HomeMy WebLinkAbout03-17-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Charlotte W. Quigley
also known as
Deceased
Petitioner{s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
COUNTY, PENNSYLVANIA
File Number ~ ~ i~ ~. lJ a ~ a
Social Security Number 202-20-2327
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the Gywn A. Zook named in the
last Will of the Decedent dated May 18, 2004 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 instrament(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; dr~te minoritare;(
r::~
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following" o~e (if any~td heir; (~;
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~_~~ ~--~
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
1000 Clazemont Road Carlisle PA 17013
(List street address, town city, township, county, state, zip code)
Decedent, then 80 years of age, died on February 14, 2009 at Claremont Nursing & Rehab Center
Decedent at death owned property with estimated values as follows:
{If domiciled in PA) All personal property $ 112,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value cf real estate in Pennsylvania $
situated as follows:
Form RW-O2 rev, 10.13.06 Page 1 of 2
(COMPLETE WALL CASES:) Attach additional sheets if necessary, tT
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the Rant of Letters in the appropriate form to
the undersigned:
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 lrnowledge 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 the ~ day of
C2V 1~
U For the Register
Signature of Personal Representative ~--~
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Signature afPersonal Representative -F r=-
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Estate of Chazlotte W. Quigley ,Deceased
File Number: a ~ C ~ ~ ~ ~C o2~ ~ a "~
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Social Security /Number: 202-20-2327 Date ofDeath:February 14, 2009
AND NOW, ~ ~~~C1tl.ClC_/ d ~ ~~."r /GGl , ~~ll~~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters Testamentary
aze hereby granted to
in the above estate
and that the instrument(s) dated May i 8, 2004
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s~ of Decedent.
FEES
Letters .. J1c~,.Q~Q.... $ a(O~J
Short Certificate(s) .. ~.... $ 8
Renunciation(s) .......... $
~-1//~ ... $ ~S
-~ ...$ ~
... $
TOTAL ...........
... $
... $
... $
... $
... $
Attorney Signature: !~
Attorney Name: Ronald E. 7ohnson
Supreme Court I.D. No.: 16453
Address: 78 West Pomfret Street
Cazlisle, PA 17013
Telephone: 717-243-0123
Form RW-02 rev. 10.13.06 Page 2 of 2
105905MS REV. 9108 t
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
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H1oB~l4a REV nzno$
TVPE/PRINT IN
vEAMANENT
BLACK INK
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No.
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Frank Yeropoli
State Registrar
f EB 2 42009
Date
COMMONWEALTH OF PENNSYLVAN)A • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH ~`, '/~` y /~
(See instructions and examples on reverse) STATE FILE NUMBER ~ ` ~~j "\ ` ] /7x~ G
1. Name of Decedent (First. mitltlle. last, sutt~xi 2- Sex 3- Sorel Security Number 4. Date ai Death (Month. tlay, year)
Charlotte ti'4. Quigle F 202 - 20 - 2327 Februa 14, 2009
5. Age (Last Blnhtlay IA tler 1 year Untler I tlay 6. Dag of Blrlh (Month, day, year) ]. Birthplace fGily and slate or foreign ceuptry) Ba. Place of Death (Check only one)
Months bays Hours MinuMS Hospital: Omer
80 vra 12/24 1928 Mechani^si~ur , PA L~inpad_nt ^ ER; oprpatiemt ^DOA ~ Nursipg Hpm¢ ^ Realtlenpe ^otnar sp¢nw
Bb. County of Death Bc. City. Roro, Twp. of Death 6tl. Facillry Name (II not InslituVOn, giv¢ street and number) 9. Was Oecetlanf of Hispanic Origin? ~ No ^Ves 10. Race. Amarcan Intlian. Blocs, White. etc.
(It yes, specily Cuban, (Spenlyl
Cumberland Middlesex rltNp• Claranont Nursing & Rehab. Center Maxipan, Ppedp Rican et¢.) White
11. Decedents Usual Occu align Kind o' work d one dun ast at wprkin life. W rrol siaie +elired 12. Was Decetlent ever in me 13. Oecetlent's EducaLOn (Specify only highest gratle wmp letedl 14. Marital Sta[us. Married, Never Mametl, 15. Surviving Spo use (II wife give maitlen name)
Kind of Work Kind el Business lintlus[ry U.S. Anmetl Foreese Elementary / Secontlary (0-12) College (t-4 or $a) Widowed. Divorcetl (SPeaY}9
Food Service Messiah Colle e ^v¢a ®ND 12 Wicbwed -
i6. Decedent's Mailing Atldress IStreel, ciN! town, stale, zip potlel Decedent's Dld Decetlent
State PA Live in e 17c
Decedent LiveO in MiddleseX T
Act
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sitl
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e 1 ]
I~es
1000 Claremont Rd. ,
,
ua
e
e
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a.
wp.
Tpwnar,ip?
nd cppnw Cumberland ,~d.^Nq Dacadam coed wuhn
Carlisle, PA 17013 Actual comics cf Cliy; Boro
19. Father's Name (first, middle, last, suffix) 19- Motheis Name (Fl+st mitlNe, maitlen surmemel
Wilbur Steward White Blanche - Bucher
20a_ Inlorrtiant's Name (Type /Print) 20d. InformenYS Meiling Adtlress (Sheet. city! bwn, scale, zw code)
A. Zook 15C Pfautz Road, Duncannon, PA 17020
21 a.
1Mb of Disposition '',, ^ Cremation ^ Donation
M
e 21b. Dale of D'ISposition IMonlh, day, year) 21 c, Place of psposilion (Name of cemetery, crematory or ocher place] 21 tl. Lxaticn (City/town, state. sip rode)
t
S
~
u Burlel ^ Removal hom Stale ;Was Gematlon or Donation Au[horixetl
^ Olner-Speciy: i byMetlkalExeminer/Loronera ^vea^Np
2 18 2009
Mt. Holt S rin s Cemete
M H 11 S ri s PA
22a. Sigreiure of Fune I rvice Lcensee tar per I as syn. 22b. License Number 22c. Name and Atltlress o1 Facility
~ ~ v FD 012633 L Etaing Brothers Funeral Home, Inc. , Carlisle, PA 17013
Complete items 23a-c only when ceNhvrg 23a. To the bell of my knowle e, tleaN occurred al Ihe'Ime. date and place staled. (Signature antl thee) 23b. License Number 23c. Date Signed (MOnlh, tlay, year)
physician is not available et lime of deaN ID ~ 4
cediN ca a of tleath.
d
Items 2423 must be completed by person 24. Time of Death 26. Date Pronounced ead (Month, day, year) 26. Wes Case Referetl ID Metlical Examiner /Coroner Iqr a Reason Others Nan Cremation or Donalien2
who pronpmces tleaN. Mi_ ~ ^Ves ~No
CAUSE OF DEATH (See instructions and examples) r Approximate interval: Part 11: Enter other scars licant tonditims conlibul'ao to tleath, 28. Did Tobago Use Contribute ID Death?
Item 2i. Part t. Enter the Chain of events - tliseases, ~.njud omplications -chat directly raus¢tl Iha tleath. DO NOT enter terminal events such as cardiac anest. Onset to DeaN but not resulting In the underlying reuse given In Pan L ^Ves [~ Probably
respiratory arreai, or vanincuiarlbriliadon witheu(shawing the etlobgy, LIS10My one cause pit each line. ^NC ^Unknown
IMMEDIATE CAUSE 1Final tliseaze or
conaition resultng in death) ~ QE~fA l~ ~A 11..-vtV1 •~
a
2s. IfF male:
^e
Due to (or as a consequence ol).
Sequan@alry Irst Wndltrons, it any, p ~p N(~~`-'j'rl V'~ )~ EkKr Fa I ~ u nE Not pregnant within past year
^ Pregnant at lime of tleath
leadingg tq the cause listetl on line a.
Enter the UNDEPLYING CAUSE Oue to Ipr as a consequence ot)-. ^ Nat pregnant, but pregnant wimin 42 tlays
(dse a ur ryury that Initiated the
AST
i
h
s
c of death
.
0ng m tleat
) L
event
resu
pue to (or as a consequence ol):
Nat Dr¢gnant, but pregnant 43 tlays Io 1 year
d. be(Me tledih
^ Unknown it
pregnant within the pest yea
r
30a. Was an Autopsy 30b. Were Autopsy Firstlings 31. Manner of Death 32a. Date of Inlury (Month, day, year) 32b. Describe How Injury Occurretl 32c. Place of Inlury: Horne, Farm. Street, Facfory
Perkamed? Available Prior Io Completion
N OMic¢ Builtling, etc. (Specity)
m copse m D¢am, ewral ^ rlpmmiee
Q
^ Acadant ^ Pentling nvesfigalion 32tl-Tme of Injury 32e. Inlury ai Work? 321. Il Trenspodation Inlury (Specity) 32g-'~acahor o` Injury ISVpeI, city! fawn, state)
^ Yes ~ ^ YeS ^ No
^ $uicitle ^ Goultl Npl be Delermine0 ~s
^Ves ^ No
^ Driver / Operator ^ Pas engen ^Petleslrian
M ^Oiher-Specity:
33a. Cedlfer (check only Orel 33b. Sgna!ura end `file o! GaNfi¢r
• Certifying physician iPhysicsan certifysng cause of tleath when another physician has pronounced tleath and compietetl liem 23)
To the best of my knovAetlge, death occurred due to the cause(s) end manner as staled_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ ,
• Pronouncing antl cartlfylnq physician (Physcian bosh pronouncing tleath and cenitying to cause of death)
t
^
d
d 33c. L'censa Number aid. pate Sgned IMOn(h. tlay, year)
manner as s
ate
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Ta the best of my knowletlge, death Occurretl al the time, tlate, and place, antl due to the cause(s) an
Metlical Examiner. Coroner ~O` OV 2G ~ ~ L Z r ( •G
Dn the basis of examination and I or investigation. In my opinion. death occurretl at the time, date, antl place, and due to the cause(s) and manner as stated- ^ A
;
' P
~ Name antl
nni
ddress of Person Who Gcmplel¢d Cause cl Death Ittem 2
'i iv, e
o
35-Regis:rars5 i Disiri Nynif~r 1
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~~~~ Fhed (Month. day. year) fihv~ /r~_ ~~ H,
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D b r~1o Gooo No>~ R/, Euo~~ Yn r7o z~
Disposition Permit No ~~ ~{- `~~~
Oath of Personal Representative
COMMONWEgj,TH OF PENNSYLVANIA
COUNTY OF CUMBERLA;~ ~ SS
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CPI
[71
I, CHARLOTTE W. QUIGLEY, of the Township of Dickinson, County of Cumberland, and
Commonwealth of Pennsylvania, declare this to be my Last Will and revoke any will or codicil
previously made by me.
ITEM 1: Upon my demise, I direct that my body be buried and not cremated in Lot No.
60(n), Section "E", Row 22 in the Mount Holly Spring Cemetery, Mount Holly Springs, Cumberland
County, Pennsylvania.
ITEM 2: I direct that all my just debts and funeral expenses be paid as soon as practical
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after my death.
ITEM 3: I direct that all taxes and interest and penalties thereon that may be assessed in
consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from
my residuary estate as a part of the expense of the administration of my Estate.
ITEM 4: I give, devise and bequeath all the rest, residue and remainder of my estate of
every nature and wheresoever situate, together with insurance thereon, as follows:
A. Seventy percent (70%) to my husband, EDWIN W. QUIGLEY. Should my husband,
Edwin W. Quigley, predecease me or fail to survive me for a period of thirty (30) days, I
give, devise and bequeath his share to my daughter, GWYN ZOOK or her issue.
B. Thirty percent (30%) unto my daughter, GWYN ZOOK, per stirpes.
Page 1 of 3
ITEM 5: Until distributed, no gift or beneficial interest shall be subject to anticipation or
voluntary or involuntary alienation.
ITEM 6: I appoint my daughter, GWYN ZOOK as Executrix of this my Last Will. If my
daughter, G`;TY*d ZOOK, Yredec:,ases me or elects rot to serve as my Executrix, I appoint my neighbor,
KIMBERLY A. HAGENBUCH, of 1461 Pine Road, Carlisle, Cumberland County, Pennsylvania,
Executrix of this my Last Will.
ITEM 7: I direct that my personal representative or her successor shall not be required to
give bond for the faithful performance of her duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, this J~ day of , 2004.
~ ,
~~ iu~`
HARLOTTE W. QUIGL
Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will
and Testament in our presence, who, at her request, in her presence and in the presence of each other,
have eunto subscribed our name as testing witnesses. ~- ~
K,~,~'' r1~~
~,~,~,~ esiding at L~.,
residing at ~y'(~ l 1' lh,~ f(~, ~CLt.~~ . ;~:'/{
Page 2 of 3
COMMONWEALTH OF PENNSYLVANIA )
ss:
j COUNTY OF CUMBERLAND )
~/ ~,t
We, CHARLOTTE W. QUIGLEY, ~G7 tfr'trt t~' and
_L
~~ ~ ~~,.. l y t`~r~ CJ'~~a k1 ~ c~ ,the Testatrix and the witnesses respectively, whose names are
signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she
had signed willingly, and that she executed it as her free and voluntary act for the purpose therein
expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as
witness and that to the best of his or her knowledge, the Testatrix was at the time eighteen (18) years or
older, of sound mind and under no constraint or undue influence.
~ ~ ~1.
CHARLOTTE W. QUIGLEY
1
Witness
~~ ~
fitness f: , ~
Subscribed, sworn and acknowledged before me I7;~t ~ Nom` l~- ~: ~,.~ -~._._- by CHARLOTTE
W. QUIGLEY, the Testatrix, and subscribed and sworn to before me by
l,t. t ,w% ~`, ~'ut ~ f E' ~~ and !~~ ~v~ /~ ` ' ~ v;~, the witnesses, this
,' ~ ~ day of /~ ,~ y , 2004.
1
,.---
Notary Public EAL)
- ~~ --
Page 3 of 3