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HomeMy WebLinkAbout03-20-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of Wdham C. Wilson also known as Deceased COUNTY, PENNSYL~,'ANIA ~, , ^-, File Number Q'+ 1 ~, %'~ ~~ ^~ ~ i Social Security Number 189-18-7239 Petitioner(s), who is/are 18 years of age or older, apply(ies) for. ~ ~~~ (COMPLETE 'A' or 'B' BELOW:) ~" ~ ~ - z -~~ ~•~ ~:. ~- - ~~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~---s rwramed in the last Will of the Decedent dated and codicil(s) dated ~ ~~:i - -~,.. :~ ~~ .~, ~ (State relevant circumstances, e.g., renunciation, death of executor, etc.) -~ ----1 Y O Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the instrumaut~s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ©/ B. Grant of Letters of Adm-nistration (If applicable, enter: e.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; daraate rninoretate) Petitoner(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 Adminisrratioiz, e.t.a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Name Relationship Residence Kenneth E. Wilson Brother 429 Hogestown Rd., Mechanicsburg, PA 17050 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 429 Hogestown Rd., Mechanicsburg, Cumberland County, Pennsvlvania, 17050 lLi.rt sweet address, town/city, township, county, state, zip code) Decedent, then 84 years of age, died on January 5, 2009 at Claremont Nursing & Rehab, 1000 Claremont Rd., Carlisle Pennsvlvania 17013 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 2,000.00 (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 20,000.00 situated as follows: Citizens Bank and 429 Hogestown Rd., Mechanicsburg, PA 17050 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 foam to the undersigned: Si nature T ed or rinted name and residence Kenneth E. Wilson, 429 Hogestown Rd., Mechanicsburg, PA 17050 Form XW-0? rc-v 10.13.06 Page 1 Of 2 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 Decedent, Petitioner(s) will well and truly administer the estate according to law, Sworn to or affirmed and subscribed before me the ~~ day of h~ -v~~~ ,~`~ ~-^ For the Register C7 ~:~: Signature of Personal Representative ~> ~ `- _+ ~~ ". 1 Signature of Personal Representative Signantire of Personal Representative r, ~-,~ .;7 J :.- ,o y File Number: ~ '' ~`"A 'u~ 1 ~' -a state of William C. Wilson Deceased Social Security Number: 189-18-7239 Date of Death: January 5, 2009 c_ AND NOW, L' (~r"G~l, ~' ~ , in consideration of the foregoing Petition, satisfactory- proof having been presented before me; IS DECREED that Letters Administration are hereby granted to Kenneth E. Wilson and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s). of Decedent. FEES Letters ...:~~ ~ ~ ~~' .. $ ~r Short Certificate(s) .. l..... $ `'~ Renunciation(s) .......... $ ,..~ •$ .,. $ .. $ ... $ ... $ ... $ TOTAL .... .. $ ~ lc~~` °-°e-. Attorney Signature: Attorney Name: `` sa Marie Supreme Court I.D. No.: 53788 Address: 3901 Market Street ~~ C7 °~, in the above estate ~~_ Camp Hill, Pennsylvania 17011 Telephone: 717-737-0464 Fonr~ RW-0? rev. 10.!3.06 Page ` Of r`~~F;~Jt~~: t is i1ie~~j:; ~~ r_ls~pi(_;~te the s: cad, ~sy phc~it~s3~t c~~° ~~:'r~°.a ~' ~~U i~ ~3(~ . ,.'. . REVlvzoas PRINT IN ANENT ~K INK gyp, n r '~:~, 4 _ "~~, ; ,~ v`"; ~.~ ~, a$~a r` •~= ~ ~ i L 1 .2 .1 gay. .~ ~', ,~~ y +' COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) rv.;: C~ <Y o -: t~, = ~ = v1_ ~ A) -:.a r f~T7 .-/ k _ i~ ' _ _ ~~ D ~ ~, Q - ~ ~ ."`f _ ,. Name of Decedent (Fvst, midtlle, last. suhixj 2. Sex _.. .._,.__,.., ~.. 3. Social Security Number ..~. ~ U... ~ i .. 4. Date of Death (Month, day. year) William C. Wilson male 189 -18 = 7239 Jan. 5, 2009 5. Age (Last Birthday) Under 1 year Untler 1 tlay 6. Date of Ridh (Month, tlay, year) 7, Birthplace (Giry and state or foreign country) 8a. Place of Death (Check only one) 84 I,fe Morons Days Hcurs Minmes Sept.4,1924 West Fairview,PA HospitaC Other. ^mafient p ^ ER /Outpatient ^ DOA Nursing Home ^ Resitlence ^Other -Specity. Bb. County of Death 8c. City, Boro, Twp. of Death gd. Facility Name (It not mslilutlon, give street and number) 9. Was Decetlent of Hispanic Origin? ~ NO ^Yes 10 Race American ':ntlian Bla k Wh t t Cumberland Middlesex Twp , . , c , i e. e c. (If yes, Specity Cuban, S i Claremont Nursin & R h b ie~ . g e a Mexidan,PuertoRican,alc) w~ e 17. Decedent's Usual Occu elan Klnd of work done durln most of w¢rkin Ille. Do not slate retired 12. Was Decedent ever in the 13. Decedent's Education (Specity only highest grade completed) 14, Marital Status: Married, Never Married, 15. Surviving Spouse (I'svrte eive maden name Kintl of Work I(mtl of Business I Intlustry , ; U.S. Armed Forces? Elementary I Secondary (0-12) College (1-4 or 5+l Widowed, Dlvorcetl tSpeciryl house ainter aintin Yaa ^Nd 12 never married tb. Decedent's Mailing Address (Street, cny r town, state zip code) 1000 Clare o t Rd Decedent's Did Decedent M i d d 1 e s e x Actual Reamende ,7a State Penns vlvania ^vema ,7c ~vea Decedent Ltvetln m n . Carlisle PA 17013 Township? 7 p. ,Ib. County Cumberland 17d ^No, Decedent Lived wither , Actual Limns of Gtv Borc _18. Falheis Name IFirsi, middle, last, suiilx) 19-Mother's Name (First. middle, maiden sumeme) Earl Wilson Minnie Zeller 20e. Iniprmant's Name (Type / PnnQ Kenneth Wilson 20b, tnlormant's Malting Adtlress (Street, city /town, stale, zip cotle) 429 Hogestown Rd.,Mechanicsburg,PA 17050 21 a. Method of Oispositidn ^ Cremation ^ Donation eddal ^ Removal from State !Was Cremation a Donation Auth ized 21 b. Dale of Disposition (Month, tlay, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 21tl. Location (City /Town. slate. zio code) or ^ that -S ecity j by Medical Examiner I C roner4 ^ ^ Jan . 9, 2 0 0 9 S l a t e H i 11 C em e t e r y h i r e m a n s t o wn P A p o Yes No • , 22 Nrµnf Funer I Se licensee (or person acririg as such) 22b. Ucense Number 22c. Name and Atltlress of Facility ~/ FD-013163-L Musselman FH&CS,324 Hummel Ave. ,Lemoyne, PA 17043 Complete Items 23ac only when cenitying 23a. To he best of my knowledge, th occurtetl al the time, sate end place staled (Signature antl title) 236. License Number 23c Date Signed (Monet day yearl physroian 6 not available al lime of death to cedltycauseeldeath, - q - 6H ~~ Y ~ =~~ %~ t ' ~ , ~. ~r.. c.,-. .7V . P.~ :~~ ~ 4L '-.~L- ~~/lN1~t Al~y ~~5 .li`C. `. Items 2426 must be compleletl by person 24. Time of Death 25. Date Pronounced Dead (Month, tlay, year) 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other Ilan :remotion or Donationc who pronounces death ~I ~'~ M' ~ ,f JC;, b11.lG~,yv C~5 r ^Yes ty~No CAUSE OF DEATN (See Instructions antl examples) r Approximate interval: Item 27. Pan I Enter the chain of events -diseases. ~niunes or complications - that directly caused the tlealh DO NOT enter terminal events such as cardiac a est Pan II: Enter other ' iii n " omnb t rig to tlealh, 28. Did Tobacco Use Contribute to Death? , . rr , Onset to Dealn IaaPlrafPly Brf¢el, Of YBn(flCUlar f~IIBtIdn Wihall 6hoWng (hB BI10¢gy. Llat IXly OnB CBaae On each line. but not resulting in the underlying cause given In Pan I. ^Yes ^ P•obably Q Np ^ Urkm¢wm IMMEDIATE CAUSE (Final disease or corbifron resulting In death) .~ a 1 hj P ~ I l~tOv.1 29. II Female. Due to (or as a consequence o(f: ~ ^ N¢I pregnant vnrhm east yea' Sequentially list conditions, rf any b. ®~ fti(`i ht T(A leadeng ld the cause listed on line a. ^ Pregnant at time of tlealh Due to (or as a copse Enter the UNDENLYING CAUSE quanta off: ^ N¢I pregnant, but pregnant wnnin 42 days (tllsease or injury that initlafed the c t events resulting to death) LAST. r of tlealh Due io (or as a consequence op. ^ Not pregnant, but pregnam c3 tlays to i year d [] Unknown al pregnant wunin the past veer 30a. Was an Autopsy 30b. Were Autopsy Findings 31, Manner of Death 32a. Date of InJury 1Monih, Uay, year) 32b. Describe How Injury Occuretl 32c-Place al Ina Home Farm Street Fa t Performed? Available Pngr Ip G¢mpleGOm [~ Natural ^ Homicide , , c c Office Builtling. etc. (Spealyj ry of Cause of Death? ^ Yes ~ No ^Yes ^ No ^ Acmdent ^ Pending Investigation 32d. Time of Iniury 32e. Injury at Work? 32C If Transponadon Injury (Speayyf 32g. Location of tnlury (Street, city/town. stare! ^ Suicide ^ Could Ida be Determined ^Yes ^ Ne ^ Drwer I Operator ^ Passenger ^Pedesirian M. ^Olher-Specify: 33a. Certifier (check only one) 33b. Signature and The of Cenifler • Cenliying physician (phystctan cennying cause of deatn when another pnysktan has pronouncatl tlealh and completed Item 23) To the best of my knowledge, death occurtetl due fo the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Pronouncing and cenjiying physician (Physician both pronouncing tlealh antl terrifying to cause M death) 33c. License Number 33a Date Si ned (Month tla rl To the best of my knowledge, death occurtetl at the time, date, antl place, antl due to the cause(s) antl manner as statetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ . g . y, yea • Medical Examiner I Coroner M rJ _ O ~ ~{'{ - L I _ `J _ O 5 On the basis of examinallon and I or invesflgetlon, in my opinion, tlealh occurred at the time, tlale, antl place, and due to the cause(s) and manner as statetl_ ^ 34 Name antl Address of Person Who Compleletl Cause D ih Ihem 27) Type /Print 35. Ragisir gnature and Dr~ii)'!y / ~ C;~ e~ ICI I "~! 1 ~ 36. Da a Filed (Month, tlay, year) . EAU gs ~ M - SOS gFr ~D / 7 ~ ~ 1130 [~vo~ ~o~ 2p ~uoL.A1 P~ t~oLs ----.__~_._..,_ n_3ny~5o