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HomeMy WebLinkAbout12-11-09YLT1TiON FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of TODD R, DEVEREAUX File Number ~~- ZDU~-//~7 also known as Deceased Social Security Number 207-60-7995 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the last Will of the Decedent dated and codicil(s) dated namgd iti;;~e 4.' ~~_~ r~,-, (State relevant circumstances, e.g., renunciation, death of executor, etc.) r J ~ T) ~ ~ _ ~j 2 Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executiorro~i`fine instrurr~t(s) of~~"fe~dw; for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~., ~ ;: G7 B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d. b. n. c. t. a.; pendente liter durante absentia; durante minoritate) 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 Administration, c.t.a. or d. b. n.c.t.a., enter date of Will in SectionA above and complete list of heirs.) Name Relationshi Residence Robert T. Devereaux Son 2057 Pennwick Road, Lancaster, 17 (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in (List street address, town/city, township, county, state, zip code) County, Pennsylvania with his /her last principal residence at 17011 Decedent, then 44 years of age, died on December 4, 2009 at 2023 Yale Avenue, Camp Hi11., PA .RPP rPr,,,r,r~ ~~„ of Robert T Devereaux filed herewit Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 4 , 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 $_ 125, 000.00 situated as follows: _ 202 Ya1 Av n ,P ~, arnv 1ii11 PA 17011 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: '601 of ua~wo 'f d or rinted name and residence Raymond C. Devereaux, 2702 Logan Street, Camp Hill, PA 17011 ,r~ C, ~ D ,t t-P ...... _ 1. Form RW-02 rev. 10.13.06 Page 1 of ~~~ Uath 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. Swom to or affirmed and subscribed before me the 1 ~ day of Decembner 2009 t~ , or the Register ~' \ N ignature of Pe nal Representative Raymond e~eaux D ° ~;: ,~ . o _ - .~ ' 4 ~~ µQ Q r~ ;c; r .1 ..y .J .. . C7 L ^`" Signature of Personal Representative ~ j-~ _ T ~ ts_, _ • Signature of Personal Representative ~ r r ~ _ ~ -~~ _ '~ N r ~ ..t~l File Number: ~ j'2 ~ [ ~ ~l Estate of TODD R. DEVEREAUX ,Deceased Social Security Number: 2~~07--60-7995 Date of Death: December 4, 2009 AND NOW, December (-1''' 2009 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to Ravmand C . Deyex•eaux in the above estate FEES Letters ............... $ Z _U~ S~~~B~,,tck~~, & RE EMA'N, P . C . ~ Short Certificate(s) ........ $ ~ 2' Uy Attorney Signature: By Renunciation(s) .......... $ J`! ~ ... $ ZJ' . So Attorney Name: Richard C . Snelbaker • • • $ b'~~ Supreme Court I.D. No.: 406355 ... $ $ Address: 44 West Main Street •••$ 'Mechanicsburg, PA 17055 ... $ ... $ • • • $ Telephone: (717) 697-8528 ... $ TOTAL .............. $ ~6 •~ ~' Form RW-02 rev. 10.13.06 Page Z Of 2 cn rv t~ ~ '^" <..- ~ r l RENUNCIATION ~ ~'~ REGISTER OF WILLS `=~ ~ f"~M ;. _ ~ rv CUMBERLAND COUNTY PENNSYLVANIA - ' t~ `~ ' ~~~ , v, Estate of TODD R. DEVEREAUX I, Robert T. Devereaux (Print Name) son and sole heir Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to $~vmond C. Devereaux. father of decedent and I hereby request that the filing of an administrator's bond be waived and excused. December 7, 2009 (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills Form RW-06 rev. 10.13.06 (si a o ex ev eaux 2057 Pennwic'c Road (Street Address) Lancaster, PA 17601 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this 7th day of December 2009 n o ~..~~., _.i- Notary Public My Commission Expires: (Signature and Seal of Notazy or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA Nofedel Seel Susan L Matra, Nolagt Pubic Med>ani~sg Sao, Ctlnbedand Ooir~y My Gomm~lon F~Nes Nov. 24.2011 iyr,~h~t oEnrts~rlv~n~~ 4co~.~.Iarinn ~f ~Rl~o+ariee H105.805 REV (01/07) /J~/~(]~//// ~J LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 This is to certify that the information here given i correctly copied from an original Certificate of Deatl duly filed with me as Local Registrar. The origina certificate will be forwarded to the State Vita Records Office for permanent filing. P 15933825 Certification Number dt-~ Local Registrar ate <'~ C tv o °_ ~ © rn ~: ~ _• _ rn ='~~ '; _ - cry --- ~ . r~-~'-r' _+~ ,,--~ a ~ I .', C] -Ya ~ REV 11/1008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ANENT RIM IN CORONER'S CERTIFICATE OF DEATH 'K "'~ (See Instructions and examples on reverse) 7 ~~ ~ S cTaTF FII F NI IxxR[o 1. Name d Decoded (firM, midde. Mel, we{xl 2. Sr 3. Sada Satudy Number 4. Date d Deadl (Mato, day, year) Todd R Devereaux Male - ~ December 3, 2009 5. Age (Last Bedxby) Under 1 lAlde 1 h 8. Dee d BMIr Monty, 7. adplea antl Aare a mumry) Be. PMca d Deadl (Check or) F1ospIM1: Omer: 44 August 4, 1965 Yre ^ir,p,tMd ^ERIOutpatienl ^DDA ^Nuraing Nana Resrosnce ^o9ul,. Spac;ly BD. County d Death 8c. wp. d DrM Bd FecRry Name (" rill inatnutlon, give old 9. Wr Decedelt d Hiaparac Onpn? ~ No ^ Yr 18. Roca: American IMMn, Blocs. Wnne. ek. ' Cumberland Camp Hill ISM 2023 Yale Avenue ("y"''P°`"''01D81' ~C Mexican. Puerto Rlan, Bro.) 11. Decedent's Uarl KMId d work dor - rtpa d Ma. Do nd ebb reti 12. Wr Oebedanl aver in N1e 13. Decedents Educatlon (Specny ady higMel grade domdaMQ) 14. Medal Statue: Monied, Never Merrieq 15. Surviving Spouse (11 wife. give maroon name) Kind d Was 16d d Buarae I Nxluary U.S. Armed Facr? EMmentary I SacorMary (0.12) Cortege (1d a 5+) Widowed, ~~ (S'OedM ^Yr No 18. Daaxbd's Madklg Adder ( . city I tam. store, zip cede) DeeMM'a Did Decedent 2023 Yale Avenue AcpW Reeldelce 17a Sole Pa ~ h a 17c. ^ Yr, oecedad LNed in wwnsNp? r"p Hill P 17011 17b.D«nn a->mberland 17d ~ ~ ~~^ imp Hill a City / Bao 18. Faille's Name (Fiat. nlidde, Mal. adfix) 19. Mother's Name (FiM, mlhM, maiden aurtume) ZOa. Iraarmanl's Name (rYD• / Pnd) lob. Inlormant's Mannp Adder (Sheet, cNY /town, arere, zip mile) Ra Devereaux 2702 Lo an Street Hill Pa 17011 21a. Mahod d DMDdeitihn ~ Crer9M ^ Dalatlon 21b. Date d DMpaenron (Mash, deY.Yrrl 21c. PMce d DMOOallorl (Nrle d cerr•terl', aemalpY a onle place) 21d. loceion ICiry /town, slate. nP coda) ^ Ramorakomstare ~ ~ ~ o Aa"rodrd"""~tl ^ Madl wl err kbr r ^ W br spaddy Yr^No December 9 2009 Hollin er Cremator Mt Ho11y Springs,Pa d Servka t.keree ecblg r earn) 22b. Licenr NunlMr 22e. Name and Addrs d Feoifiry ~ - - a 17011 23ac ady eHer1 23e. ro the boa d my , drill ocaned a db tlnb, deb and pbce awed. (SpMture end 1Poe1 230. Ucerae Number 23c. Dare Signed (MOnM, dari veer) phyekial b nil avwble tl bre a dealt to untiY ear p dean. n«r 21-28 mua ha mnpMled by Penn 24. rkrw d Drill 25. Deb Pralaaloed Deed (Meal, day, Year) 28. Wee Case Rererted ro Medroa Examine / Coverer fa a Reason Ottrer Man Cremelion a Donation? wla Rauatwadrtit• Unknown P. M. December 4, 2009 rr ^No CAi18E 1]F DEATH (S•e itutrteeaon• and •xemplss) , Approarnere eaerva: Ran II: Ede aebr ~ 28. Did Tmecco tike Caadhure ro Drin? nom 27. Pen I: Err d• ~maOY- dewae, Aair• a eantpficetldte-1Mt dreeYy eared th deeM. DO NOT ode renllilel evade osltll r eardec Brest. r Orlae ro DeWI bd net reaultln9ln tlla urldenyklp ease given ro Pat I. ^ Yr ^ Pmbady trpkebly ema, a venhkWer flbr6tion widad aflaekq thaetMrogy. Ua aay ore care an each Mb. TE CAUSE FaW dMere a ~ i ^ No ^ UnMxwm aral re•nnpin rSrm) Multiple Traumatic Iniuries ~ e ~~nFena•: . ~ Duero (a u a mragrrke dl: ~ ^ Nd pregnant wdlxn past year a~y~~"!M'~ b...Fall in Home ; Mrq b the aua bbd an Mb a ^ Pregnadamwddrln . Duero (a r a ooneequenca ot): ~ Y W 6 CA B E 5r r M IAWEII L U ^ Nil pregrlent, bd pregted within a2 rya B I a a yr y d dl a ~ ~ r 2vrM rosun drill) LAST. c' ~ of drnl Duero (or r a oaleeaalnee d): I Nil ^ pregnenL bd pregnam 43 days to 1 year d. ; haae dean ^ Unknown n pegant withn dw past Year 30a Wr r Adlapey Sob. Ware Auro{•y 31. Manner d Ordl 32e. Deb d k{Illy (Mona, day, year) 32b. DerrDe Now IrMury Oxurre0 32c. Piece d Injury: Hurtle, Farm. Street. Factory, Pedamed? AvWMePrerrocarpMlan a tour d Dean? ^Nehlra ^ftonticke Nov. 30, 2009 Fall in home 01"CB'"e~lIHome ~WS ^ No ~vr ^ No ~ACtldent ^ Penang Nnestlgetlal 32d. rare d l~pr%. 32e. Iryay a worm 321. n Trermpormtion sPrrY ($oeoly) 32g. tocatron d Injlry (9rseL dY / roan, aere) ^saidde ^CaadNdbeDetemtiwd M 2:00 P ^Yr ~"° ^~/` ^P•r•r9•r ^~~ ' ale Avenue Camp Hill PA . . other ~ S pedQc , , 33a. Certifier (deck atly anJ 33b. siptelae and • Gr>RyNtg pNyeidal IPNyadan wrlNyNlg rnlee d d~ wMn anWter ptryskaan lMe prapaxletl deetil aro dompleMd lMm 23) ~ CO rune r ~ ~ TonlebrtdmylaawlMge, death acbnd du•bBb aae•a(e)elM rnrxterrelaad-------------------'-------'----- ^ • PreneurcktY aid eartllyYlg phraldr IPhYaden botli Pronol+ra+^9 dash and aNlyirlg ro our d death) Ma a w dam m d M a w da n m ^ b 33c. Number 33d. Dare 5",wd (Mond,. day, yearl To1•abatdmy tow p., e t orxaan . a., . , r P »,r »ro tenr.p). nl.arrr,Mt.d------------------ • rdeueattaenMbrlcaorw y~ On Me heat d eun~lan end I a MwNpatlm, ro mY apidon, dash oularad a tlw tlnr, deY, and pbca, eM dr ro the eeur(a) end nwrr r aMted_ ill December 7, 2009 34. Nameaga d Perean Wre OoniPlebd Care Drtll (IMm 27) Typo / P4m Mi L N i G~ ~° oMhla lo~{ / I dl / I I ae.oabped(Momm'mxrrn chas . orr s, oroner 6375 Basehore Road, Suite $1 , /~ ~ Dli9 Mechaniesbur PA 17050 . - a dspoeNion Pertnn No. // % CJ~ O/ I'~ T ?` /~v,•c ~ d ~/~,•. ~ J s ~ ~f`e-~', ~.,.~( T~`i~- C, s ~t 1c ~ f ~/.~' . /6, zeioy c N a -x' Q ~, o ,- ; . ~~ '_,-: '- t ,_: C'f1 C!1 ~ CT f'f': i-Fl -~' ~ c~.,~ ~~ ~ Z __ :'7 ~^~'y ~L•/ ~ ~ s ~ ~97 '`F 1T ~ ~ i ~ t'l.r,r»t,ivvlr.: uUt.'1'UAN ELECTRONIC MALFUNCTION WITH TIMECLOCK - T'HE CLOCK D.~ I`E ON THIS DO(:UMENT IS ]2 HOURS BEHIND TI-IE ACTUAL TIME. --REGISTER OF ~X7LLC/CLERK OF ORPHANS' CRT'