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HomeMy WebLinkAbout07-10-08PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Gloria S Myers also known as COUNTY, PENNSYLVANIA File Number 21 - 08 r ,Deceased Social Security Number 171-28-4474 Richard E. Myers Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE A' or 'B' BELOW.•) Q A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the Executor named in the last Will of the Decedent dated 08/24/1989 and codicil(s) dated (State relevant circumstances, e. g., renunciation, death of executor, etc.) 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 app ica e, en er: c..a ; ..n.c..a.; pe en e i e; uran e a sen ia; uran a moron a e 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: (!f Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Name Relationship Residence c~ ~ i <~ ' ® ~ ~ ; r :~~ ._ ( -~\~L1 V (COMPLETE /N ALL CASES.) Attach additional sheets if necessary. ' - ~ = ~~ ~~" tiiG ~ - r; Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence. ~~ _ 109 South 17th Street, Camp Hill, PA 17011 (Camp Hill Borough) ~ .c' (List street address, town/city, township, county, state, zip code) Decedent, then 72 years of age, died on 01/22/2008 at Holy Spirit Hospital, Camp Hill, PA Decedent at death owned property with estimated values as follows: ~ (If domiciled in PA) (If not domiciled in PA) (If not domiciled in PA) Value of real estate in Pennsylvania situated as follows: ~~i~~c~, ~+U ~p~~I~ ~ , o DO, ~v ~~ 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: or printed name and residence \ J ~ Richard E. Myers 109 South 17th Street x ~,.~ n ~ "~~ _ Camp Hill, PA 17011 Form REGISTER OF WILLS OF CUMBERLAND rcev. ~u-is-zuuo All personal property Personal property in Pennsylvania Personal property in County Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2 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 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 before me this ~~~ day of For the Register Signature of Personal Representative Signature of Personal Representative File Number: 21 - 08 e ~ ~ r-~ C7 Estate of Gloria S Myers , Decea~p , Social Security Number: 171-28-0474 Date of Death: 01/22/2008 ~ c`~ r'- . ~~ ;, t. t::. c~ <- s _~ ~ ~~ _ AND NOW, , in consideration of the foregoing Pefrti~,C~r,~~tisfactor~roof~ . U -~ i having been presented before me, IT IS DECREED that Letters Testamentary :-~ T ~~ ~_ ~ r1 _ -t are hereby granted to Richard E. Myers z° ~~ in the eve estate and that the instrument(s) dated 08/24/1989 described in the Petition be admitted to probate and filled of record as the last Will (and C odicil(s)) of Decedent. FEES , .,.,~ ~ ,.. Letters............`.-F„~~„iU~~~.~.~~~}.... $ ~~ , r l~ ~ . '' Register of calls ` ~ ~ J "~`y ~'' ........ Short Certificate(s)....... $ L~ . QG 1 Renunciation(s) ............................. $ Attorney Signature: .~~~- ,~ ~~t ~ ~ $ I~j• Ejfl Attorney Name: Gr M Kerwin ~~ $ '~ ~~ ! Supreme Court I.D. No. : 21222 ~ ~ ' d ~ $ ` Kerwin 8~ Kerwin $ Address: 4245 Route 209 $ Elizabethville, PA 17023 $ Telephone: 717/362-3215 $ TOTAL .................................... $ ~ ~-, Form RW-OY Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 IUS.S09 RG4' tUl/I?'I LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by phoi:ostat or photograph. Fee for this certificate. X6.00 P 1120789 Certification Number This is to certify that the information here given is correctly a~pied from un original Certificate of Death duly filed with me as Local Registrar. The original certificate ~>vrill be forwarded to the State Vita] Records t~fficc for permanent thin;. JA N t ~ 1U Local Re~*istrar- Date [slued =_ ..: "' L [;_ ~ - `~ U ~ t i ~ :J ~ (. ~ O ~3 Q - ~„' GV REV I1/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRSNT IN tANENT CERTIFICATE OF DEATH f C~ n CK INK (See instructions and examples on reverse) srnrE FILE NumBEa ~ .1 ` ~ r1 . ~ t~ L Name of Decetlenl (First, middle, lash suffix) 2. Sex 3. Social Securty Number 4. D ,ate of Deam (Month, tlay, year) ' Gloria S. M ers Female 171 - 28 - 4474 cc~ 5. Age (Last &rthday) Under 1 year UrMer 1 day 6. Date of 8idh (Month, pay, year) 7, &rthplan (City and slate a taeign caa¢ry) Ba. Place of Death (Check only one) Monlm Days Hars Mnules H08p1t81: Other: 72 Yra. October 13 1935 Berr $bur Pa ^Inpatient ER /ouroatiem ^DOA Nursing Homa ^Resrderrn ^Other Specify: County of Death 8c. Gay, Boro, Twp. of Death Bb Bd. FaciFty Neme (I7 not institutbn, give street and number) 9. Was Decedent of Hisperric Orlg'm? No ^ Yes 10. Race: American Indian, Black, While, etc. . r (If yes, speclty Cuban, (Speci 7 to ~ 1 Cumberland East Pennsboro ~ . ~ ~ Mexican, Puerto Rican, etc.) C) 11. Decedent's Usual Oc tqn (KirM of work dote du - most W wo ' IBe. Do not state retired 12. Was Deceden ever in the 13. Decedent's Education ( ity only highest grade completed) 14. Martial Status: Marred, Never Married, 15. Surviving Spouse (11 wile, give maitlen name) Divorced (Speciy) Witlowed Klntl of Work K'xsd of Business! Industry Secretary Interstate Tax , U.S. Armed Forces? Elementary! Secondary (012) College (1-4 or 6~) ^Yea ~N° 12 Married Richard M ers 16. Decedent's Maitirg Address (Street city /sown, site, zip code) DecedenYS Did Decedent Pa L'rve in a 17c Decedent Lived in Twp. ^ Yes 109 South 17th Street , . Actual Residence 17a. Slate '°wr'ab'p? 17d. ~ ~, a a~sl ~ivadwimm Camp Hill 7 D I Cumberland Cam Hi11 Pa 17011 ° lL D;~,B°r° b. OUn y , 18. Father's Name (First, middle, tall, sWlix) 19. Momm's Nama (First misksa, maiden surname; Eu ere Sn der Mar Stine ZOa. Imormant's Name (Type / Pnnp 20b. Informant's Mailing Address (Street, cMy I town, lute, zip code) Richard M ers 109 South 17th Street Ca Hill Pa 17011 21a. Method o1 Disposflion ~ ^Cremalion ^ Donator 21b. Dale of Disposton (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 27d. Location (City Hawn, state, zp Dada) [~Burai ^Removalfrom Stale ;Was Crematbna0onadon Atsthorzed • ^ Omer ~ S ~ by Medcal Examiner I Corarler7 ^ Vas ^ No Januar 25 2008 Rollin Green Cemeter Cam Hill Pa grwMe of F rat Se a cling as such) 22b. License Number 22p. Nanre and Address of Facility 011654-L ers-Harper Funeral Home Inc 1903 Market Street Cam Hill Pa 1701 M ~ y gate Hems 23ac Dory when nnityirg 23a. To Ire best of my knowredge, death occurred al me Fete, dale aM gate stated. (Signature and title) 23b. Lkense Number 23c. Oate Signed (Month, day, year) physician is not available at tlme al Beam to ceniy reuse of seam. 24. Time of Death n 25. Date Pronounced Dead (M°nM, day, year) 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other Than Cremation or Donation? hems 24~2fi must be completed M person ^ ,' wM Pronourx2s tleam. M. -~_ -~•Y~..~.,CvV~-- cst- .Z- ` 1 ^ Yes eil~. CAUSE OF DEATH (See inatructlona and ezemplen) r Approximate interval: f h di Pad II: Enter other a~mnikcant cordAiaN~contn°Dena o dears, iven in Pan I in th rl in cause t t tli d b 28. Ditl Tobacco Use Comrihule to Death? ^ Yes ^ Probably ac anes az car , r Onsal b Deam Item 27. Pan P. Enter the cha n of everrts -diseases, injures, or cromplicatior s - Thal directy caused me death. DO N0T enter terminal events srlc ~ . g g u r¢su rg e Ix e y no i respiratory arrest, or ventricular faarillation wanout showing the euaogy. Lill only one cause on each line. [~-NO~- ^ UMmown IMMEDIATE CAUSE (Final tlisease a ,^, ' j` ~ ~ / ~ (~ M ~ . condAan resulting in death) / L ~ v i ~ / ~ ~ /'/~ 29. It Female: ear [~-y7p( ye nant within ast r _~. ~ e. g p y y Due to (a as a consequence ot). r r ^ Pregnant al lime of death r It any p Sequent~Ny Rsl cwtditions , , , kadi b the cause listed on Nita a. ~ ^ Not pregnant, out pregnant within 42 days Due to (or as a consequence of•: Enter the UNDERLYING CAUSE (disease a injury mat InAUled me of tleath D- events resukmg m death) LAST. t ^ N°I Dregrwnt, but pregnant 43 days to 1 year DU¢ t0 (°r as a cnneegUenpe O ): ~ d r before death ^ Unkrawn it pregnant within the past year • 30a. Was an Autopsy 306. Were Autopsy Findings 31. Manner of Deam 32a. Date of Injury (Month day, year) 32D. Describe Hav Injury Occuned 32c. Place of Injury: Home, fans, Slreel, Fact°ry, DHw;e Buiklirg, etc. (SpecilyJ Pedomred? Available Pror to Gompletiar f De th? f C ^ Natural ^ Homicitle rrr a o ause o ^ Accident ^ Pending Irnesagalxsn 32d. Tsme of Injury 32e. Injury al Work? 321. If Tmnsportetion Injury (Spacdyl 329. location of kgwy (Street, dty I town, stale) ~~,,,,,,, ,,, ^ Yes ~ No ^ Yes ^ NO ^ Yes ^ No ^ Driver / Operate ^ PasserK3ar ^Petlestnen ^ Suidtle ^ Coultl Not be Delermirw.d M ^ Omer ~ Spedly: , 33a. Gertifrer (check only one) 33b. Signature antl TNe of filler, • Cenitying physician (Physician nnilying cause of tleath when andher physican Has pronounced death and compleed Item 23) . _ . _ _ _ _ .. _ _ _ _ _ _ .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ death xcurted due to the nose(s) aM manner as sated kd e f k T h `~,~ ~,~' W /~ ~ '~' _ _ raw , e best o my g o t of death) rr to us i m d Linnse~ umber i 33c 33d. Date Signed (Month, day, year) y ng ca ca e an • Prarwurscing and nrtllying physician (Physician born pronouncing dee To Ire bnt of my knowledge, death occurred at the tlme, date, and place, erM due to me cause(s) and manner es statecL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ . ~ q ~ ~ ~/iG / < ~ ` ,~~y, ~• v ~' r ''1 rl ~ ~~~ r{•~' / r r ~ '( X r • Medical Examiner) Coroner On the basis of examination entl 1 or investigation, In my opinion, death occurretl at the time, date, and place, and tlue to the cause(s) antl manner as etated_ ^ d Atldresa of Person Who Compleletl~use of Deam (Item 27) Type I Print 34 Nama an r ~ ~ 36. Registrar s Si re arW Distrktr / _ 36. Date Filed (Monet, day, year) 7 /~ ~ / ~~~ ~l ~~ ~ ~ Disposition Permit No. aD S ~T~l O LAST WILL AND TESTAMENT' I, Gloria S. Myers, a resident of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understand- ing, do make, publish and declare this as and for my last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments, or writings in the nature thereof, by me at any time heretofore made. I. I nominate, constitute and appoint my husband, Richard E. Myers, to be Executor of this, my last Will and Testament. Should a substitute or successor be required, I nominate, constitute and appoint as such my son, Jeffrey S. Myers. I direct that neither my said husband nor my said son shall be required to give bond for the faithful performance of his duties hereunder in this or any other jurisdiction, and that if, notwithstanding this direction, any bond is required by any law, statute or rule of court, no surety be required thereon. II. I give, devise and bequeath all of my property and estate, of whatsoever kind and wheresoever situate, of which I shall die seized or possessed, or of which I shall be entitled to dispose at the time of my death, to my husband, Rich- ard E. Myers, the same to be his absolutely, providing my said husband survives me by a period of three (3) months. III. In the event my said husband, Richard E. Myers, should fail to survive me by a period of three (3) months, then I give, devise and bequeath all of my property and estate, of whatsoever kind and wheresoever situate, of which I shall die seized or possessed, or of which I shall be entitled to dispose at the time of my death, in equal shares to my son, Jeffrey S. Myers, and my daughter, Vicki L. Mathias, the same to be theirs absolutely. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last Will and Testament, this day of August, 1989. ~ ; ' - ~ .. ~ ~ ~ ~' (Seal ) ~ f_ - ~~.~ - - ~ ~ ~ , ~,~ Gloria S. Mye '- _ u ; ~ ~ ~--' _ _ .... ~ ~ r,j S i -. -. ~ L1. LL U n~ SIGNED, SEALED PUBLISHED AND DECLARED by Gloria S. Myers, the above named Testatrix, as and for her last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. r~ FCC ~' ti~l '7 j `~ N Addre s ~- r i `~ Name Address / 71~5~ OATH OF NON-SUBSCRIBING WITNESS(ES) REGISTER OF WILLS ~UM6~~A~~~ COUNTY, PENNSYLVANIA Estate of t~ ~C. Q ~ > ~ ~t2.~' Deceased U ~.,C ~ O ?< y r/! , Kc ~ w ~ lv and ~~ C !~ f? ~ ~ ~ , ~' ~E,~.S > (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well- acquainted with (-~ ~ ~ ~ 1 ~ S ~? %~~p~S and amlare familiar with the handwriting and signature of the decedent, and that the signature of ~~'~jy'I ~ /TS~C~`~ to the foregoing instrument purporting to be the Last Will and Testament:/Codicil of Ij J~ ~~" j f'!'/~h-~~ is in l~s/her own proper handwriting. i (Signal -e) ~~ ~5 ~'~~~~ ~ ~ q (Street Address) ~ ~i~~ ~~-~~~~~ L~~ ~~ (City, State, Zip) ~ .~~~ 7 Executed in Register's Office Sworn to or affirmed and subscribed befor e this ~ ~ day of ( / , Q~. (Signature) (St/re~et~Address)y~ / / /~ / ~c~~, stag, z~p~ :- C'> C-'~ © -- ~' ~ ~ -t7 ~.._ C : i -~ am i"' , c " cr: ~ ; _~ ~ w -, <~ -t, ~ ~_ `_ _ , ~ ~ ~ v -- .c- Form RW-04 rev. !0.13.0(