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Home My WebLink About10-11-07 (3) PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Estate of Robert E. St.Cyr also known as File Number a \ \:)'1 c>C,i).,1 , Deceased Social Security Number 003-12-9850 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 last Will ofthe Decedent dated and codicil(s) dated named in the 1'-,..j ( , . ,J -:~ .;=,::; (State relevant circumstances, e.g., renunciation, death of executor, etc.) ;'.(-, --.J CJ C-) -..-{ .' , Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ofthe:i~$~mentts) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: "'0 IlJ B. Grant of Letters of Administration .--'1, () (If applicable, enter: c.t.a.: d. b.n.c.t.a.; pendente lite; durante absentia; duranf1l. iiilllOritate) ..r:- Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if any) afd 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.) I Name RelationshiD Residence I Bruce St.Cyr Son 15993 Cove Lane, Dumfries, VA 22025-1411 Jeffrey E. St.Cyr Son 1915 Douglas Drive, Carlisle, PA 17013 M. Pauline Shunk Daughter 1220 Means Hollow Rd, Shippensburg, PA 17257-9478 (COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary. Decedent was domiciled at death in Cumberland 1915 Doue:las Drive. Carlisle. P A 17013 (List street address. townlcity, township, county, state. zip code) County, Pennsylvania with his / her last principal residence at Decedent, then 80 years of age, died on January 16,2007 at Carlisle, 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 P A) Personal property in County Value of real estate in Pennsylvania 15,000.00 $ $ $ $ 140,000.00 situated as follows: 1915 Douglas Drive, North Middleton Township, Cumberland County, Pennsylvania 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 fonn to the undersigned: T d or tinted name and residence Jeffrey E. St.Cyr, 1915 Douglas Drive, Carlisle, PA 17013 Form RW-02 rev. 10.13.06 Page 1 of2 ~ ( 0'1 O~~) Petition for Probate and Grant of Letters Register of Wills of Cumberland County, Pennsylvania Estate of Robert E. St.Cyr, Deceased File Number: r<) Date of Death: January 16, 2007 Social Security Number: 003-12-9850 (Continuation Page) G.J ~r:- (Pan B.) ~ Additional Listing of Heirs of Decedent Name Gregory W. St.Cyr Phillip H St.Cyr Relationship Son Son Residence 416 Al~ine Street, Norman OK 73072-5115 712 15 Street, New Grmberland, P A 17070-1511 Oath of Personal Representative COMMONWEALTII OF PENNSYL VANIA SS COUNTY OF Cumberland The Petitioner(s) above-named swear(s) or affinn(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. before me the , \ day of ~~- 7: <;i ~ 19na e If ersonal kepresentative Sworn to or affirmed and subscribed Signature of Personal Representative Signature of Personal Representative C) ,-- <:;~ ~..."._) !':::.J I":::'~."" -.J -r=, ....---" File Number: :1-. \ 0'""\ Chd-i) Estate of Robert E. St.Cyr , De@sed Date ofDeath:Januarv 16.2007 Co) Social Security Number: 003-12-9850 ...,ij.- r- AND NOW, Ji1 0 V trY! hPA - I q d Of) 7 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to Jeffrey E. St.Cyr in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. .' ". . FEES ~do. ~CLt.n~~'~tJ'A~'" " J" ~ Q " J .f\ Register 0 Wills _ ~.. _ ~ Letters.... uv.,.OQ. $ o<~ _ _ _ Short Certificate(s) . . . . . . . . $ Attorney Signature: Renunciation(s) ...3..... $ /..;;:- .J C P . . . $ /0 ~0 ...$ S- '" $ ... $ ... $ '" $ '" $ ... $ ... $ C)~, 'I -e:e&- TOTAL .............. $ IV Attorney Name: Supreme Court J.D. No.: 87380 Address: Wolf & Wolf, Attorneys at Law IO West High Street Carlisle, PA 17013-2922 Telephone: 717-241-4436 Form RW-02 rev. 10.13.06 Page 2 of2 H105.905MS REV. 6/06 This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records III accordance with Act 66, P.L. 304, approved by the G,eneral Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. .;2\ () I O~ /1 .~ ' d vro ~ GfJJ>>-Xc (fWlfoL No. Fra~) Yeropoli Stat~~istrar Calvin B. Johnson, M.D., M.P.H. Secretary of Health 1040228 FEB 0 9 2ii~ Hto5-~43 REV 11/2.006 TYPE I PRINT IN PERMANENT BLACK INK COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) Co) 1. Name of Decedent (First. mkidle, last, suffu:) e. Date 01 Binh jMon\\'\, , year) 80 1926 8b. Gounlyof Death 8cl. fllCilityName (ItnOl InSlitulion, give street and nurrtlerj Cumberland Sgt. ~"1"k~~ Class 12. Was Decedent e"9r ir>. the U.S. Armed Forres? liJves DNa Decedent's l\ctuaJAesicHlnce 17a.Stale 14. Marilal Status: Married, Never Married Widowed. Divorced (~ widowed . 16. Decedent's MaiHng Address (Street, c;Jty I toWn, stale, zip code) 1915 Douglas Drive Carlisle, PA 17013 17b. County "1'11T1no.....l :llnrl 17c.1iI Yes, Decedent Uved in 17d. 0 No, Decedent Uved 'rihin Acluallinilsof N=t:h MiOQl<;tt,;,"l 'wp. City/Born 18. Father's Name {first, rowe, last, suffix) 91arence R. St.Cyr 19. Molher's Name (First. middle, maiden surname) lOa. Inlt'lfTt1antS=tiami"(Type f rln1)- 2Ob. Inlormanrs Mailing Address (Stleet, city I town, state, zip code) 1915 Dou las Dr., Carlisle, PA 17013 21c. Place 01 Disposition (Name of cemetery, c:rematofyor other pace) 21d. Localion (City I \oWI1, state, zip cocIe) Hoffman-Roth Funeral Home & Cremato Carlisle, PA 17013 "".N,m"""Add""or_ Hoffman-Roth Funeral Home & Crematory Q W ~ ~ ~ it Jeffre 21a. Method of Disposition o Burial 0 RerTKlVaI ff'OfTl State o """-S".d% 22a. Signature of F nera! S_e Licensee (or ~ Ccrnplete Hems 23a-c only when c:ertifying pt..~isno\availabieattimeofdl.ath\c certify ceuseoIdealh. \\ems 2.4-'2.6 mOO be wnpIe\ee ~ person who pronounces death. 23b. Lic8nse Number 23c. Date Signed (MoottI, day, Y~f) 100 j\ M. 26. Was Case Referred to Medical Examiner! Coroner lor a Reason Other than Cremation or Donation? DVes ~o 24. TmeotDeath ~ATe~~n~ ~1W) disaa"::' c: It I'-D .J IC b~CT1Jt PI,..'l.--MD,J#-'i \),-<;c:,t-st: ApproKimale interval: Part II: Enter other sianificanl mndilion!; contrtbulina 10 dllilth. 28. Did lobacoo Use Contrllute 10 Death? Onset to Death but not resulting in lhe underlying cause given in Part I. D Y8$ 0 Probably o No 0 Unknown 29.IIFElfTlale' o NoIpreg13r1twithinpastyear o Pregnant at time of death o Nc.tpregnant, but pragnant wilhin 42 days "death o Not pre\1W1t, but pregnant 43 days 10 1 year beIoredeath o Unknown if pregnant within lI1e past year 32c. Place 01 Injury: Home, Farm, Street, Fadory, QfficeBuldlng,e1c. (Specify) Due 10 (or as a consequence oQ: ~:~~J;i~=~=,;~~ a. Enler the UNDERlYING CAUSE ~8~~~QYm~~~re,.~e b. Que \0 (or as a conseqoence of): Due to (or as a oonseque~ of): d. DYes I2f'NO DYes DNo 31. MannerolOealh .w'NaIOral 0 Homicide D Acciderll 0 Pendng lnvestigatlon DSuicIOe DCwldNct'OeOe1ermlneo 32d. TimeoflnjlJlY 3Oa. Was an Aulopsy Performed? 3Ob. WereAul:opsyFinclngs Available Prier IQ Completion of Causa of Death? tl5 01 ~ 1; ~ 32f. If Transportalion Injury (Specify) o DriVer I Operator 0 Passengar OPeclestnan M. Other. Specify: 33a.Certifierlchecl<onlyone) 33b.SlgnatureanclTIIleOICertiIi~ ;:~~::rorm~i~:~:nd~~~=;::~~::nc~~~~:n~~::rh:::,~_~~~d~_m~I~~~~~~_________________ 0 ... 1" . PronoUl\clng and ~Ing physician (Physician bath pI'U!\OI.Il'\dn death and cer\iIying to caus& l)\ dealh} 0' 33c. License Number 33d. Dale Signed (Month, day, year) . ~Oe:a~==~~=:,d.IthOCCUrmlat1hetimeld"le,.ndPlltcelanclduetOtheCllUse{S)i1ndmannerasslaled_____...____________ M D 0(041 (..,t~L- (II ~("l..e~+ On tM basIs ot exam\na\iorl and I Of iTMl1ltlgation, in my opinion, QelIlI1 occurred at the 'lime, date, and p1ac:e, and due 10 ttle cause(s) and manner as stated.. 0 34. Name and Address of Person Who Completed Cause of Death (11em 27) Type I Print 1l.JA-' (oL.L..;...Jj 1'1J) CP-HC. CA-I'-USUc PA I,,"",. ~.R~~~=a~~~'"-~ ft ~ L-~ /I I d. I \ 10 Disposition Permit No. ?' () l 61d.t RENUNCIATION Cumberland REGISTER OF WILLS COUNTY, PENNSYLVANIA :'::..1 c..) Estate of Robert E. S1. Cyr .f.- , rieceased I, Bruce S1. Cyr (print Name) , in my capacity/relationship as of the above Decedent, hereby renounce the right to Son administer the Estate of the Decedent and respectfully request that Letters be issued to Jeffrey S1. Cyr 0\ i'i\~~ 20\)') ~~~- (Signature) \ \~, ~ Ccv( L.J (Street Address) -:D\J~1t~ ~ {A "Z..U)'t,5 · \ ~l , (City, State, Zip) (Date) 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 renuncialioq f9.t- the purposes stated within on this '3f>-..r day of m~ , ~07 ' 4~ tI~ Notary Public My Commission Expires: 19 ~ 3 0- ;20 \ 0 (Signature and Seal ofNolaty or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Deputy for Register of Wills Form RW-06 rev. 10.13.06 ? \ 01 6'1;).\ Cumberland REGISTER OF WILLS COUNTY, PENNSYLVANIA RENUNCIATION C,_! .z:- .- -' Estate of Robert E. St. Cyr , Deceased I, Gregory W. St. Cyr (print Name) , in my capacity/relationship as of the above Decedent, hereby renounce the right to Son administer the Estate of the Decedent and respectfully request that Letters be issued to Jeffrey St. Cyr ,; 4p".,1 ol&07 (Date) ~,~iu! rf~ ~/b /I~/6~-e M- (Street Address) Mlruu~~. ()K 7507;2.. (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 .;). day of ~ ~)7 /~ ~ ~:~ L. My Commission Expires: q.S-- 0'1: Deputy for Register of Wills Form RW-06 rev,10,}3,06 (Signature and Seal of Notary or other official qualified to administer oaths, Show date of expiration of Notary's ~illilJlll)ll "" =-<M CAJt 11// " O~ ........... )'oA "" ~ ~ ...~~y ,.(J~..~~ -=- ::: :,.0 V('\\-:. = f #00014937 . = - . '-- :- ': \, INAN~D :<r.: = ~ '. FORf$' ... -:, .... ~ ..... .:::- '" .......... ....' "" " I, \' '1""11\\\\ ). \ l,{\ oqJ'\ o c' =.;:~ RENUNCIATION Cumberland REGISTER OF WILLS COUNlY, PENNSYLVANIA C,') ..;:- .r Estate of Robert E. St. Cyr , Deceased I Pauline M. Shunk , (print Name) ( It\ . ?f1 ULIf\1 E) , in my capacity/relationship as Daughter of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Jeffrey St. Cyr ~7-:2 /tJ 7 '111~ ~~h~ (Signature) I (Date) 1~{l 0 '?J1~ /hif!d)J Ru (Street Address) f1:ti:z~~/P/l 17.2--5-7 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 remmciatipn for the purposes stated within on this ~ day of ~f\v'\\ \ , ~(fl . ~Uf\Q)()~~ otary Public My Commission Expires: I\k.~ 2F5 :;;j;SJ1 Deputy for Register of Wills (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 COMMONWEALTH OF PENNSYLVANlA I NOTARIAL SEAL . LAUREN R. ASSISE. Notary ~= Stllppensbura Twp.. Cumberland 2009 My Comm\sslon Expires Aug. 25,