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HomeMy WebLinkAbout07-24-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~ t~.m ~A--~~_ COUNTY, PENNSYLVANIA Estate oi, 1 /~G~,~ 1 S - = rti(- !"T 06 Lp~~ File Number p~ ~ ~ C~ ~~,~ v also b:nown as _ F ~-~Y ,Deceased Social Security Number I (7 -~g '-gQ 7 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMIPLETE '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 rv (State relevant circurns[ances, e.g., renunciation, death of executor, etc.) -~~~~ - r- , Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the=uisimen~offercd =' for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ ~ ,-.~ ~ ' B. Grant of Letters of Administration _ ,-t =-=t --- Qfapplica6le, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durmue nbsentia; durnnte minoritate) f..ft 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 Adirtinistration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) = r~ ~i~4~a (COMPLETE IN ALL CASES:) Attach additional sheets if [tecessary, Q/~ Decedent was domiciled at death in p __._ County, Pennsylvania with his /her last principal residence at U E~T'i4 (List sheet address, [orvn/city, totivnship, county, stale, zip code) Decedent, then ~_ years of age, died on3at ~~ ~eu,rvT 12Y Y ~ E6t3(~S7 ~E"~~J/L[ ~ ~, ~~a (~~ Decedent at death owned property with estimated values as follows: (If 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 $ ,~310~.2~ situated as follows: pprty~ 1~ Q ~ ~ Cd 2NG(ZS'TG~/J[ Wheretbre, Petitioner(s) respecttitlly 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 Q,178; Form RGV-U? rev. ro.l3.oa Page I of 2 Oath of Personal Representative COI\~IMONWEALTH OF PENNSYLVANIA SS COUNTY OF~^j~{rvLl3Ef~LA>~D 'Che Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con•ect to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioners} will well and truly administer the estate according to law. Sworn to ~r affirmed and subscribed before i the ~_ %day o L~ ~~~~ ,~ .~ , or the Register ~u -~'n - ~ - Signature ajPersonal Representative i-r~ N `7 .~° _• Signature oJPersonal Representative -~ ~~ ~ : ~: . -- r7 --{ File Number: ((~~ , l~~ ~ p b~1~ Estate of ~.nn~~ 7' ~rd.~. -~p(~2'1' ,Deceased Social Security Nu(mber: ~~ lr~/ 5 ~ ~~~ ~ Date of Death: J (.L.'U ~ ~ 07~~ AND NOW, J ~ ~ of `T ~6~~ , in con ideration oft e fore oing Petition, satisfactory proof having been presented before me, I S D/]~,CREE that Letters {'11~~7 (~ ~,c.-~G[~-~ are hereby granted to ~{~(L ~, r~ r~ ~ D~Pf aix! that the instrument(s) dated in the above estate described in the Petition be admitted to probate and filed of record s the last Will (and dicil(s)) of De dent. FEES _ ., 3 ~ 7 . ~ ~ ~ Register of ~ !s Letters ............... $ Short Certificate(s) ........ $ Attorney Signature: Renwlciation(s) .... ~ ..... $ Js-' ~/~ $ /a Attorney Name: - t-h-'t • ~ • $ S Supreme Court LD. No.: ... $ $ Address: ... $ ... $ ... $ ' ' ' $ Telephone: ... $ TOTAL .............. $ Fcuin RW-03 rev. 10.13.0( Page 2 of 2 105.805 REV (01/07) 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 ~.4~64~338 Certification Number i108.1a4 REV 118008 TYPE /PRINT IN PERMANENT BLACK INK 0 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. Q F`p~ '~'~ .tU~ t 1~ 2008 c.~w ~ C.~L°~~~~o~r Local Registrar `~ Date Issued r^v n ~® ~ ~ = f -1- ~ ~ r n rv - : - - ~; ~ .~ ~~ ~~ - -, r'j ~-a -~ r -.~ Y .. '1 C1 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ CORONER'S CERTIFICATE OF DEATH a~ OPj Q.-.~,~ (See Instructions and examples on reverse) STATE FILE NUMBER 1(J1~J1G 1. Name d Decadent (Fxs6 mkde, lest. sumx) 2. Sax 3. Social Security Number a. Data d Death (MOnm, day, year) Dennis E Hoover Male 190 - 58 - 8071 July 17, 2008 5. Aga (Lear BiMxley) Under 1 Under 1 8. Data d Birm (, ~Y. Y~~ 7. BlMpleoe (' eM slate w lordgn canlry) Ba Place of Deem (Check an one) 33 "°"" °"` ""°° a"re" Oct.21,1974 Hmpaah omen Yre Carlisle, PA ^mpmiem ^ER/(]utpegenl ^DDA ^Nursirg Horne Residence ^Omer-Spedly • Bb. Caunry d Uaam &. Ciry, Bo Deem fkt Facility Narra (II not insmutlon, give street eM nwnher) 9. Was Decedent d Hispenk Originl ~ No ^Yas 10. Ras: American Inden, Black, While, ek. ~ Cumberland Upper Frankford 76 Country View Estates Ma~n,PDenoRl °an',ek.) White 11. DecetleM's Usual Tan Kmtl d work dma most d life. Donor sbte rear 12. Was Decedent ever in me 13. DecedenYS Etlucedon (Spedry only highest grade mmpreted) 11. Marital Sretus: Marled, Never Merced, 15. SuMVing Spouse (If wile, give maiden name) WMOwed Divorced ISpedM Kxxl d Work KIM d Buakese / Intlrady , U.S. Armed Forces? Ebmenbry /Secondary (o-121 Cdlege Iti or N) Laborer Borders, Inc. ^Vas 5d"° 12 Never Married - - 18. Decedent's Mvlirg Address (Street, dry /lawn. state. rip code) 76 Country View Estates DecedenCS Did Dacedem Upper Frankford Pctuel Residerx. 17a. Side PA Live in a nc. ®Vea. Oxetlanl Lived in Twp. rww,aND? - Newville, PA 17241 rill ^ ~~DecedeMlJvedwithin ~ aaa 17b.Caamr Cumberland 18. Femer's Name IRret mitlde, lest, suRal 19. Homer's Narre (Rre+• mitlde, maiden sumarnel Richard S. Hoover, Sr. Charlotte M. Bi 20e. Idorment§ Name (Type /Print) 20b. IdomrertYS Mailkg Address (Street, dry / town, slate, zpr cotle) Richard S. Hoover Sr. 218 Sunset Drive Selin PA 21 a. Memotl of Dieposkicn ~ []~Cremeban ^ Danetlan 21b. Date of Disposbon (MOmh, daY, Year) 21c. Place of DreD°sg°° (Name of cemetery cremelary w Omer place) 21tl. Location (Ciry /town, slate, zip cede) ^ Bwiel ^ Removal Rom Stela Wea Cramalbn w Datatlon Aumorlmd~J ^ 7/22/2008 Evans Cranation Services Leola, PA No ^ ahar.speay: hyMadlulExrrthKr/COronar? txYea ~ 22a. SigreWre u Lkansee lw parser s - 220. License Numbar 22c. Name eM Address d FadMy . ~ FD 012633 L Fhaain Brothers Ehneral Herne Inc. Carlisle PA 17013 Comprele Rama 23ec ody when Certeying 23e. To aw beat of my anawbdJe, occured at dw lime, date and place slated. (Sigrebre end eeej 23b. License Number 23c. Dale Signed (MOnM, day, year) phyakbn a MI aralbde et ame d seam m cemry d deem. ma 2a-28 m,p he mmpMed by Parson H 24. Time d beam AprX . 25. Dare Ptawunced Deed 1• ~Y. YWU) 26. W Gese Referred to Medial Fxambar /Coroner tar a Reason Omer man Cremation w Donadon? a ,• wropromwxwsdaam. 6:00 A M. July 17, 2008 Yes ^"° CAUSE OF DEATH (Sae Inssrsscsloro and examples) r Approximate krenal: Pan II: Enter dtar =:v,w..,m Cwx1K- _- onaw+!Laa to tleetll Nen re Pan L in Huse dtl i m d 28. Did Tabawo Use Cwihihuta b Deem? ^ Vas ^ Ptobady den 27. Part I: Enter me dmhl d events- dueeses, kjuriea, w complicelkm -mat directly eased Ure deem. W NDT solar twminelevenb wdi es cardiac artasL I Drell ro Deem g rg n e un arry g Wt not res reaPkal°ry artesL w ventrkdar tlhdlalbn wdMd stowing me Blkbgy Ua only are Cause on each line. i ^ No ^ Urdoawn W ~rti USE IRreI disease w rig codes) in H 29. K Female: ear ^ Nd d itlYn ast -~ a. i~ anQ Due to (or as a consequence op: IM condtlorre N an pregre w p y ^ Pregnant at time d deem , Y, b. be re cause Mated w Loa a. Due ro Iw as a consequence oQ: EE~DERLYINfi CAUSE ~~1wsaew w injury met mitlaled mB ^ Nd Dragnad, but pregnant wimm 12 days ddeah o. bvenb r~aerg m deem) UST. Nd arn, but 43 de to 1 ^ Preg° Wegnanl Ys Year Dua to Iw as a consequence on: bdwa deem ^ lmawwn tl pregnem wI1Mn me peat year d. - age. Wes an Auopsy 30b. Were Autopsy Findings 31. Memer of Deem 32a. Dare d Injury (M°°W, tlaY.Year) 326. Describe How Injury Occuretl 32c. Race d Injuy: Homo$.oFae~ngnr, Street, Faawy, OK Buikeng, eo. (. ) Pedmnsd7 Avenade Ptar ro Compeam ^"sN~ ^"°~"~ July 17, 2008 Intentional hanging rl OIDE: dceaa.a Deem? N ^ Aotitlax ^ Pegg Imeeagedon 32d Tme d Injury Aprx 32a. In'ryry al Wow? 321. K Trenspabtlon Injury (Specify) 32g. lacetkn d Injury (Street, dry / aw.m, able) ^ Yes ~ No ~' o ^ Vas ^ Suidde ^caddNaeeoelemdned ~ . 6:00 A ^ Dri,ar / oPererer ^ Passenger ^Peaeewn ^Yas 1$~NO Dun y View Estates,Newville,PA , M. omw-~7 Sae. cemrrer laxxk oNy ww) aab. sgrewre and r a Coroner • Canxyl,g PhYel°b° (Rrytiden carNying aerie a Beam wMn andhv MYrecb° has w°nwmaad deem and mmperee Item z3) ------------------- ^ rodw crre(q and merxler ee ebled M ~ m ~ -------------- oceun Ue Te the lwatdmy loowbdge, dee Pro°°w°kg one certlyinp PNYe~ (Phyakbn bdh praautag deem erd ceraMAg ro cause d deaml ^ 33c. ' Number sad. Date signed IMonm, der. Yom) To dre 6esidmy krwwredgs,dam occurred„me mne,eare, and piece, end sue to the Dwne(el and mennxuarele~----------------- July 21, 2008 • Aledlnl ExmdrtarsxamlMl°n arM / or Mvptlgelbn, m my opMbn, deem occurred et the tlnre, dab. end pba, end due to Uri ceuce(s) erM manner ere sreletl_ ~ 271 TYPel Pdnl dJ~laemmee aanpdd rereYaSs ~+~o ortglyed a1 ofPersan 34. 0 T ~ 2 r 15 l:0 NO M1CRa21 d ~ sig~rearau ~ I ~ 1 a eFaed(Mmm,aey,yea~ ~ /1 6375 Basehore Road Suite PA 7050 i b h I l la I ~ l Q60 an cs urg, Mec ~ DisposPoOn PertnK No. ` / of ~ (~[ a ~ o$ o ~~~ n3 r~ C7 c~ G C7 ~ RENUNCIATION ~, ~' ~ , ='.~n rv - __,.. _. `_ ^ ' REGISTER OF WILLS --; -,`- -~ C_V ~ C~-~ ~ a t'~G~1 COUNTY, PENNSYLVANIA ' ~ ' ' -` _~ -- T _, .. J ;. CT, OC Estate of ~ek'lrl 1 S ~ - ~oc5v~e~ ,Deceased I, C~-~~ ~ b ~ / v~ • ~ (~~~ r , in my capacity/relationship as __ tt~ (Print Name) t~ ~ OT~1 P t~ of the above Decedent, hereby renounce the right to admixaster the Estate of the Decedent and respectfully request that Letters be issued to ~CNRl~17~S lv~a~~~~ ~~le+ -.~ - ~ ~r -©~ -- (Date) Executed in Register's Office Sworn to or affirmed an subscribed before me this day of Jc~ f c,~ , 0 Depu for Register of ~z, ills (Signature) (Street Address) (City, State, Zip) 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 Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. !0.13.06