HomeMy WebLinkAbout02-27-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYL VANIA
Estate of William S. Brinley
also known as
File Number
cJl () 8 ():J/3
, Deceased
Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE ~' or 'B' BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated and codicil(s) dated
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(State relevant circumstances, e.g., renunciation, death of executor, etc.)
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ofthe~e~) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: - Ii Z
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121 B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
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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, e.t.a. or d.b.n.e.t.a., enter date of Will in Section A above and complete list of heirs.)
Name
Relationshi
minor daughter
mother
Residence
118 White Dogwood Drive, Etters, P A 17319
1040 Swarthmore Road, New Cumberland, P A 17070
Samantha M. Brinley
Phoebe A. Brinley
(COMPLETE IN ALL CASES:) AUach additional sheets ifnecessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his / her last principal residence at
1040 Swarthmore Road, New Cumberland Borough, Cumberland County. Pennsvlvania 17070
(List street address, tawn/city, township, county, state, zip code)
Decedent, then 43 years of age, died on February 15,2008
Cumberland County, Pennsvlvania
at Holy Spirit Hospital, East Pennsboro Township,
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(Ifnot domiciled in PA) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
$
$
$
$
10,000.00
83,560.00
situated as follows: 427 Hillside Road, New Cumberland Borough, 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 ed or rinted name and residence
Phoebe A. Brinley, 1040 Swarthmore Road, New Cumberland, PA 17070
Form RW-02 rev. 10.13.06
Page 1 of2
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Oath of Personal Representative
SS
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.
before me the
File Number:
Estate of William S. Brinley
Social Security Number:
Signature of Personal Representative
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Signature of Personal Representative
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, Deceased
Date of Death: February 15,2008
AND NOW,
having been presented before me, IT IS DECREED that Letters
are hereby granted to Phoebe A. Brinlev
. in consideration of the foregoing Petition, satisfactory proof
of Administration
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of rec
FEES
Letters
$ ~/O, DO
4flCf)
Short Certificate(s) . . . . . . .. $
Renunciation(s) .......... $
~ / ... $J1l!L
){YJ at? ,WI / . . . $~
.. . $
.. . $
.. . $
.. . $
... $
.. . $
...$
TOTAL. . . . . . . . . . . . . . $
OK Q.~.o.efr
FormRW-02 rev. 10.13.06
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Attorney Signature:
Attorney Name:
Robert P. Kline, Esquire
Supreme Court I.D. No.: 58798
Address:
P.O. Box 461
New Cumberland, PA 17070
Telephone:
(717) 770-2540
Page 2 of2
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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 14122029
Certification Number
This is to certify that the information here given is
correctly copied f"om an original Certificate of Death
duly filed with IT e as Local Registrar. The original
certificate will he forwarded to the State Vital
Records Office h,r permanent filing.
:~ /J; ~~. FE~ 1 6 l008
Local Registrar Date Issued
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REV 1112006
PRINT IN
MNENT
CK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
1, Name of Decadenl (First middle, last, suffix)
6. Date of Birth (Month, day, year)
4 1964
Cumberland
HvL.... ~fl',"/:"1"" trn"I{~
12. Was Decedent ever in the 13. Decedent's Education (Specify only highest grade completed)
U.S. Armed Forces? Elementary I Secondary (0-12) College (1-4 or 5+)
3
11. Decedenfs Usual lion Kind of wor1I done durin most 01 'M)f1I;i life. Do not stale ra .
Kiod 01 WorIo; Kind 01 Busiless I Industry
Site Foreman MASS Construct onOve. [XNo
. 16. Decedents Mailing Address (Street. city I town, state, zip code) Decedent's
1040 Swarthmore Road Act",'Res<lence Ua,Slate
New Cumberland, PA 17070
PA
Cumberland
19. Mother's Name (Rrsl, middle, maiden surname)
Phoebe A. Snell
17b. County
18. Fathers Name (First, middle, last, suffix)
Samuel S. Brinle
Sr.
2Ob. Infonnanfs MaWing Address (Street, city I town, state, zip code)
510 Poplar Avenue, New Cumberland, PA
21d. location (City I town, stale. zip code)
/5 ~oo"t
14. Marital Status: Married, Never Married,
Wktowed, Divorced (Spacif;j
Divorced
Did Decedenl
Liveina
Township?
17c. 0 Ves, Decedenllived in
Ud!la~u=~~dw"t'n New Cumberland
Twp.
City/Bom
22c. Name and Address 01 FacilIty
21b. Date of Disposition (Month, day, year) 21c. Place of Disposition (Name 01 cemetery, crematol)' or olher place)
2008 BFH Crematory
Grantville,PA 17028
tone & Murra
25. Date Pronounced Dead (Month, day, year)
rrZh '-';'/t"w-. I ~ J- 0 U '6
CAUSE OF DEATH (See Instructions and examples)
Item 27. Part I: Enter the ~ - diseases, injuries, Of complications -that directly caused the death. DO NOT enter terminal events soch as cardiac arrest.
respiratory arrest, 01" ventlic\Jlar fibrillation without showing the eliolom'. Ust only one cause on each fine.
=~g~~~~~~ d:~) dise:;
Approximate interval:
Onset to Dealh
a,
l4.-mu ;( (Ihh:; t
Sequentially lis! conditions, it any,
~~~~ J:D~~:~~ru~w a.
ldisease Of injury that initialed the
events resulting m death) LAST.
..r;'ttJ; ~J P';;:OPNA-i..
I
Due to (or as a consequence o~: i
b. COITC,e-((v/4Jf
Due to (ohas a consequence 01): _
rtl.COlf{)i./( ;/i1'A-/lllr
Due to (or as a ~seqoence o~:.~ _
d. ,c E 1'1/ A (. f1'r7 Lt.,uf 1;;'
1
kit/-( .eE
3Oa. Was an Autopsy
Performed?
31. Manner of Death
o Naturet O_de
o Accident 0 Pending Investigation
o Sudde 0 COOd No! be Determined
M,
n. Were Autopsy Findings
AvaUabIe Prior 10 Completion
of Cause of Death?
OVes Jl1 No
o Ves 0 No
32d. Time of Injury
33a. Certifl8l (check only one)
Certifying physlcllln (Physician certifying cause of death when another physician has pfOl'\OUnced death and compleled Item 23)
10 the best of my knowledge, death occurred due to the cause(s) and manner IS stated- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
Pronouncing and certifying physician (Physician both pronouncing death and certifying 10 cause of dealh)
To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner as stated.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
Medlcal Examiner I Coroner
On the baal. of examination and I or Investigation, In my opinion, death occurred at lhe time, dlIte, and place, and due 10 !he cause(s) and manner as stated_ 0
I d( I II ~I / ( I ::2i'di"'~tff
Disposilion Permit No. 0/9.% 0 r
35. Registrar's
~
FH
408 3rd. st. New Cumberland PA 17070
23b. license Number
23c. Dale Signed (Month, day, year)
26. Was Case Relerred to Medical Examir'\ef I Coroner for a Reason Other lhan Cremation Of Donation?
Dves No
Part II: Enter other sioniflCanl conditions contribulina 10 dealh,
but nOl resulting in the underlying cause given in Part I.
211. Did Tobacco Use Cootribute to Death?
o Ve. 0 Probab~
ONo OUn-.,
29. tf Female:
o Not pregnant within past year
o Pregnant at time ol death
o Not pregnanl, bUt pregnant within 42 days
otdeath
o Not pregnant, out pregnant 43 days to 1 year
beiore death
o Unknown if pregnant within the pas! year
32c. = ~u~n:~: ~t~~~~) Stree!. Faclory.
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330. L~1;~
th~,~~
1\/00
34. Name and Address of Person Who Completed Cause 01 Death (Item 27) Type / Print
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1"1-702