HomeMy WebLinkAbout11-28-07
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REGISTER OF WILLS OF
PETITION FOR PROBATE AND GRANT OF LETTERS
(j)(Y)/JrJlfAtVO COUNTY, PENNSYL VANIA
:SOHAl C MaJEUY
, Deceased
FileNumber ~/- OI-IO~5
Social Security Number fee - 2Q -7'1'12
Estate of
also known as
Petitiooer(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BEWW:)
fll{ A. Pro........ Gnnt of ........1i:!!fG""... -.... Pditioo",,-,) t, I ~ r ' 6- f- L 1/ ~~
CWilloftheDecedentdated DJ,2. 9.1 andcodicil(s)dated 0) 2..if//~J - Not.JE. ~)
named in the
(State relevant cirr:wrutances. e.g.. remmciation. death of executor. etc.)
Excqx.. foll_ Doced<nt did nol many. _... dI_'" did nnl h_. dDId.... m ~='m ofth, ...........(,j off,red
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
o B. Grant of Letters of AdministratiOD
.
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(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; cbuante absentia; durii!fJ~norltate) :::: . . ;p
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following s~~ any)~ hei;tX.i3
Administration, C.t.a. ordb.n.c.t.a., enter date of Will in Section A above andcomplete list of heirs.} ',' j~ r;:; .....::: (:":j c~
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Name
RelatMmsbip
o
1l/l.8
Decedent, then
fi,
years of age, died on
/0/31/0)
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at
l2fJi'o!:.f'Jc(.
Decedent at death owned property with estimated values as follows:
v<ff 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:
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 undersi .
.
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEAL TH OF PENNSYL VANIA
. COUNTY OF Of.( fl18f1l ~
SS
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 of Petitioner( s) and that, as personal representative( s) of the Decedent, Petitioner( s) will well and truly
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Signature of Personal Rel}~sentative //
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Signature of Personal Representative //-'
administer the estate according to law.
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File Number:
E_of tJl/N L ~(}#~1
Social Secwity Number: lEE; - zo - C) if <.f l. Date 0 Death:
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Letters ............... $ y~O, OtJ
Short Certificate(s) . . . . . . . . $ c9 () . dU
Rconnciation(s) .......... $
("-"I.ll ...$/IQ.Ot>
~0P ... $lO.<x)
(hjO'fY\U-+II)Y\ . . . $ t:S. u1)
. .. $
...$
'" $
... $
...$
...$
TOTAL ...... .. .. . .. . S.f510.00 MO
and that the instrument( s) dated "3 - ri4..:..J qq s-
- ".
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. .'
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Register of Wills . . . .' '
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Attorney Signature: . '. . . ,
---:.-'in the above estate
FEES
Attorney Name:
Supreme Comt to. No.:
Address:
Telephone:
.
Form RW-02 rev. 10.13.06
Page 2 of2
U'(\_~<HH:: ?'::V fr;'jn-:,
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
Certification Number
P 13988767
Local Registrar
Date Issued
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
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REV 11 f2006
, PRINT IN
"ANE>IT
CK !NK
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1, Name of DectdenllFirsl, middle, last, suffix)
John C. McNelly
s. Age (las1Birthday)
81
STATE FILE NUMBER
6. Dale of Birth (Month, day, ar)
3. Social Security Number
188 - 20
4. Date of Death (Month, day, .year)
9442 October 31, 2007
7. Birthplace (C" al'ld state 01" 10
Sa. Place of Death (Check only ooe)
Hospital Other'
o Inpatient 0 ER f Outpatienl 0 DOA 0 Nursing Home ~ Residence DOlher _ Specify:
9. Was Decedent of Hispank: Origin? !:Xl No 0 Yes 10. Race: American Indian. Black, While, ate
(If ye.. ."ecHy Cuban. (Speci/YI
Mexican, Puerlo Rican, etc.) Whi t e
14. Marital Status: Married, Never Married,
Widowed. Divorced (Specify)
Yrs.
April 2, 1926
8b. County 01 Death
8d. Facility Name (If not instiMion, give street al'ld numlJer)
Cumberland New Cumberland
11, Decedent's Usual Occu lion Kind of work done du .
KindofWOft
17a. S1ale
Pennsylvania
D~ Decedenl
Livelna
Township?
17c. 0 Yes, Decedent lived in
17d.UNo, Decedent lived within
Aclual Umits of
17b. County
r.nmh..rlRnrl
19. Mother's Name (First, midlte, maiden somame)
Stella Kenned
2Ob, Informant's Mailing Address (Street, city I town, state, zip code)
1459 Hillcrest Ct., #501, Camp Hill, PA 17011
New Cumberland
Twp.
City
21c, Place 01 Disposition (Name 01 cemelery, crematory or other place)
21d. location (City Ilown, state, zip code)
4,2007
Evans Cremator
chaefferstown, PA 17088
22c. Name and Address of Facility
Parthemore FH&CS Inc.
23a. To the best of my knowledge, death occurred althe lime, date and place staled. (Signal1Jre and 1iI1e)
PO Box 431 New Cumberland PA 17070-0431
23b. license Number 23c. Date S~ (Monlh, day, yearl
24. TIme 01 Death
25. Dale Pronounced Dead (Month, day, year)
=f:~~~~~~\dise~
A rox. 3:00 AM
CAUSE OF DEATH (See instructions and examples)
Ilem 27. Part I: Enter the ~ - diseases, injunes. or complications - thai directly caused the death. DO NOT enter lemlinal events such as cardiac arresi.
respiratory arrest, or ventricular ftbrillalion without showing the eliology. List only one cause on each line.
Clf\j1e ~ (
C(J,'et.
e.
I Approximate mIeNS):
I Onset to Death
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!sud4eJ.(
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26. Was Case Referred 10 Medical Examiner I Coroner for a A9ason OIher than Cremation or Donahoo?
Dyes .li;:INo
Part II: Enter other skJnilicanl condlllons conlributina 10 death, 28. Did Tobacco Use Contribute to Death?
but not reSlJlling in the undertying cause given in Part I. 0 Yes 0 Probably
.J2(No D Unknown
29," Female:
o Not pregnant within paSI year
o Pregnant at time of dealh
o Not pregnBnl. but pregnant within 42 days
ofcleath
o Nolpregnanl, buI pregnanl 43 days to 1 year
before death
o Unknown d pregnant wi1hin the past year
32c. Place of Injury: Home, Farm, Slree!. FactOfy.
Office Building, etc. ($pecity)
=:t~='~=a.
Enler!he UNDERLYING CAUSE
~T ~~1n~~~r&1r.1he
b.
Due to (or as a consequence of):
d.
3Oa. Was an Autopsy
Perlom1ed,
DYes~
3Otl. Were Autopsy Fil'ldings
Available Prior to Comple1ion
of Cause of Dealh?
DYes~
31. Manner of Death
~ral 0 Homicide
o Accident 0 Pending Invesligalion
o Suicide D Coold NoI be Delem1ined
32d, Time of Injury
329. Location of Injury (Slreet, City I town, stale}
M.
338. Cerlifier (check only one)
Certlfytng physician {Physician certifying cause of death when anottJer physician has prorlOlJllC'ed death and completed Item 23}
To the bell of my knowtedge, death occurred due to the eaU8e(s) and manner alltaled_ _.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
~=:~~,a~ ~":::~~~a~~:= :~I~~:;~e:~~~a:~:~ot~~~~~~~ manner as staled_ _ _ .. _.. .. _ _ _ _ _ _ _ _.. _ _ 0
Medical Examiner I Coroner
On the basts of examination and I or Invesllgation, In my opinion, death occurred allhe lime, date, and place, and due to the cause(s) and manner as stated_ 0
141/1dl /1/ I
PA. f7(J'"/4
DISposilion Permit No. 001051
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LAST WILL AND TESTAMENT
OF
JOHN C. MCNELLY
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I, JOHN C. McNELLY, of New Cumberland, County ofi~ber'f'an(f_; ~:';
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and Commonwealth of Pennsylvania, do hereby revoke al.:t~illS!:=anq.: ,(o~
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codicils, as well as all instruments of a testameritary n~ure" 'i"")
heretofore made by me, and do hereby make, publish and declare this
to be my Last Will and Testament in the manner and form following:
FIRST: I direct that all my just debts and funeral expenses
be paid as soon after my decease as shall be practicable.
SECOND:
I give, devise and bequeath all of my property of
every nature and description, real, personal and mixed, and
wheresoever situate and whether acquired before or after the
execution of this Will, to my son, Jeffrey Alvin McNelly,
absolutely and forever.
THIRD:
If my son, Jeffrey Alvin MCNelly, should predecease
me, then I give, devise and bequeath all of my property of every
nature and description, real, personal and mixed, and wheresoever
situate and whether acquired before or after the execution of this
Will, to my grandchildren in equal shares per capita.
FOURTH:
I hereby nominate, constitute and appoint my son,
Jeffrey Alvin MCNelly, as the Executor of this, my Last Will and
Testament.
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IN WITNESS WHEREOF, I the said JOHN C. MCNELLY, have, to this,
~ my Last Will and Testament, contained in this and one preceding
sheet, set my hand and seal to the bottom of each of ~e sai~wo :0
sheets this J,t-f-lC1ay of March, One Thousand Nine Hundre~~ Niiati~:1 ~
Five (1995) .._~~~ ~ [~!~
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This instrument, consisting of two typewritten pages, each
bearing the hand and seal of the above-named testator, was by him
on the date hereof, signed, published and declared by him to be his
Last Will and Testament in our presence, who at his request, and in
his presence and in the presence of each other, we believing him to
be of sound and disposing mind and memory, have hereunto subscribed
~
witnesses.
~Y
NJrE .
kIJAtl~. fi:bzfI rl1L~
NAME .
I({u'tl In.1fm()f? ~
NAME
~~01. NOll
ADDRES
&WI d.., !inn3t( j/1lJ1/tL /7020-
ADDRESS
ilmmOf) (, ~OJt, j}-1 /1090
ADDRESS '
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF V~ ~
SS.
Before me, a Notary PUblic, in and for said County and State,
personally appeared JOHN C. MCNELLY, who acknowledged that he did
sign the aforegoing instrument and that the same is his free act
and deed.
.
IN TESTIMONY WHEREOF, I have hereunto set my hand and official
seal this J.,4:!hday of March, 1995. .'
~tZ.~
Notary PUblicr .
:45584
Notarial Seal
Kathe~ne C. Calhoun, Notary Public
WashIngton Twp.. Dauphin County
My Commission Expires Oct. 26, 1998