HomeMy WebLinkAbout11-17-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
Estate of William E. Denison
also known as
Deceased
COUNTY", PENNSYLVANIA
FileNumber_ ~/ `[~~^~ ~~~~
Social Security Plumber 209-12-9403
Petitioner(s), who is/are 18 years of~ age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
^ 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
_-, _ ~ --
1 ~~ ~ -1
(State relevant circumstances, e.g., renunciation, death of executor, etc.) _ _
-~ tV ' `w i-`ri
_~
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution i]~the instrume tt,s) offered-, `'
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~
® B. Grant of Letters of Administration
(]f applicable, enter: c. t. a.: d.b.n.c.t.a.; pendente file; durante absentia; durance minoritate)
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. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
Name Relationshi Residence
Virginia B. Denison Suriving Spouse 5445 Rivendale Blvd., Mechanicsburg, PA 17050
Debra Cantor Daughter 1390 Armitagf: Way, Mechanicsburg, PA 17050
(COMPLETE /N ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
5445 Rivendale Blvd.. Mechanicsbure Upper Allen Township PA 17050
(L~st street address, town/city, Township, county, state, zip code)
Decedent, then 80 years of age, died on August 20, 2008 at Messiah Village
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 88,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
'Cotal p
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition az~d the grant of Letters in the appropriate form to
the undersigned:
~ ~ ~~ '~~ ~ I Virginia B. Denison, 5445 Rivendale Blvd., Mechanicsburg, PA 17050
Form RW-O2 rev. 10.13.Oh Page 1 of 2'.
~~
N
C7
o _7~~
' ~_' ~ nam~d~~r~~e
,. ,
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 Decede~it, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~~ day of
OL~~
t .
Fort Register
Signature of
Signature of Personal Representative
Signature of Persona! Representative
~
e
n~
~ ~
r
7 _. ,
,,.` ,-.
_. r-' .~ ;
! J
_ ^-~~
~
.
File Number:_ ~ ~ ` ~~ " ~ ~~~
Estate of William E. Denison ,Deceased
Social Se~c]urity Npumber: 209-12-9403 Date of Death: August 20, 2008
AND NOW, ~ ! ~ /~~ ~~ , ~~., in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters Administration
are hereby granted to Virginia B. Denison -'
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) .......... $
~.1C~ ... $_ 1(~.~
~~1,1 (11L1 fi~~~ ... $ ,(~(7
... $
... $
... $
... $
... $
... $
... $_
TOTAL .............. $_ a~ a .~
Attorney Name:
Address: McNees Wallace & Nurick LLC
100 Pine Street, PO Box 1 166
Harrisburg, PA 17108-1 166
Telephone: (717)237-5362
Form Rw-o2 rev. ln.l3.n~ Page 2 of 2
Supreme Court I.D. No.: 76397
S REV. 9/DS
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital R~cor~~s in~~c ordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. _
Military
Status
H10;i443 REV ttppDfi
TYPE 1 PRINT IN
PERMANENT
BLACK INK
WARNING: It is illegal to duplicate this copy by photostat or photograph.
594161
No.
r) ~j
~__.
Frank Yeropoli
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECOfiDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
-_'~
-, C-
_ _`-T.7
STATE FILE NUMBER
0
N
a
a
2
L]
ti
~I
3
w
U
0
ar ~
~.. -
20Q0~ t~-'~ -J
v _
..b r.
(~Q ;.-
••V Vy~~•1 li
o :-.
t. rvame of uecetlenl (FUSI, middle, last suAix) 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year)
William E. Denison male
209 - 12 - 9403 August 20, 2008
5. Age (last &rttday) Under 1 year Under 1 day fi. Date of Binh (Month, day, year) 7. &Mplace (City antl slate or foreign country) fie. Place of Death (Check onh one)
MonNS Days Haas AMNes Hospital: OArer:
• 80 Yrs. March 19, 1928 Harrisburg, PA ^Inpabent ^ERroNpabent ^DOA
®Nursing Home ^ Residence ^Other -Specify:
'
Bb. County of Death 6c. City, Boro. Trop. of Death M. Fadliry Name QI trot institution, give street and number) 9. Was Decedent of Hispanic Origin? ~ No ^Yes 10. Race: American Indian, Black, WhAe
etc.
•
,
~ pt yes, specify Cuban, (SpeciM
Cumberland Upper Allen Twp. m ESSl /~ ' I // Q
~
~ (
N U
~)
~ 4-~
i Mexican, Puedo Rican, etc) white
/ I
11. Decedent's Uwal Occu lion Kind of work done Burin most d wakin tile. Do rat state retire 12, Was Decedent ever in the 13. Decedent's Eduplion (Specify only highest grade completed) 14. Marital Slags: Married, Never Married, 15. Surviving Spouse (If wife, give maiden name)
Kind d Work Ki
U
S
Armed For
?
d d B
.
.
ces
n
usiness I Indust
Widowed, flivaced S eci
ry I~t Elementary I Secondary (a12) College (1-4 or 5+) (P M
Colonel Armed Forces L
xYes ^ND 12 4
,
Married Virginia C. Braswell
• 16. Decedent's Mailing Address (Street, city f lawn, state, zip code) Decedent's
Did Decedent
5445 Rivendale Blvd. ActualResiderce t7a.5tate Pennsylvania Towns
DecedenlLivedin Hampden
17a®Yes
a
,
Twa
h
~
Mechanicsburg, PA 17050 t>b. County Cumberland p 17d.^No, Decedent LNetl wilNn
Actual Gmils of ~, I ~
16. Father's Name (First middle, last suhix( 19. Mother's Name (Rrst mkkde, maiden surname)
Robert Denison Pauline Motter
20a. Infonnanl's Name (Type I Print)
Virginia B
Denison 20b. Inlonnant's Mailing Address (Sheet city I town, state, zip codQ
. 5445 Rivendale Blvd., Mechanicsburg, PA 17050
21a. Method of DisposAior ^ Cremation ^ Donaton
Burial ^ Removal from State ; 21b. Date d DisposiMn (Month, day, year) 21c. Place of Disposdbn (Name of cemetery, crematory or oNer place) 21 d. Location (City I town, stale, zip cede)
Was Cremator a Donator Authorized
^ OlherSpecih~ ! byMedkalEraminerlCoroner? ^Yes^Nw
•
August 25, 2008
Rolling Green Cemetery
Lower Allen 15,Tp., PA 17011
22a. SgnaNr o I Se ce C persm acthg as such) 22b. License Number 22c. Name and Address of Facility
• - FD 012 848 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
Canplele Gems 23a only when certihdrig
physician a rid available ar time d deatA b 23a. To the bell of my knowledge, death oauned at Me tlme, date and place slated. (Signature and Atle) 23b. License Number 23c. Date Si
grted (Month, day, year)
cerdh cause d death
~ roll 24P'aa~ixrmces~d~al~leted ~ ce~ 24. Time of Death j O
P 25. Date Prorxxrczd Dead (Month, day, year) /~ ~
~ 26. Was Case Referred to Medical Examiner I Coroner for a Reason Other than Crematbn a Donation?
. M. ~
O~ ~ O,". ^Yes []No
CAUSE OF DEATN (See insUta:Uons and a ampks) roximate interval:
ttem 27. Pan I: Eller the kr o r~ -diseases, irquries, a canpGcations -that d'aeNy roused the death. DO NOT enter terminal events such as carduc arrest
~ ~ Pan II: Enter dher
~~ s '~A0 to--di~•
26. Did Tabaao Use Contribute W Death?
,
respiratory anent a venlncular fihdlletion wA1aW showing the etiology. Lint onh one cause on each line. r onut Po Death but not resdlirg in tltu underlying pose given h Pad I. ^Yes ^ Robady
r
WMEDIATE CA 9 E (Fu~ disease or r
cendtion resupin h ath ~ No ^ Unkrnwm
-,~ a, IhA/ll hoKl i
Lt , 29
If Female:
„"'
-krtisamt,
Due to (a as a conse
uence
off /O~
u~~ .
q
.
: ^ Nd pregnant rnMh past year
SequenAalh Ld cerrdlions, d an ,
leadrg to the pose tided m the a. b' --~( HQy r ~ i ~(~1,}'~'IS
Enter the UNDERLWNG CAUSE uue ro, as a consequence oq. r
w/ r ~O.J
^ Pregnant at tsne d dplh
' (dsease a injury Thar hAated the /I --~~.u r
c. ~
VV 0 d
TU
~
i ^ Nd pregnant, but pregnant within 42 days
.
• evenk resrdtirg in Beall) UST,
~(,
(~{.~F
A r .liyJ
i
Due to (or as nse
uence o~ r of death
q
r ^ Not pregmd, bN pregnant 43 days to t year
d. r
r
before death
^
30a. Was an ANOpsy
30h. Were Adapsy Fmdngs
31. r d Death
32
p
t
d h
M Untcrraam d pregnant wilNn the pad year
Penornred?
Available Prior to Completion a.
a
e
jury (
onth, day, year) 32b. Describe How Injury Occurred
32c. Plop of hNry: Home, Farm, Street, Fachry,
d Cause d Death? ~~ ^ Homitide Office Bdklin9, ek. (SPephl
/
^ y~ u N0 ^Yes ry(~
uu ^ Accklent ^ Pendng Investigation 32tl. Time d Irrjury 32e. Injury at Work? 321. II Transponalion Injury (Spedhf 32g. Location d Irrjury (Street, city I town, stale)
^ Suicide ^ Could Nd be Detemuned ^Yes ^ No ^ Driver l ppemlor ^ Passenger ^Pedestdan
M Other ~ Specih:
33a. Cemfia (check onh °ne) 33b. Sigpture antl TNe of CeNfier
Certilyirg physician (Physkian certifying pose d death when andlwr physidan has pronounced death all cengleted Aem 23)
To the best d my knowledge
deadr aaumd due to the pusNs) a
d
/~~~
~
,
n
maarer as slated_ _ _ _ _ _ _ _ _
------------------------
~ ~Yh9 phydcian (Phyddan bollr prawunckg death all certiyin
to pose d d
th - V'
~W/W / ~
//
g
ea
)
To the best d my kewwlMgq deatlr oaurred at the time, rick, and plop, ell due W the Donets) all manner a9 staled- _ -- _ _ _ _ _ _ _ _ _ _ ^
klediWExamirrerlCoroner ____ 33c Cleanse Number
/
/-1D/~~S~~/
t~
'
33d. Dale Sgrred (klonth, ~y, Year)
On th
b
i
d
i
i /
J
/ // 7 V Dd~a~-~Q~~
e
as
s
exam
rut
on end I a investigalbn, in my opinion, death occurred at the Arne, dale, and plxe
all due to the pusNs) and manner as sUhd
^
,
_ 34. Name and Address of Person Who Completed Cause of Deatlt (Item 27) Type! Print
36. Registrar's 3 re and Dishkd umber
- ~ l dl ~I °~I ~I ~I 36. Da Fled (Monts, day, yearf ,fi97e/r•'ff MOOR Q g Ks N /HD
/9LGuN ~
4
/VC
rov
d ~ ,
,
M7
- sF/V/GddunLG_ .OA /7o.CS
U Disposition Permit No. ll2 L ~15~ 5
RENUI`~CIATION
~o tea
``~~
==t-
a a, _
~ ~ 7 _~
-'=~~ ° pia
'
REGISTER OF WILLS
~ ~ m
~?
' .~.I ~ ~ ~
{ ~
d ~
Lta~'1 J~~'rl/r~~~ COUNTY
PENNSYLVA]VIA , f
_
~~„ t
, C 3
-
,~ , ~
3 4
~--- = ,
O
C~0
Estate of __ i~~~~ ~ ! (I lr a 1'~ ~ l~ ~ -, / S (5?ti-..
Deceased
I,
in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
i l- i ~~ ~~~~~
(Date)
(Sign re)
~:~. -
(St"r~ee~t Address)
~~-_I~lr'~/,?tea- ! ~~~`~~~'
(City, Stale, Zip)
Executed in Register's Office
Sworn to or affirm ~,~n~ subscribed
befor me this f day
of %
_,~_•
,~9 ~ ~
Deputy-(f~o~r Re aster of ills
g
Executed out of Re gister's Office
Before the undersiL;ned 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 E~:pires:
(Signature and Seal of Notar;~ or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RbV-06 rev. 10.13.06