute and appoint my two (2)
daughters, the aforementioned SUSAN JANE RODGERS and PATRICE
ANN \'1 I LLEY , Co-Executrices of this my Last Will and Testament,
and direct that they be excused from posting bond or other
security for the faithful performance of their duties in any
jurisdiction.
IN HITNESS villEREOF, I have hereunto set my hand and seal
this I /
day of April, A. D., 1995.
(f~~
Raymond E. Divelbiss
( SEAL
-2-
Signed, sealed, published and declared by the above
named, RATI10ND E. DIVELBISS, as and for his Last Will and
Testament, in the presence of us, who have subscribed our
names hereto as witnesses, at the request of said testator,
in his presence and in the presence of each other.
-3-
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND
)
I, RAYHOND E. DIVELBISS , the testat or
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 and Testament;
that I signed it willingly; and that I signed it as my free and volun-
tary act and deed, for the purposes therein contained.
Sworn and affirmed to and acknowledged
RAyl-I01ID E. DIVELBISS , the testator
day of ApT'; 1 ' A. D. , 1995.
before me;bD'l ~
, this I J -
.
',~.
00415:1
_......--_....'"~...~. ,
COMMONWEALTH OF PENNSYLVANIA
)
)
SS.
t~t:L~~;:~ S~~~~'" ". Pub~!'~ ':
.....,;'In Ka'.; 1:::<'J:...l, . ""~~..nrl (,~"y"\,, .~.
''''''>'''') 'So Gi'mO?l'.." "',......... J O'
Mecl1an\cs~rg.' rg:~"", .;'...~~ 5 ',Sf;"i I
My GornmiSSlCo '-^t"""O ,"v', , .'
~.p~~tiOOOf.Nolali&6
COUNTY OF CUMBERLAND
We, the undersigned, J. ROBERT STAUFFER
and ERIKA L. LEVENHAGEN , the witnesses whose names are
sLgned to the attached or foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the
testat or , RAYHOND L. DIVELBISS , sign and exe-
cute the instrument as his~ Last Will and Testament; that the
said testator , RAYMOND L. DIVELBISS , executed it as
hls/:tunc 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; and that to the best of our knowledge, the
testator was, at the time, eighteen (18) or more years of age,
of sound mind, and under no constraint, duress or undue influence.
/Vf ~ f7 5:1-.
Seal
. ,Notary Public
, CuntJeifancl County
ExPms Nov. 6, 199-7
. Assoc:ialion of
Sworn and subscribed to before
me this 1/ ~ay of
April 1995.
a \ D 11 DS~
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
--I
-.T7'1
r'.,}
Estate of
RAYMOND E. DIVELBISS
-... , Deceased
I,
Patrice Ann Willey
(Print Name)
daughter
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
(Signature) P a tr ice
Susan Jane Rodqers.
June
(Date)
7~
, 2007
105 Sherborne Drive
(Street Address)
Spartanburg, SC 29307
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this / j'h. day
of June 2007
~/~-~
ota Public
My Commission Expires: t)q/2 '5/20/6
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Deputy for Register of Wills
FormRW-06 rev. 10.13.06