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HomeMy WebLinkAbout12-15-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland Estate of Henry Franklin Eisenhower, III also known as Deceased COUNTY, PENNSYLVANIA File Number ~~ ~ (! ~ ~ S.3 Social Security Number 209-50-9468 Petitioner(s). who is/are 18 years of age or older, appiy(ies) for: (COMiPLETE 'A' or 'B' BELOW:) A. Probate and Grant of betters Testamentary and aver that Petitioner(s) is !are the last WiJI of the Decedent dated and codicils} 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 probbate, was not the victim of a killing and was never adjudicated an incapacitated person: B. Grant of Letters of Administration (If applicable, enter: at_a.; d. b.n.c.t.u.; pendente life; durante absentia; durance minoritate) N c:a Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following sputa-~s~f any} an~eirs: ((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.) -~' ~ p .~ rY1 _ C Name Relationshi Residence ~'` r_. -~ Cory L. Eisenhower Brother 4475 Panza Dr, Mechanicsburg, PA: t'~~50 GJl ~~ _` ~ _ .ro _ _- _;~ fV ~ - (CONfPLETE I!l~ALL CASE:) Attach additional sheets if necessary. ~' W ~~ W Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 4821 Brian Road Mechanicsburg, PA 17050 _ (List street address, town/city, township, county, state, zip code) Decedent, then 39 years of age, died on November 11, 2008 at Holy Spitit Hospital, Camp Hill, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA} A11 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 $ 7 0,500.00 120,000.00 situated as t~~llows: Personal property at Decedent's address, Real property located at 1408 Ford Ave, Hamsburg, Dauphin County PA named in the Fortin RW-OZ rev. 10.13.06 Page 1 Of 2 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: ~/~ ~\ ~ > ~ - _ ~_, - ~ r.~ - , z~ ~/ ,~' Q LIST OF CREDITORS OF HENRY F. EISENHOWER III, DECEASED ~ ~ ~ b ~ ZS~ 1. Sovereign Bank, 601 Penn St, Reading, PA 19601 a. Mortgage b. Credit Card 2. GMAC, Post Office Box 9001951 Louisville, KY 40290-1951 3. Great Lakes Student Loan, Post Office Box 3059 Milwaukee, WI 53201-3059 4. West Shore EMS, 205 Grandview Ave, Ste 211, Camp Hill, PA 17011. 5. State Farm Insurance, 1500 State Farm Blvd. Charlottesville, VA 22909 ~-~ .:~ {_- ~ ~~ ~ ~~ _,~ ~ - _l I -© ~ _ _,1`I, _ ,17 -~ (~ .. ~~ ,1 r- ~- O LIST OF CRED~rI`~RS OF HENRY F. EISENHOWER III, DECEASED 1. Sovereign Bank, 601 Penn St, Reading, PA 19601 a. Mortgage ~ $77,414 b. Credit Card~$1,522.47 2. GMAC, Post Office Box 9001951 Louisville, KY 40290-1951 Auto Loan~11,932.45 ~2 ~ b~G~ ~~53 3. Great Lakes Student Loan, Post Office Box 3059 Milwaukee, WI 53201-3059 Student Loan~86,000.00 4. West Shore EMS, 205 Grandview Ave, Ste 211, Camp Hill, PA 17011 Ambulance Bi11~950.00 5. State Farm Insurance, 1500 State Farm Blvd. Charlottesville, VA 22909 Auto Insurance~$307.2U c} n ~ , l `. -C: • ~.~. i ~\ _ 1 `..___ ' -^.~ Y~ .~ ~, ~~ 4"-T C: ~~ • I '-' .-.,. i . V ~ ~ 'i ~. ` 7 ~ N -: .~ O Oath of Personal Representative COPv1MONWEALTH OF PENNSYLVANIA COl_INTY OF Cumberland SS The Petitioner(s) above-named swear(s) ar 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 tntly administer the estate according to law. Sworn to or affirmed and subscribed t~ before me the ~ ~ day of ~C~ ~ U~ For the Register File Number: Signature of FJ'ersonal Representative Signature of Personal Representative ~_ c~7 `~ Ate, Signature of Personal Representative ~_~_ ~ i" - - ~ c` - -~~ r--- n U] ~.. ~t c~ \25~ _ ~-- ~ _~, --~ N ; Estate of Henry Franklin Eisenhower, III ,Deceased ~ G3 Social Security Number: 209-50-9468 Date of Death:November 11, 2008 AND NOW, _, in consideration of the foregoing Petition. satisfactory proof havi~~ng been presented before me, [T IS DECREED that Letters of Administration are hereby granted to Cory L. Eisenhower in the above estate and chat the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and • (s)) of Decedent. FEES ~ ' ~+ _ O Regi terrbf t s °- -- Letters ............... $ lil c ~i Short Certificate(s) ...~ L~... $ ~Cr Attorney Signature: ~ Renunciations} .... ~ .... $ 1 S Jghn Ma ernick IV ~~ Attorney Name: y ~ (~,\~; - _ ... $ 5 Supreme Court LD. No.: 88609 $ Address: 1107 Shannon Ln. Carlisle, PA 17013 ... $ ... $ ... $ ... $ _~, ••• $- Telephone: 717-609-7599 _ ... $ ...........$ 3. TOTAL ... ~V 0.00 corm xw oZ rev. lo. l3.n~ Page 2 of 2 105.905MS REV. 9/08 This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. Military Status .~ „ ~, ~~2C~ r ~~ No. (~ Frank Yeropoli State Registrar NOV 1 $ ,~$ Date rv ~ ;•;.~ c.. Q c:a i - 1,7 C~ - -T- J > r--- ~ :, i' ~~ G C'~ C.fl - ~ ,~ li Q `~ Sri/ ~ -~ ( _ N105.14d REV 712006 lp~iF'iECTl~i2 I (~~' l a S COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS - ~t __._ 1 ~ _ TYPE/PRINT IN -~ PERMANENT pF~; FD QAT~; 11-18-08ns CORONER'S CERTIFICATE OF DEATH _~~ N ~ - `~~' BLACK INK 1131-393 (See instructions and examples on reverse) STATE FILE NUMBERS 1. Name d Decedent (F~rst, mkldle, last, sotto) 2. Sez 3. Social Secunry Number 4. Date d Deem (Monm, day, year..., Henry F Eisenhower III Male 209 - 50 - 9468 November 11;''2008 S. Age (Last Blnhday) Under 1 year Untler t day 6. Dale oI Binh (MOnih, tlay yeaQ 7. Birthplace (' and state a Wraign Gantry) Ba. Piece d Deem (Cheri ady awj 39 a ~"' ~' ~'"°' June 12, 1969 Hospital: Omer: ,y~ Harrisburg PA ,,m , ^ I„pa~,,, ER r pl Oulpaned ^ DOA ^ Nurs'xg Noma ^ Residence ^Omer - Specdly: 8b. Canty of Death Bc. Ciry, Twp. t Daelh 6d. Fedkly Nama (If not ireMuda, give street and amber) 9. Was Decedent of Hispanic Origin? ~No ^ Yes 10. Race: American Irgian, Black, While, ek. Cumberland East Pennsboro Holy Spirit Hospital AlexxanPlrenoRicen,ek.) yjh~ { 17. Decedent's Usual Oo. Kkd d wok d ew d most d Ne. Do not slate reared 12. Was Decoded ever kl th 13. Decetle~n'S Edxana (Specify omy hghest 9rede carp ieed) 14. Marital Status: Married, Never A4arried, 16. Surviving Spo use (II wile, give maiden name) KiM al Work Kind d Busness /Industry U.S. Armetl Faces? Elementary / Seantlary (I}t2) College (t d a Et) Widowed, DNOrced (Specify) Chemical 'Fn inset Manufacturin ®Ye5 ^Np 5+ Dever Married • 1fi. Depdan'S Megkg Pddrass (Shed. city / mwn, stale, zip coda) 4821 'Brian Road Decedent's Did Decedent Adpl Residexe va smte Pennsvlvania ~ ,7°. ®Yes. Decedent Iced k, Hampden T ~p PA 17050 trlechanicsbur fro. Cady Cumberland na. ^ No, Depded Lived wnNn g, As,ai umbsd Gn/Bnro 1S. Fame's Nama (PIM, middle, lest, sdlix) 1p. Mdhets Name (Fxsl, middle, maitlen surname) Hear F. Eisenhower II Shirley A. Besets 20a. Intamant's Name (type /Print) ZW. Inlamant'S Mailkg Address (Shed, dry r Poxm, store, z'q teas) Shirley A. Botts 4821 Brian Road Mechanicsbur PA 17050 21 a. Method d Disposinan ^ Cremation ^ Doretlon 21b. Date d Dispos"ion (Monm, day, year) 21c. Place of Disposi"on (Name d certrete7. aemaLay a omaz place) 27d Laatim icily! lam, stale, ip cotle) g] sadN ^ Removal from slam ' wu cramMlen er Donenonaatlwrlxed ^ Omer - Spedry: by Me~cei Examiner I Coronet ^ Yes ^ No Nov. 17 2008 I Indiantown Ga National Cgnet P cry Annville PA I ~ 22a. Signature d Funeta Service ~ lot pa amwg as such) 226. Licese Number 22c. Name and Atldress d Fanaly 8 Market Plaza Way - ~ FI)- 11667 Mal zzi Flaneral Home Mechanicsb PA 17055 Canpide Harts 23ec ay when . To the best d my knowledge, death az:aree al th• lue, tlete and place slated. (Signature and dne) 236. License Number 23c. Oats Signed (Modh, day, year) physician a rid evadable n time of deem ro pniry cause d death. • Items 24-26 must he cant"sled by person 24. Time of Death 26. Date Prawunced Deatl (Modh, day, year] 26. Was Gale Referred to Medal Examine /Coroner for a Reason Other then Cremalpn or Donation? wMVronaxxeedpm. 10:37 P. M. November 11, 2008 ~YeS ^Pro CAUSE OF DEATH (See Lrnlructlons and examples) I Appmgpnale interval: Pan II: Eda Omer ' 2fi. Did Tobaaa Use CorNrihule to Death? Item 27. Pan I: Enter the rzain o/ suede - dispsas, irgudes, a pmpkptlons -mat directly causetl me tleatlr. DO NOT enter terminal events such as pr6ac anesL r Onset Io Deem but Hal ntsWirg M the unpaying cause given in Pen L ^ Yes ^ Prabady respiratory anasl, a vedncuMr fibnlMnon wimal showing are etidogy. Lkl say one pose p eaM lire. r ^ No ^ Unlupwn IMMEgATE CAUSE fFimil tlispse or coneitmn reautlingn m) _„~ a. Atherosclerotic Cardiovascular Disease ~ ~~"F~B~ ^ Due to (a as a axaequenp on: I ' Nol pregnant wnhn pest year ^ Pre nant at tme d d em waOOyy km ardaions, if any, b. ~ Se~ued~ g e ~¢ad~~q ro the pose Lisletl a dna a. Due to a as a Con t Enter me UNDERLYING CAUSE ( ~u~ 01~~ I N pregnant wimn 42 days ^ a preyiant' but (tlispse a Kljay mat initu4e~nro r events resulting m death) lA r of deem • Due to (a az a catsequence dl: r ^ Nd pregnant, M pregnant 43 days b 1 year d. betas tlaeN ^ Unmoam d pfeg~aM within the past year 3p. Wes an Auropsy ilOb. Were ANOpsy Firtdngs 31. Manner of Death 32e. Date d Inryry (MOdh, day, ypr) 32b. Descnhe How Iryury Oauned 32c. Place d uijuury: Hone, Farm. Street, Factory, Pedamed? Avadada Pray ro Compkga ~Netural ^ Nadckne Ofice BuiMkg, etc (Spea'h) d Cause d Deem? ~L pJ Yes ^ No ' Yes ^ No ^ P.rcHenl ^ Pendng Lmesngation 32d. Tare d injury 32e. tmury at Woyz? 321. li iransponatmn Injury (SpeMy1 32g. Loplion d Injury (Shed, city /taws, stale) J ~ ^ Suidtle ^ GouM Nd 6e Determined M ^ Yes ^ No ^ Dmrer / Operalar ^ Passenger ^Petlestnan pther~ SpeaTy 33a. Gendie (Mack ordy ane) 33b. Signature • CMNying phyekMn (Physician pnlMn9 pose d daaM when andher physician hasptoraunced OeaN aM catpleted Item 23) Co tone r - To tM best of my knowMdpe, deNh occurred dw kMe qux(s)aM manner weleted_________________________________ ^ • Pronounemg ami cerdlyhrg physcian (Physiden bash praandng Beam aM cenilying to pose d death) end d a e t h tl t l d i d 4 ^ 33c. License N 33d. Date Signed IMadz day, ypr) p ce, u o t e ceuae(a)an manner ae s a TO the Dori of my ano4vAdpe, death occurre nmet me, sle, are ed__________________ November 13 2008 • Medaal Examirxa I Corona ~ , On tM hash of 4aenllnstbn end I a MVeangMlalt, in my opinbn, tleath acurre4 rt the nme, Gate, and place, and dw to the cause(s) ard mamte u aMte4 ~, a Addre d P I Cause Deem Item 27 T /Pant tt~c~Tae~ ~"~Porrfs ~orbne~y~ ;gegisrar's ureipolDistliclrlu~i6ar ~. la I~ I~ I ~ I ~ I UWJ ~tllr'(YT `~n 36?e dea(~nm,aax 1 t( ~gK%er.t~(~ , 6375 Basehorg'Road Suite ill Mechanicsbur PA 7050 Disqunbn Perm" No. 0251 119 "L l Q~~ IZ`J~ RENUNCIATION REGISTER ~F WILLS (; ~;,t-~, 5~..+^ ~~.:.,~,~t. COUNTY, PENNSYLVANIA Estate of 9~ L-. T it ~ ~~ S e4~ 4~~-ti ~, ~-- ~-~ ,:.:] C_~ ~ J :_: r ,_, - ~; ._ -- i ~;~ vt ~. ~ _. 1 --+ 1~ >~J _~ Deceased in my capacitylrelationship as (Print Name) ~' ~,~-~{~~ ~ ~- of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to _~ ~~ ~~ ~ . r I I ~ ~ ~'~~~~ ~~ (Date) ~~ (Sl~wture) (Street Address) V r`Cc~~G~/\.c S~wr~ ~J~ ~ ~ Us..~ (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills 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 ,~ Notary Public -, My Commission Expires: c~ "` ~ ~~, ~ ~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL PAULA K SMfTH, NOTARY PUBLIC SILVER SPRING TWP., CUMBERLAND COUNTY MY COMMISSION EXPIRES FEBRUARY 3, 2012 .Z ~~ ~, ~; ~ 2 S~ RENUNCIATION _~ REGISTER OF WILLS ~~ `~ ~~-~ ~-~ ~ j ~I,~Yv1 ~L'.T`~0.~~~ _ COUNTY, PENNSYLVANIA ~=' ° ~; -~~; c , ., _~ _, r'- ~-. L _7 _ .J _.._. ..l _~ 13 1, .j I ~ / ~ .. ;. .,. Estate of __(-I P I~ J" ~G? y~~I ~ ~l ~ 1 S-~G'l ~1 D~%£' I' ~~. ,Deceased= I, ~~ V2 ~ ~~ l ~ tt L- r S-~ V1 ~ ~~-~-~~ ~~~ ~~ ~ ~'~~ ~ ~ , in my capacitylrelationship as (Print Name) e~ ~ ~ .~ ~ r of the above Decedent, hereby renounce the right to administer the Estate of-t-he Decedent and respectfully request that Letters be issued to (Date) A v (si ature> 7vU ~ ~ ~ ~ ~~ dSv~~ l~v-~ u~- (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed be;fore me this day of Deputy for Register of Wills Farm RW-06 rev. 10.13.06 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 purp. ses stated within on this ~_ day l~et~ry Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission. ) ~ _- ~!i 09~ Q RED+P ~~~\ 1- i ~; Z5 (Z :~~ RENUNCIATION y REGISdTER OF WILLS ~--~' ~ ~-~ ~' 1 C~l~.._ COUNTY, PENNSYLVANIA Estate of ~~ ~-tl ~y' ~~ ~, 1.5-t',-~ ~ 01,..~'~ s^. ~~ ~~ ~ - >r- _ ~.~ . -. ' ~= =, ._ ; ; < ~ ` ~ ~' .. i'.i ,~J Deceased I, j'/~ , ,~ / e -, ~. ~ ~~ s , in my capacity/relationship as (Prim M ~ ~~ ~' /z of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~~ ~'~,' L . ~ ~ s-~.r'1 ~ ,7 td.J (owe) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Forrn RW-Q6 rev. !0.!3.06 (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 . /.~G'~~8~~ ~QD Notary Public My Commission Expires: ~ t3D~ ~~~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL GAIL P. STRICKLER, Notary Public Camp Hiil Born, Cumberland County My Commission Expires._Jar~._ 30, ~OI2