HomeMy WebLinkAbout03-27-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA
estate of Steven G. Dollins File Number o~ l ~ Cj$ - ~ ~~~
also known as
.Deceased Social Security Number
Petitioner(s), who is/are 18 years ofage or older, apply(ies) tor:
(COMPLETE 'A' OR 'B' BELOW.•)
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the named in the
last Will of the Decedent dated and codicil(s) dated
f4_J
(State relevant circumstances, e.g., renunciation. death of executor. etc.j
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: ~ --
B. Grant of Letters of Administration
(lfapplicab(e. enter: c. t. a.; d. b. n. c. t. a.: pendentelite: duranteabsentia; duranteminoritate) ~-~
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:(lf
Administration, c. t. a. or d. b. n. c. t. a.. enter date of Will in Section .A above and complete list of heirs.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal residence at
79 Hillside Circle Camp Hill PA 17011
(List street address, toti>>nicity, township. county, state. =ip code)
Decedent, then 26 years ofage, died on 3/6/2008 at State Steet
Harrisburg PA 17101
Decedent at death owned property with estimated values as follows
([f domiciled in PA) All personal property $ 15 000 00
([f not domiciled in PA) Personal property in Pennsylvania $
([f not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
Wherefo~, 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:
Signature Typed or printed name and residence
~ ~ ~~.~.~ Carolyn Dollins
Pa e 1 of 2
-0? rev. 10.13.06 g
(COMPLETE W ALL CASES:) Attach additional sheets if necessary.
Continuation of Petition for Probate and Grant of Letters
Steven G. Dollins
Decedent Name
Page 1
073747902
Social Security Number
Surviving Heirs
Name Relationship Residence
79 Hillside Circle
22 Highway 665
~-
c~:-;
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
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 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
r~ --~-4-~..~
before me theme day of
,~
For the Register
of Personal
Signature of Personal Representative
Signature of Personal Representative
File Number: ~~ -d~- ~~~ ~.:
Estate of Steven G. Dollins ,Deceased
S 'al Security Number: 073747902 Date of Death: 3/6/2008
,,~`O
AND NO ~ O , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters n~mj~(°~rol'bt~YL ____~
are hereby granted to Carolyn Dollins b~
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of
FEES
Letters ......................
Short Certificate(s) ~•...
Renunciation s)
TOTAL
~.~_
$ ~ nU
$ ~L , cs-~
$ 5c~
$ US ~ G
~eco~ ~s the last Will (and ~odicil(s)) of Decedent.
`~.~~a
l `~ Register of Will of ~
s-~. 6 ~-- ~ ~ ~ ~ ~~
Attorney Signature: ~,
Attorney Name: Karl E. Rominger
Supreme Court I.D. No.: 81924
Address: 155 South Hanover Street
Carlisle
PA 17013
Telephone: 717-241-6070
!~ orm RW-n1 rev. 1 n.13. n6 Page 2 of 2
. ,_-,-
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 14123288
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.
d`~ MAR 12U
Loco Regtstrar Date Issued
. J
~` J
1
I 1.144 REV 11I200fi
YPE / PRINT IN
PERMANENT
BUCK INK
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS -
CORONER'S CERTIFICATE OF DEATH r.--'
___ __
1. Name of Decetled (Fist, mode, laal, six)
Steven G
Dollins ..r...-
2. Sev vy .....,~,,.~,. ,.,
3. Social Secudry Number o
4. Date of Oeelh (Metro, day, yeerl
. Male 073 _ 74_ 7902 March 6, 2008
5. Age (test Birdxlay) UMer 1 ar Uakr 1 day 6. Date of Blrm (Metro, , yr~ 7. &rmplace (C and stele a ) Sa. Place d Deelh (Check my ore)
klanea Deye Roux kenuM Hospilel; Other
2 5 yre J u 1 y 2 ~ , 19 8 2 Fort Bragg, N. C.
^ InpalieM ^ ER / Outpatient ^ DOq ^ Nursing Home ^ Residence iglother -Specify:
Sh. Cmnry d Deam Bc. CRy, Bore, Twp. of Deem ad. Farikty Name (If rtol hsowtlon, gwe shed ant number) 9. Wes Decedent d Hispanic Orlgh7 ®No ^Yas 10. Race: AmeRcen Indian. Black, While, ek.
Dauphin Harrisburg State Street & Ro al Terrace (Ny°°'°D°`m]D~' (scatdyi
y
Mexican, Puerto Rican. dc.) tl~llte
11. Decedenre Uwel Khd d work done moat d He. Do not state rd 12. Was Decedent ever in the 13. OecedenYs EAtcenm (Spedly oNy Highest grade cangktad) 14. Marital SANS: Married, Never Maned, 15. SurWNng Spouse (II wife
gve maiden name)
,
NiM d Wok r Khd d &dress! Indussy U.S. Armed Forces? Elementary /Secondary (D-12) College (1.4 or 5a) (Pac'ly')
Self Eulployed Al s Pizza Shop Owner ^y~ wk>awa,DNonea s
L~9Nt 12
• 16. Decedents MaiNrq Address (SlreeL ley /town, state, zp nodal Decedent's PA Did Decedent
79 Hillside Circle Aauef Rasitlence 17a. slate Uve Ina 17c.~] yea Decedent IJVed h Eas P n hOTO
Twp
Township? 17d. ^ No, Decadent Lived wdhh
Camp Hill, PA ]7011 nb.Cmny Cumberland
Actual Lkdls of CAy 1 Boo
1B. FameYS Name IFlrst midde, Iml, sulnx( 19. MoIMr's Name (Rrd, mUde
rreidan surname)
,
Thanes G. Ibllins Karin B. Pinkl
20a. InlanwM's Name (Type I PRM) 20h. InlortnanYs Melirg Address (Street dry! lawn, state, zip code)
Carolyn A. Dollins 112 Shady Lane Enola, PA 17025
21a. MrRhoO d DISPOSIOOn ~ Cremation ^ Danatron
^ Bunal ^ Removal from Slate
W 21 b. Date d GSDcenlon (Metro, daK year) 21c. Place d Dlsposnbn fName a cemetery, aemerory a dha pace) 21tl. Lowtlm (Gry f town, orate, zip code)
)
as Crernetlon a Dorrtion Adhorired
^ tkher-sPetry: (byMamerP:aminar/coroner? ras^NO
Hollinger Cranatory
Mt. Ho11y Springs, PA 17065
22a. SlyuNre d Ftneral Service Lcerrsee (a person actlng u such) 22b. license NuMer 22t. Name ant Adtress d Faddy
- i.y,. ~ ?~ ~..~.;' FD 012774-L Richardson Funeral Home Inc. 29 S. Enola Dr. Enola, PA 17025
Complete name 23et m when takfyklg
physiaan u rrol ewiebk at ame d deem to 23a. Tome bd my ktwwledge, tleam ocaared at the time, date and place stafetl. (Sgretue ant t91a)
~' 23b. IJcerxa Number 23c. Date S'
gnetl (Monet, day, Year)
mdly tease d deem.
name 24-26 must be
mnplded by P°rsor+
"^0p°"°"n~^°af^ 2a. rare d Deem
APPrOx:
01
36 P
25. DeY Prdpumad Dead (MOMn, day. year)
March 6
2008
26. Was Case Referted to Medical Examine / Canner for a Reason Other man Cremation or Donatbn?
:
M. , ®vn ^No
CAUSE OF DEATH (See Ireetructbna and exampke) r Approximate interval: Part It tartar dher :imift~ caMlicns coo n:s. to -m 2B. Did Tobacco Use Cadribde ro Deem?
Hem 27. Pert I: Enter ttw cheh a erems - dsesses, iryuks, a canpkcatione - Ihel dtedy reused tk tleam. W NOT enter temrhd ewn3 such as cerdac arrest r
Onset b Deem but rel resulting h me aMedying cause gNm h PaR I. ^ Vas Prd>a
r°splrelay wrest a venlrkdar IibnMibn wMwd aMwkg ttre elkxagy. LM mN one eeuee m each line. ^ dY
IMMEDIATE CAUSE Frol dsease a i ^ No ^ Unknown
i
d
l
~
ton
l
on reau
lhgh
t") .-.~ a, Multiple Traumatic Injuries ; ze.uFemak,:
Duero (« m a cort9eWerce ofJ: ; ^ Na pregnant within past year
Samerxuly Itit condoms. a airy, b. ~ ^ Pregnant at tine of death
leedrq ro me ranee listed m the a.
Entx me UNDERLYING CAUSE Due to (a ac a consequence oQ: i ^ Na pregnant, bu pmgnaM wnhn 12 days
'
(deebee or i ry
mat iigatad Me c_ d tleam
events reakYq n deem) UST.
r
Due to (or as a caeeWerce oil: ^ Na pregnant bN pregnan143 days b 1 year
d. ~ berae deem
-- ^ UrAmwn if pregnam within Ilx! past year
3M. Was en Autopsy 300, Were Auopsy Findings 31. Mamer d Deals 32a. Date d Inury (Main, day, year) 32b. Deecdbe FWw InJury Occurred 32c. Place of I home, Farts, Street, F
PaRdmad? AvaiablePnortoCmplelbn March 6
0p~~
2008 Motorc
Bda °ry~
°"°"'
le
ca
,
at.
c
vs. car
a
tural ^ Homicide y Stfeet ~' Is0e~d1'I
a Cause d Deem? ^ N
rtrt
nn
^ Yes ®No ^ Ves ^ No ~y Accidan ^ Pendng Imesl'geaon 32d. Time d I~gury 32e. Injury d Work? 321. N Trensporhlion Irpry (Speary) 32g. Laalian d Injury (Street dY! Town, slate)
^SixcUe ^CaAtlNaOeDdertnhed 1;36 pM ^Yas ®No ^Dmer/Operate ^Pasaerga ^PedaMnen State t., and Royal Terrace
Harrisburg
PA
,
,
nine - spedry
33e. caulwr (check my one)
• CMlfyhg pnyakNen (Pnysk:un cemryhg cause al tleam when aremwr Dh
skian has
rorpunced dmm
d
l
H
2 Sigrmture rde ~ ter
y
p
an
comp
deo
em
3)
To the twat of
knowl
a ,(
~ ~G'Ci
"
~
~
tl
h
• Pronouncing eM cerlnyirq phpk4n (Ph
sician bdh
ronanch
dean anti
'
t
d
~ ..~,,.,.i'
9atty J. Garber, Assistant Chief Deputy
`` .
~
,
y
p
g
ce
n
o cause
death
To the beet a knowl
ottrered k Uu time dN
end place, 0dire ro tln! cauede) eM roamer as etsted
^ ' ' ..-
(Maxh, day, year(
~ ~~°~ Ndm6er'
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• MedlcdEvamneNCororer J
March 7
2008
On the bade d enminenon ene / a hwstigetlon, In my oplMm, daalh occurred n Uw time, dale, end pkce, end due to the nause(a) and manner a° ehted_ ® ,
~. Name °nd Address of Person Who
cOf1a°'ed Cauae a Deem ptem 27) Type r Prml
35. Regstrar's signa~y,r~s~M Dicirci
- Gri~YrL O`er I v21 ~ I ~I ~ I ~ I 38. Fled m,
3 ~'j ~~'re~i Pat J. Garber
ry
1271 South 28th Street
Hamsbur , PA 17111
03-2?-' 88 ~3; 5® FROM-F.C~'IINGEI~ $ ASSOC
T-413 F~®Z~®QZ F-494
?1?Z
^~:
2808 APR -2 QM I I ~ 36
RENUNC~A.~'IC)N
REGISTER ply ~?4"ILLS
CLERK OF
ORPHAt~I`S COURT
GU~R=~..~~vD r0., PA
COCJN'TY', PENNSYLVANIA
Estate of STEVEN GLENN DOLLINS 17eceased
I, THOMAS GLENN DOLLINS in my capacity/relationship as
(f'ruu Naras)
FATHER of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters ba issued to
CAROLYN DOLLINS
MARCH 27, 2008
Gate)
~~~~
~'$1°""s~ THOMAS GLENN DOLLINS T
__$2~ Hi ~hwaY F~,~
(Saeet.fph! estj
Montegut, LA 70377
{CVry. Stars. 2ipJ
Executed in .l'tegister's Office
Sworn to or affirmed and subscribed
before me this _ day
of ,~
Deputy for Register of Wills
Executed out of Regr?ster's U, face
Before the undersigned personally appeared the
parry executing this renunciation and certified
that he ar she executed the renunciation for the
purposes stated within on this 2 7th day
1~I tary Public FRANK R , RATHLE (# 2 21 41
My Catxunission Expires: AT MY DEATH
tSi~natura and Sta! of Notary or other official qualified w
administer oaths. Shaw daft ofExpiratiait of Notary's Commission)
Thibodaux, Lafourche Parish, Louisiana
Fam R~'-06 rsr. 10.13.06