HomeMy WebLinkAbout05-21-09PETITION FOR PROBATE AND GRANT OAF' LETTERS
REGISTER OF ~l~'ILLS OF ~[.,~.,i.~.~ ~`~~~9-u~~ COLTN"TY, PE~~;SYL~'~i`;I~
Estate of __ _ ~ `_ ~ ~/^ ~~-/ ~ C3'Le%- L File Number _~c ~`% ~'~7 7~
also known as ~ o~~~'-f2,(~ L CS"G[Jl?J
Deceased Social Security Number ~ ~ ~ ' Z ~- ~~ ~ 7
Petitioner(s), who is/are 13 years of age or older, apply(ies) for:
(CO;LIPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the C~~ /' (.~ "t~jlL named in the
last Will of the Decedent dated ~ ~ ~ - -]S/ and codicil(s) dated
~°1 L-?
O
(State relevant circumstances, e.g., renunciation, death of executor, etc.) ~ ~ ~.~
'Z7 -
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of t~tt3ttume~s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: • \ ' L-" N ~ •
`n ~ --
~~:
~_, __ ~
^ Q. Grant of Letters of Administration - - t ~:
(IJnppticabte, enter: c. t.a.,, d. b. n. c.t.a.: pendenre lire; durarue absentia; durnnte-l+i~noritate) ~
-p - ..
Petitioner(s) after a proper search has /have ascertained that Decedent left no Wilt and was survived by the: following spouse (if any) ~ heirs: (If
Administration, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
~ Name Relationship Residence I
(CO,YIPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in C~ u-/~taL-7l [1~k4 County, Pennsylvania with his /her last principal residence at ~ ~~
_ (,.~.~.~~ici`r .S~t' l.4MF!_ _,lft LG ~ A Cu>yzi~~i~ ~ .o..v/J ~c+~-•~15r i ?C~~l
(Listshee[ address, town/city, township, coeurty, stale, zip code) ~ /
Decedent, then ~ years of age, died on j t ~ S YF ~d ~ ~-~-~,
Decedent at death owned property with estimated values as follows: _'SL ~
(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 $ 7 c5 ~ U
situated as follows: 171G~ (,~ /~-CNe.-~ S ~ ~l'~/`~ !T/LG ~u.~,~.~~-rte ~-i~/' ~~~, ~/`~ l~C~~/
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:
Sign/azure Ty ed or printed name and residence
d ~ ~~~~ T ~ 'T,
Form R4V-0? rev. 10.13.06 Page 1 of 2
Oath of Personal Representative
C0~4~IONWEALTH OF PENNSYLVANLA
• SS
COUNTY OF ~ ~~ ~_
'The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are five and con~ect to the best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, f etitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~ /cSf day of
rt _ aoo~
For _ e Register
Signa ure of ersona(Representative ~ ~`~='
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Si„onature ojPersonal Representative 'T~ [r ~ ~--~
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Si~nnture ojPersorlal Representative `~> {' ". g"•
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File Number:
Estate of ~~ ~~ ~ ~% ~ . ~i ~1 r ~ ~ (~ _ ,Deceased
~y J/ _ -7 J
Social Security Number: ~ / 02 ~~ `f ~ ~ / Date of Death:~~, ._
AND NOW, ~ ~S~~LLa t~ ~I~ , ~_, in consideration of the foregoing Petition, satisfactory proof
having been presented before me, I IS DEC D that LettersT S ~Q.{'1~`li° ,1~1
are hereby granted to \~ (C.(J Y )t` ~ 1 l •^ ( OI ,f f" 1 ~,f..f ~...J
T^
in the above estate
and that the instrument(s) dated ~ ~ __
described in the Petition be admitted to probate and filed of recor~ as the last Will (and Codicil(s;i) o~Decedent.
FEES
Letters ............... $_1
Short Certificate(s) ........ $~
Renunciation(s) .......... $
... $~
.. $ ~.~
... $
.. $
... $
... $
... $ ~~
TOTAL .............. $~y~
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Furw RvV-U_' rev. 10.13.0( Pale 2 of 2
Attorney Signature: ^~
OCAL REGISTRAR'S CERTIFICATION GF DE/~TH
WARNING: It is illegal to duplicate this copy by photostat or hhotogra~ll°.
(=ce 1in ?hip certfticale_ ti(,_OU
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This i~ ~:u c•erti!t. th,t tie inli)nnation !sere given is
eul)e~tly copied~l~of~~ an c Irz' Hal Cutifirate of IDeath
duly filrci ~+~ith nx •w, I_,o~ ~i Keg)strar. The original
ccrtifir(te ~~~;11 bL IL r•,uru;it~d to the Stale Vital
RecorLl; OItice fu p r;~~an~nt Cilin~~.
-~~ m. •~ ~a~s~z`~ MAY 2 20
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Lucal Re~~)~tr,u Date. l~`,ue~l
C:rtilir:)titm 'Number
ITEM # ~ / ~.
SHOi_fI.D READ AS FOLLOWS:
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Ev tritons COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
NENT" CORONER'S CERTIFICATE OF DEATH
K lNK (See instructions and examples on reverse) STATE FILE NUMBER
1. Name of Decedent (Flrst middle, last, sunixl 2. Sex 3. Soual Security Number 4. Date of Death (Month, day, year)
2009
May 8
F
l
,
ema
e 1 72 24 ~ 901 7
Beverly C Gurley
5. Age (Lass Birthtlay) Under 1 year Under 1 day 6. Date of BiM (Month, tlay, year) 7. Sinhplace (City and state or foreign country) fia. Place of Death (Check only one)
Mmms Days wours Mm~nea Hospital: Other:
81 June 6, 1927 Lemoyne, PA ~npatienl ^ERIOutpatient []DOA ^NUrsing HOme ^Resitlence ^OMer-Specity.
Yrs.
County of Death
8h Bc. City, Bo Twp. Death Btl. Fadllry Name (If not inamnion, ghre street antl number) 9. Was Decedent of Hispanic Origin? r7 No ^ Yes 1D. Race: American Indian, BIacK, White, etc.
`3Y
.
Cumberland East Pennsboro (sDa~i~
Hol S irit Hos ital mre5, sp~N D°ban,
y p p Mexkan, Puerto Rican, elc.l Wh l e
11. Decedent's Usual fion Klnd of work d one dun most of workin life. Do not state retired 12. Was Decedent aver in the 13. DecedenYS Education (Specify only highest grade completed) 14. Marital Status: Married. Never Married, 15. Surviving Spouse (If wife, give maiden name)
Widowed
Divorced (SpeciM
Kind of Work KiM of Business I Industry U.S. Armed Forces? Elementary /Secondary (042) College (1-4 or 5+) ,
d
id
house wife ^Yas ~Nq 14 owe
w
16. Decedent's Mailing Address (Street city /town, state, zip code) Decedent's Did Decedent
Slate P A Live in a 17c. ^ '/es, Decedent Livetl in Twp.
Actual Residence 17a
171 O Walnut .St. .
Township?
,7bcgi,nty Cumberland 17d.~]vq,DexedentLNedwithm Camp Hill
C
8
Camp Hill, PA 17011 oro
ity 1
4dual Limns of
16. Earner's Name (First, mddle, last, suKx) 19. Mother's Neme (First midtlle, maitlen surname)
Richard H. Steinmetz Sr. Sara Conroy
2Ca. Informant's Name (Type / Pnnq ZOb. IMormanYS Mailing Address (Street, city I town, sate, zip code)
Stephen C. Gurley 1710 Walnut St. Camp Hill, PA 17011
27a. Methotl of Dispositon ! ^ Crametbn ^ Donation 21 h. Date of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory a other place) 21 d. Laatbn ICIry I town, state, zip cotlel
~] Banat ^ Removal from Slate w tlon or Donation Assthodzetl May 13,2009 Camp Hill Cemety Camp Hill, PA
^ other ~ Speory: ; by Iwl emfner I Coroner? ^ Yes ^ No
22e. SI re of F eml Service L a 'rg as su ) 22h. License Number
011248E 22c. Name and Adtlmss of Facility
Musselman FH&CS Inc. 324 Hummel Ave.Lemoyne,PA
~
Complete Items 23a~c oMy when cedirying 23a. To the best o y krowledge, tleath occured at the time, tlate and place stated. (Signature antl title) 23b. License Numbe ~ 23c. Date Signed (Month, tlay, year)
physician is rat avanable at tone of tleath to
cemry cause of tleath
Time of Death
24 26. Date Pronounced Deatl (Month, day, year) 26. Was Case Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation?
Hems 24-26 must be completetl by person .
00 P
10 2009
8
Ma Yes ^Nq
who preraurces tleath :
. M ,
y
CAUSE OF DEATH (See Instruetlons antl examples) r Approximate Interval: Pad II: Enter other cyigplQr~t condTOns caniriout ng to death, 28. Ditl Tobacco Use Contribute to Death
Item 27. Pan 1: Enter the churn of events -diseases, injuries, or complications -that directly aiuetl me death. DO NOT enter terminal everns such as cardiac aresr, i Onset to Death hul not resulting In 9ie underlying cause given In Pan I. ^ Yes ^ Probabty
respiratory arrest, or ventricular fibrillation without showing the etiology. List onW one cause on each line. t ^ No ^ Unkrawn
IMMEDIATE CAUSE IHnal disease a r 29. If Female.
condition resumng in ath)
Head Trauma
a ^ a
m
ithin
ea
ea
t
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.
Due to for as a consequence op. pragna
w
p
y
r
n
^ Pregnant at time of tleath
Sequentially list ixxWdans, if any, b
Fall
r
.
leadingg to the cause ksted on line a Due to (or as a consequence oT): ^ No1 pregnant, but pregnant within 42 tlays
Enter the UNDERLYING CAUSE i of tleath
(diisease or u Nat mitiatatl ttte
c
events resutl ng in tleath IASL ~
Due to for as a consequence ory. ^ Nol pregnant, but pregnant 43 tlays to 1 year
cetore death
d. ^ Unknown II pregnant within the past year
30a. Was an Autopsy 3db. Were ANopsy Findings
u
c 31. Manner of Death 32a. Date of Injury (Month, day, year) 32h. Describe lbw Injury Occuretl 32c. Place of Injury: Home, Farm, Street Factory,
onicel3mltlmg,eb.(specityk
l
Perlomied? gmpe
on
AyanaaePriorto
of Cause of Death? ^Nawral ^Hgmicide May 7, 2009 Fell in hospital ospita
r.~,t Accident ^ Pending Imesligadon 320. Time of Injury Ap rX 32e. Injury at Work? 321. It Transpatalion Injury (Specity) 32g, Location of Injury (Street city! town, Gate)
^ Yes IN No
T` ^ Yes ^ No
^ Suidde ^ Ca10 Nol be Determined
^ Yes ~ No
^ Dnver I Operator ^ Passenger ^ Pedestdan
N • 2 1St Street , Camp Hill , P a .
4:00 P . M. other specityr
33a Certifier (dreck onty one) 33b, Signaure aM C '
C o r one r
• Certdyinq ptryslckn (Physician ceniying cause of death when anoMer physician Has prwaunced death antl completed Item 23)
death otturrad due to the cause(s) and manner as ateted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
knowledge
To the best of m ~
y
,
• Proraundng and oedMying physldan (Physkien both Dronouncing death and certlfying to cause of death)
^ 33c. License Number 33d. Dale Slgrtetl (Month, tlay. year;
To the best of my krowledge, death occurred et the time, date, erM dace, and due to the cause(s) antl manner ee stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ May 11, 2 00 9
• Medial Examinerl Coroner
On the Dasls o1 examinatlon antl I or investlgetion, in my opinion, deem occurred at the time, date, and place, and due to the cause(s) and manner as stated_
~a~ ~~p qdd p~~ y~o ~om~ ~atl ~ akpa 1' 7y T Print
34.
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36. Register's S' lure and Dist ~ _) ~ ~ ~ /
'` I I I I I 36. Date Filed (Monet, tlay,rarj
~=
" 6375 Basehore (toad, Suite Ill
PA 17050
chanicsbur
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Disposition Permit No. 1, ~ ~.e{ T ~ '~
=• ~ ~~ L A S T W I L L A N D T E S T A M E N T
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_ cv u1-~.' BEVERLY S. GURLEY
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~'` ~"~ I, BEVERLY S. GURLEY, of Cumberland County, Pennsylvania
declare this to be my Last Will and Testament, hereby revoking and
making void all Wills, Codicils, or writings in the nature thereof
by me at any time heretofore made.
ITEM I: I direct that the expenses of my last illness
and funeral shall be paid from my estate as an administrative
expense.
ITEM II: I give, devise, and bequeath all my rings
and other jewelry unto my daughter, Melissa 5. Gurley Hoy, of
Lemoyne, Cumberland County, Pennsylvania.
ITEM III: I give, devise, and bequeath all the rest,
residue and remainder of my estate unto my beloved husband,
Robert G. Gurley, provided that if he dies before the thirtieth
(30) day following the day of my death, this gift shall lapse or
be divested and I give such property to my issue in equal shares,
per stirpes.
ITEM IV: No interest of any beneficiary under this
Will or any Codicil hereto shall be subject to anticipation or
voluntary or involuntary alienation.
ITEM V: In addition to powers given him by law, my
Executor and his successor shall have the following powers, appli-
cable to all property held by them, effective without Court Order
''
'~ ( SEAL )
BEVERLY. GURL Y
Page one of two typewritten pages
and until actual distribution:
(A) To retain any property received by him;
(B) To sell real estate for any purpose, publicly or
privately, for such prices and on such terms as he deems proper,
without Iiabiiity on the purchasers to see to application of the
purchase moneys;
(C) To compromise Controversies;
(D) To distribute in cash or kind or both at such
valuations as he may fix.
ITEM VI: All taxes, interest, and penalties thereon
payable by reason of my death with respect to property comprising
my gross taxable estate, whether or not passing under this Will,
shall be paid from the principal of my residuary estate.
ITEM VII: I appoint my husband, Robert G. Gurley,
Executor of this Will. If he does not act or continue to act, I
appoint my son, Stephen C. Gurley, Executor in his place with the
same powers and duties. No fiduciary acting hereunder shall be
required to post bond or enter security in any jurisdiction.
IN WITNESS WHEREOF, I have set my hand and seal to this
my Las t. Will and Testament, consisting of this and one other page
at the end of which I have also set my hand and affixed seal
for greater security and better idexitification, this ~ day of
;`r
A.D., 1974.
(SEAL)
BEVERLY S GURLEY
We, the undersigned, hereby certify that the foregoing
Will was signed, sealed, published and declared by the above-named
Testatrix as and for her Last Will and Testament, in the presence
of us, who, at her request and in her presence, and in the presence
of each other, have hereunto set our hands and seals the day and
year above written, and we certify that at the time of execution
thereof, said Testatrix was of sound and disposing mind and memory.
Page t~ao of two ty +Y ritten pages
Residing at _=~~c'a ~ ~.~ ~~P
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°vv~~ Residin at '2'-~5 ~~~.S.,v~~ ~~,,,`~ ~~ti~~~~.
OATH OF NON-SUBSCRIBING ~VITNE,SS(ES)
REGISTER OF WILLS
~., -~.uo COUNTY, PENNSYLVAN[A
~ i - 0 q ~ d ~17C~
Estate of ,~ ~ v
Deceased
J^v E-~-~v ~~o
/.r-,
and ~(C~/-~-r~~~ `'-/~I-f~i~.~~Z~,
(each) being duly qualified according to law, depose(s) and say(s) that she / he / the was / ere well-
acquainted with /.~ c~/J~~~. y S C ~- c,c!2L ~ and am/are familiar
with the handwriting and signature of the decedent, and that the signature of _~c~i ~~2,C ~ S tc~~~
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~ ~v~'~c w~ ~~
is in his/her own proper handwriting.
(Sr, iatureJ
(SG ee! Addr
~~~ , ~i~. ~~3~~
(City, Stnte, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
befor^enme this ~'~(~ ~f _ day
_~~
Deputy for Register' of ills
~ ~~
(ri~gnatu e)
6. ~ ~~ ~7 Tfi ~ .
('Street Address)
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Form RW-04 rev. 10.13.06