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HomeMy WebLinkAbout01-27-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Leroy K. LeGay Sr. File Number 21 - 09 ~~ also known as _ Leroy K. LeGay Deceased Social Security Number 203-07-4352 Jay N. Dutweiler Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or '8' BELOW) ^X A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the EX@CUtOr named in the last Will of the Decedent dated 01/27/2006 and codicils} dated (State relevant circumstances, e. g., renunciation, death olexecutor, 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 1 app scab e, enter: c.t.a.: .n. c.ta.; p ente ite; uran e a sentia; urante mmonta 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: (If Administrahon, 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 ~. ~ ~ ~ L1 ~ L..- rjrJ L:~ L° :r:' . la f... N ;: , ~:::_ t~ L._1 t °_ (COkIPLET€ IN " ~ CASES.~faeh additional sheets if necessary. Decddeht Was dorr~iled at de~It Cumberland County, Pennsylvania with his /her last principal residence at Messiah Vill~le, 100 Mt. Allen Drive, Mechanicsburg, {Upper Allen Twp.), PA 17055 (List street address, towNcity, township, county, state, zip code) Decedent, then $7 years of age, died on at Messiah Village, Mechanicsburg, PA 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 $ situated as follows: Wherefore, Petitioner(s) respecNully 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 Jay N. Dutweiler 114 Hearthstone Lane x/J _ n • ~ Lebanon, PA 17042 Fcxm RW-02 Rev. f0-13-2006 350,000.00 01/11 /2009 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 -l-i~ before me this ~~ day of ~G~9 / l~-~ For the Register Jay N. Dutweiler Signature of Personal Representative Signature of Personal Representative File Number: ` 21 -09 -~3 Estate of Leroy K. LeGay Sr. ,Deceased A/K/A Leroy K. LeGay Social Security Number: ~1 203-07-4352 Date of Death: 01!1112009 AND NOW, xLCa-~-,,.. oC~ C~~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, I IS DECREED that Letters Testamentary are hereby granted to Ja N. Dutweiler in the above estate and that the instrument(s) dated 01!27/2006 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ....................................... ..... $ ~~ • C.~~ Short Certificate(s) .................... ..... $ (2 •CX'~ Renunciation(s) ......................... ..... $ ~ ~ ~. $ ~ Jr- • Chi J ~P $ to ~ a~ $ $ $ $ $ $ TOTAL ............................... ..... $ 'TUc~ -CJ~ Att Att Brinser, Wagner 8~ Zimmerman Address: 6 E. Main Street P.O. Box 323 Palmyra, PA 17078 Telephone: 717/838-6348 Form RW-OY Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group. Inc. Page 2 of 2 Supreme Court I.D. No.: 43891 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photosi:at or photograph. Fce for This certificate. X6.O0 This is to certify that the information here aivcn is correctly copied (i-knn ~m k~riginal C'crtificate of Death duly filed ~~ith me as Local Registrar. The ori~_>inal rl_rtificatc will hr forwarded to the State Vital R+`curds Of(ice fclr permanent filing. ~,%' ., ) P 150~9~~~_ ~~~~ %' r., ~ ;'~,,~~- ~ '' Certification Number ~Lc cal Rey=ish~ar Date Issued N ~ ~ C-Q ~ .d ._ . ~ ~ ~' r ~ _ x xx• ~ ; ~ 7 nme R l l ii.~ J '~' _~ 1 ~w3 EV nrz6o6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE /PRINT IN P -`~ C~ ~'"; [- : °} ERMANENT BLACK INK CERTIFICATE OF DEATH t--1 ^ ~_i \ r ~ _ •_T 1 ~~ ~ i _ lSww Instn rrHnnc ~..d e.•.....t..e ,... __..____. C i.. ~ T ., 0 ' STATE FILE NUMBE~J •'~' _ _; ("_ ' 1. Name of Decadent (First, middle. past sultlxl M`dxle 3. 20Securiry Numbero7 4352 _ Date f Death (MOnm, da~,~aar) Lego K. Leta Sr. 3 - Jan 1 200. 5. Age Mast Binhtlay) Under 1 year Under 1 day 6. Date d Birth (Month, day, year) 7. BiMpWCa (City aM state or fore country) Bor. Place of Death (Check Dory one) MoM~ nays curs M~~, 87 April 3, 1921 Lebanon, PA "°~°'~ O1har ^ Inpatient ^ ER / Oulpalient ^ DOA Nursing Home ^ Resdence []Other ~ Speciry: ' orb. County of Death rx. City, eoro, Twp. of Deam Btl. FaaRy Name (If not institution, give street and number) 9. Wag Decedent of Hispanic O n~ ngin? Fitt" ^ Yes 10, Race: AmenWn Intllen Black WhA6 etp , , , . Cumberland of yaa, aprlcAy taboo, ,Spay) upper Allen Twp . egg ; ~ k Mexican, Puerto Rican, att.) • 11 Deoadenl's Usual Occa align (Kmtl of work done du' moll cf workin Ida. Do mt state renretl 12. Was Decedent ever in dre 13. DecedenYS Educano dY Doty highest grade completed) 14. Martial Status: Mamad, Never Marred, 15. Survivvg Spouse (lf wife, give maiden name) Kith of Work Kintl of Business / IM U. S. Armetl Forces? st ry u Elemen8ry /Secondary (0.12) College (td or 6.) Widowed, Divorced (Specd» ress o erator steel~YeS ^Ne widowed ~ 16. Decedent's MaiNty Address (SIr691, city /town, stale, zip catlel Decedent's Did Decatlanl 100 Mt Act l R itl Allen Dr 17 P ' ~ 1 ' ua . es ence a. Stale r P.1 3T1C~ TTr113 1Ve r a 17c Yes, Decedent lived in lt~7PT A~~PI'L i os is T cap wr ht Mechanicsburg, PA 17055 ,ro ceamY GSamberland p' ,7d ^ No, pecadem uvad wlmin Acual Limits of City / Bom I6. Famer's Name (First, middle, NsL sutlix) 19. Momels Nana (First, rtlitltlle, maiden surname) John LeGay Lottie Behney 20a. Informant's Name (Type 1 Pnntl 20b. InformanYS Mooing Atldrsss (SOeel, cAy /town, slate, zip code) Lego K. LeGay Jr , . 12 E. Evergreen Road Lebanon, PA 17042 21 a. Method d Disposition i ^ Cremation ^ Donation 21 b. Date of Disposition (Mmm, day, year) 21c. Place of gsposition (Name d cemetery, crematory a other place) 21 d. Location (Coy /town slate ~(8unal ^ Removal I zi coda) Sl l , , p rom a a j Wes Cremation or Donatlon Aulhorimtl ^ Omer ~ Speciry~ : by Medical Ex Iner l Caranerl ^ yqe ^ Nd January 16, 2009 Grand View Memorial Park Annville PA 17003 , 22a. rebl Funeral Serv 'tenses ( f as we ~ 22b. License Number 22c. Name and Address of FaciWy • ~ s-012433-L earner Funeral Home & Crematory Inc. 618 E. Main St Annville;~~3 . Comple Items 23ac Doty when certitpng 23a. To the best of my Mnowletlge, deem accwred al the tines, date and place sUted. (Signature and title) ~ DhYsici 23b. Uwnse Number nr-0 avarlabk at lime of Beam to 23c. Date Signed IMOmh, tlay, Yeatl cemy rouse oPdeam. Items 24-26 must ba tom 161ed b P Y person wM pronounces death. 24. Time of Deam 25. Date Pronounced Deatl (Morph, daY. Y~r) 26. Wes Case Raterted to Medical Examiner /Coroner for a Reason Other Ihan Crematbn or Donadon? ` d M. ^ Yes Jo CAUSE OP DEATH (See instructions antl exam lee ~~~ ~~ b ~ m Item 27. Pant Enter me rna n of evem~ -diseases, injwes, or compkcatiora - that dr p ) r ApproumaNS interval: Part II: Enter other ~ 28. Did Tobacco llse CanlnMe b Daeth? eclry caused the deem. DO NOT ewer temlkw events sirh a9 cardiac arrest t , Orkset to Daatlt respiratory artesl, a venlnalar tibrWation wAhoW snowing the etbbgy. List oNy one rouse on eedl Ime. r Out not restAtirtg in me urdedying cause gven in Part L ^ Y esrr, ProbeOty . ~ IMMEDIATE CAUSE IIf~al disease or j ENO ^ Unknown / condAdn resultirg In deem) ~~ S /~ h C ~/L ~l // 2 Q/7 f {~~~~1Lf M Q r ~Q~ 29. II Female: -~ a. T IrI~~L~'I U ~1'(2 F~'2. i.'/ te~ Due to (or as ~ rr ,, a consequence ol). ; ' " L'lrAOt pregt ant widen past year Sequentiall list conditio A y ns, any, b_ ~~ Q/'fc /U ,~~~e leading to the a listed on line a. [~L~r 0"~j ^ Praylent at time of death E D ~ ; nter the UNDERLYING CAUSE ue to (or as a consequence oQ. (dsease or In)ury shat initiated Nor c r ~I ^ a nant Out pregnant wMn 42 days events retyping in tleaml LAST. . dealh l lM~~i~ S IZlQ ~~ I L ~ - r.~ Due to (or as a consequence of) x J y . ^ Nol pregram, but pregnant 13 days to 1 year d ~~ // . i f-'f ~°/ ~/Y1 before tleam ^ Unknown A pregnant wdhin me pest year 30a. Was w Autopry 306. Were Autopsy FMirgs 31. Manner of Death 32a. Date of Iryury (MOnm, tley, Year) 32h. Describe How IrQury Occurretl Pertomwd? AvaA G P i a e r cr to Completion ~ ~ 32c. Place M Injurr. None, Fartn, Slreel. Factory, ^ of Cause of Deam? LCJ Natural Homicide Ollks guikGnj, etc (Spealy/ ~ ^ Ves [~.NO ^ yos [L~lo ^ Accident ^ Pentluy Investgalion 32d. Time of Injury 32e. Injury at Wode? 32f. tl Trsreporlarlon Injury (Sp¢dlyJ 32g. LowAOn of Injury ($Ireel, dry /town, sUte) ^ Suicide ^ Dad Not be Delerminetl ^ Yes ^ No ^ Driver /Operator ^ passenger ^Petlestrian M. ^Other~ Speciry.~ 33a. CenNer (check only one) :330. Sigrrelure and Title of Cerlilier • CertiTying physician ;Physician canitying cause of death when anomer physican has pronounced death and completed Clem 23) To the best of my knowlisdge, tleaM occurred due to me cause(s) and manner as slaled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ ~~ • P _ _ _ _ ronouncing and cartitying physician (physician born pronouncing tleath and cenilying to cause of deem) 7o the best of my knowledge, tleam occurretl at the time, dale, and place, and due W the cause(s) and manner as stated ^ 33c. License Number 33d, Oale Sgnetl (MO tn da earl ~ y, ? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Metlkal Examinezl Doroner ,/)nom ~~ ~~ ~~ I I ^ `('Ij On the basis of examination aM / or imestigatlon, in my opinion death occurred al the time dale tl l , r!l/ U , , , an p aty, and due ld the cause(s) and manner as daled_ ^ 34. NaMme aM^ A,ddIress Hof /Person Wdho Cpomp~kt drC~ause of Deatn Itemm 27) Type /Print 35. Registrar's Si n- istr,cl Number / f 3fi. Date Filed (Momh, tlay, year) ~ /l/~Q/~ ~x/x/~-~ f~ ~~ ~ ~ ~, 1G0/ ~ Q ~ d ~ti~ ~ ~5 ~ ~ ~ O p 7 /YLL.j,9,TJ fJ/Li r6 -- ' A /rJ~ C- ~ ti r / ~~SJ Disposition Permit No. V ~ 6 d7 ~ J X/ LAST WILL AND TESTAMENT OF LEROYK. LeGAY, SR. I, LEROY K. LeGAY, SR., of the Township of Upper Allen, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. I. ~? ..~ I direct the payment of all my just debts and funeral expenses as soon after my ° c° t+~ ~ decease as the same can be conveniently done. ;~~=~' "' L ' ~__. , ~ ,, _ , _, Tt I give, devise and bequeath twenty-five (25%) per cent. of my estate to my son, ^' „ ~ ,_ ~ ' LEROY K. LeGAY, JR., absolutely and unconditionally. 3. I give, devise and bequeath seventy-five (75%) per cent. of my estate to my stepson, JAY N. DUTWEILER, absolutely and unconditionally. LASTLY, I nominate, constitute and appoint my stepson, JAY N. DUTWEILER, Executor of this my Last Will and Testament and direct that he be excused from posting -1- bond or other security for the faithful performance of his duties, in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~ day of January, A. D. 2006. - -~ ~ ~~~ SE ~ ~-) Leroy eGay, Sr. -2- COMMONWEALTH OF PENNSYLVANIA ) SS COUNTY OF CUMBERLAND ) I, LEROY K. LeGAY, SR., the testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the same instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act and deed, for the purposes therein expressed. Sworn and subscribed to before me this ~7~' day of January, 2006. Notary Public ~~ ~/ ~~ .~ SEAL ( ) Ler . LeGay, Sr. NOTARIAL SEAL Mectt~a°il~u~g ~~ Ct mabe 1a d Co. MY Commission Expires June 27, 2007 COMMONWEALTH OF PENNSYLVANIA ) SS COUNTY OF CUMBERLAND ) We, the undersigned, J. ROBERT STAUFFER and JOHN M. EAKIN, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testator, LEROY K. LeGAY, SR., sign and execute the instrument as his Last Will and Testament; that the said testator executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testator, signed the Will as witnesses; and that, to the best of our knowledge, the testator was, at the time, eighteen (18) or more years of age, of sound mind, and. ur}~der np constraint, duress or undue influence. ,, y,, f ,) Sworn and subscribed to before me this ~7~ day of January, 2006. Notary Public _.... NOTARIAL SEAL HEIDI M. NELSON, Notary Public - 3 - Mechanicsburg 8oro, Cumberland Co. MY Commission Expires June 27, 2007