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HomeMy WebLinkAbout04-28-09PETITION FOR PROBATE AND GRANT OF LETTERS Register of Wills of Cumberland County, Pennsylvania Estate of KEVIN M. EDDY File No. ~-C -[~' ~ ~`N~ _ Deceased Social Security No. 379-56-9504 VICKI A. EDDY Petitioner, who is 18 years of age or older, applies for: (COMPLETE "A" OR "B" BELOW:) ^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the named in the Last Will of the Decedent, dated and codicils(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 adopt the instrument(s) offered for probate; was not the victim of a killing and was never adjudicated an in; ~ r- ~ '~ ex~'cutlo% of-. te~ersnn ~~ -~~ ~ ~~ , B. Grant of Letters of Administration ~ cn (if applicable, enter: c.t.a.; d.b.n.c.t.a.; pendent elite; durante absentia; durante minoritate Petitioner, after a proper search has ascertained that Decedent left no Will and was survived by the heirs listed below. Vicki A. Eddy, requests that Letters of Administration be granted to her, the Petitioner, Vicki A. Eddy, the Petitioner, who is the Surviving Spouse and Sole Heir of the Estate Name Relationshi Residence Vicki A. Eddy Spouse 311 Walton Street Lemo ne, PA 17043 (COMPLETE IN ALL CASES): Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 311 Walton Street Borough of Lemoyne Cumberland County Pennsylvania 17043 (List street, address, town/city, county, state, zip code) Decedent, then 56 years of age, died on March 14.2009 at Holy Spirit Hospital, camp Hill, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property .....................................................................$ 4.040.00 (If not domiciled in PA) Personal property in Pennsylvania .....................................$ (If not domiciled in PA) Personal property in County ....................................................$ Value of real estate in Pennsylvania ......................................................................................................................$ Total ......................................................................................................... $ 4.040.00 Real Estate situated as fol Wherefore, Petitioner respectfully requests the grant of Letters in the appropriate form to the undersigned: Si nature T ed or rinted name and residence Vicki A. Eddy 311 Walton Street Lemoyne, PA 17043 ~' Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF The Petitioner above-named swears or affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law. Sworn to and affirmed and subscribed Before me this ~~ day of ~- 2009. ~~ ~- ~ ~~ ~ VICK/A. EDDY <~ c._. O r _n :s c~ ~~~~ .-:: -;., - ~~~ -, J` _:~ n File No. ~ ~ ' ~~ ~ d~0~ Estate of KEVIN M. EDDY ,Deceased. rn Social Security No: 379-56-9504 Date of Death: March 14, 2009 AND NOW, a~~ , 2009, in consideration of the foregoing Petition, satisfactory proof having been presen ed efore me, IT IS DECREED that Letters of Administration are hereby granted to Vicki A. Eddy in the above estate. FEES Letters ........................... Short Certificate(s) Renunciation .............. Affidavit ( ) .................. Extra Pages ( )....... Codicil ............................ JCP ee...................... Inventory ...................... Other .............................. TOTAL......... ~ ~(~-(~ $ $- ©o S S~ S $ ~,0~ s R 53~~ r~ ~~ ~ v Attorney Signature: Attorney: RALPH H. WRIGHT, JR . I.D. No: 56113 Address: Johnson Duffie Stewart & Weidner, 301 Market Street P.O. Box 109 Lemoyne, PA 17043- Telephone: 717-761-4540 ---~-- .o ',; s~ f -w ~_ ~ ~- N n - ~~~ ~ ~. C ~ xp ~. ~=, ~--, IIIi.Sr15 KGA' HIIrO') LOCAL REGISTRAR'S CERTIFICATION OF DEAT'F~ WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 This is to certify that tht~ information here given is correctly copied from an original Certificate of Death duly filed with me as Lucal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. P 1518014 /~ Certification Number Local Registrar ate slue nor +7 n _ _ _ __. _. _ ._~ ~ y. ~-- , 1 ~ _. __ , - __ - - -- . ayr __ t ~ .. '` ~1 ~ f «Tt ~ - ~~ ~ ~ _ ---I D t.T] . aEV nrmoe COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN CERTIFICATE OF DEATH IAN~NT rces,w lnnfrurtFens and examples on reverse) CTETF FII F NI IMRRR 2. Sex 3. Social Seanry Number 4. Date of Death (Monts, day, year) 1. Name a Decederd (Fret. midde, lest. 5ullix) ~ Male 379 - 56 _ 9504 March 14, 2009 Kevin M. Edd 5. Age (Last eirmmyl Under t year Under 1 day 6. Dale of Birth (Monts, da , r 7. Sultplece (Ci and state a lorebrt cou 1 6a. Place of Deelh (Check on one) char: ,bwre 0.y Hums kxnao Hospital: Augl3St 19, 1952 Kalamazoo, MI ®Inpaient ^ERlOulpelient ^p0A ^NUrsing Home ^Residence ^Other Spaciry: 56 • Vrs gp Caordy a Death fic. Ciry, Boro. Trop. a Death Btl. Faddry Name (II nor mstdaion, give slrea end number) 9. Wes Decedent a Hispanic Origin? ®Ne ^ Yes I D. Race: American IMian, Slack, WMIe, etc. (It yes, specify Cuban, (~iM Cumberland E. Pennsboro Twp. Holy Spirit Hospital Mexaen,PueraRican.etca white 11. Decetlerx's Usual lion Kind of work Oota tlun most d lea. Do not state refired 12. Was Decedent ever in the 13. Decedents Etltaanon (Specify anry Highest grade completed) 14. Martial Status: Marnetl, Never Monied, 16. Surviving Spouse (II wife, give maiden name) Witlawetl, Divorced (SPeoM U.S. Armed Forces? Elementary / Secontlary (612) College 11-4 ar 5+) Kaxtawak KiMOIBusirass/lydustry Vicki Ann Fanus 12 Married ^ ®r4 res ^ Mena er Rentals • ,s. Decedenra Melling Atldress (sneer. pity /town. state. np gods) Decedent's Did Decedent Pennsylvania Mme in a I Tc. ^ Yes. Decedent ~wea in Twp Actual Resaence 17a. State 311 Walton Street Township? nd.~NO,l3ecetlenuivetlwnhin Lemo ne Cumberland Y ci rS Lemoyne, PA 17043 ty aa t7b coanry Acraal Limas p, 16. Father's Name (First, midde, lest. safix) James Malcolm Eddy 19. Momer's Name (First, midde, maiden surname) Priscilla Ann Burden 26a. InfomanYS Name (Type / Prtnt) 26b. Informant's Meiling Addreu IStreel, city I lawn, smte, zip code) Vicki A. Eddy 311 Walton Street,•Lemo ne, PA 17043 27a. Method a Dis{xai6m i ®Cnemation ^ Donation 21b. Dale d Dieposdion (Month, day, year) 21c. Place a Dieposilion (Name of cemetery, crematory or otller place) 21tl. Location (Coy 1 town, scale. zip cotle) ^ &rlial ^ Removal Iron State 'Was Crmatbn ar Donetlon Authorized 2009 March 16 ? ®v ^N • ~ Evans Cremator Schaefferstown PA 17088 , p es byMadleelExemlrter/Coroner ^ omar.~;y. ~ 22e. F Servkx License (a person ailing as such) 22b. Utxnee Number 22c. Nerve and Address of Fedidy FD 012 848 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 -~ - • ~ _, ._ Caryba hems 23ac only rodeo ca^M~^9 23e. To Me best of my kmwbdge, deattt r fine, a arts rated. (Signature end title) 23h. License Number 23c. Date Signed (Month, tlay, Year) physlaan is rot available 91 aura of deem a .' ~ N ~ r `, ~~ ~ L ~~,~ ~ >/~ ~ C![:i `~' ' candy cause a seem. ttC~X~ `- to Medaal Examiner I Coroner for a Reason Other than Cremation or Donation? ned Time of Death 26. Del raaunce0 Deetl (MOnm, day, year) 26. Was Case Rele 24 ~ ~ . Items 2426 must ba carpeted by person • eta Dronaxxes deem. /~'1 . S ~,M. ~ ~t-C ~ (`1 (~9 ^ Yes IIG1YO CAUSE OF DEATH (See Instructiane end exempbs) , Apgozknele imerval: Part II: Enter other sanaiL r cordtliora contribuem to tleam, iven In Pant th nderl in cause tli i b 26. Did Tabayco Use Contribute a Death? ~~Vp% ^ Probably Kern 27. Part I: Eder the n~9pALgYE015 -diseases, injunee, a ConplicelioM - that daectly reused aw death. DO NOT enter terminal evenN such as wrtliec artem, i Onset Io Death . e u y g g ng n ut not resu k U respiratory anent. a venlriLUlar IibrDalbn valour stowing the etblogy. Usr Doty one cause on each line. r nown n ^ No ^ r IYNEDIATE CAUSE IFnel tliseese a - q (( t _ f 1~YLcL, r n m) ( .. a~i ~C ~Gt ~1 ~ ~ l col wrtdaion reaul& l~~ l ( ( ~ ~/ 29. If Fcmak: ear re nant within pass ^ Nol g , . . r , . i _~ a. / )7 Due to ar as a consequence off: r y p g Pregnaa al time of tleam 1 o ^ditims q a^ fi S lN 11 • e o equen 5 Y~ b. ~ Iaadxq m the cause fiend on kra a. pus to (a as a consequence oq: ~ r Ender f}te UNDERLYING CAUSE (dtreaze a njury mat ialieletl the ~ ^ Not Pregnant, but Pregnant withn 42 days of death c creme resaang a eeemt usr. , ^ Na Pregnant, but pregnam 43 days l0 7 year Due ro (or as a consequence op: r before death ^ Unknown II pregnant wphin me pest year tl. 36a. Was an AMOpsy 36b. Were AMapsy Fetdngs 31. Manner of Deam 32e. Dale of Injury IManm, day, year) 32b. Oescdtie How Injury Occurred 32c. Place of Injury: Home. Farm, Street, Factory, Oxice building, etc. (Speaty) Penormetl? Available Prbr Io Campletbn ^ NaWrel ^ Homicide of Cause of Deam? ^ Aeeaenl ^ Pentlirg Irnesagalbn 32d. Time of Injury 32e. Iryury at Wane? 321. If Tranaponelbn Injury (SpeayJ 32g. Laatmn a Injury (Street, city! tarn, sate) ^ Yes ^ No ^ Vas ^ No ^ Yes ^ No ^ Driver I Operator ^ Passenger ^ Pedestnen ^ Suicide ^ Coultl Not be Detennkad M purer ~ SpeaTy: 33a Cereaer Ictack anti o"el 23 re aM Title a CeNAAr 7~ ~ ~ 1 ) • CsrtiyNg gtydclrr (Physcian cedityrg rouse of deem when enaner PMdcie^ has prorauraed death era congleretl Item ___ ^ _ nM ea eWad d h iA Lc / .,( / ~YG • / ~~ . -' J( J _ .______~____________________ mN e CaaaNe)M TO tM beta my lorowledge,deeUI OCCURed dUe lO t • Pmwurdng and aertllYing phyefaen (Physidan bah pronouncing death aM cendyirg a cause of deem) ^ t t d d • 33c. License Number 33d. Dale Signed (_ m. tlay, yeah) " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ manner ae a e e To tla beW a my lotoaded9e, eeedt occurred at the Hme, dNe, eM place, eM dce to the ceueelc) an .. ~` , - ~=- ~j S .~ /s a tAedkel Examiner 7 Coroner On the heeh a exuMnslbn and I or inresdgetbn, In my opinion, deem occurtad M pee tlma, date, end phce, end due to the pueele) end manner ore Wtad_ ^ ersm WM Completed Cause a Deem (Item 271 Type / P t P 34. Name and Address a ~ /I . "_". ( ''ry ~ 36. Rrgsl Nre acrd N Idl ~I~I ~ I' I 36. Dare Fibd (Mon ,day, Year) , 9 3 1.16-~ .'I's7i(t ..r .~~m , j ~ ~ `~yj z dL,;tet:4 d~"~ s.-x,~- , ~i(!.; rr~u i%~ii ~ !D Dlsoosaion Permit NO. L~: l: J 23G`~l