HomeMy WebLinkAbout12-16-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Stephen W, Moore !L l _o ~- ~' (p'"f
File Number
also known as
Deceased Socia] Security Number 282-48-4027
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 named in the
last Will of the Decedent dated and codicil(s) dated ev
0
(State relevant circumstances, e.g., renunciation, death of executor, etc.) f-~_. ~ n <~! ::t
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution' e~strum~ t(s) o~P,.ed-~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~7 ~+ , ` ~ `i=':
m B. Grant of Letters of Administration ~. ;~ ,_
(If applicable, enter: c.t.a.; d. b. n. c. t. a.; pendente life; durante absentia; durante minoritatl~pD ''•
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 Section A above and complete list of heirs.)
Name Relationshi
Residence
Susan C. Moore Wife 61 Windsor Way, Camp Hill, PA 17011
Betty Mathers-Moore Mother 4323 South Mean Court #3, Independence, MO 64055
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
61 Windsor Wav, Came Hill, East Pennsboro Township Cumberland County, PA 17011
(List street address, town/city, township, county, state, zip code)
Decedent, then 51 years of age, died on December 2, 2009 at 61 Windsor Way, Camp Hill, East Pennsboro Township,
Cumberland County, PA 17011
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 $ 0.00
(If not domiciled in PA) Personal property in County $ 0.00
Value of real estate in Pennsylvania $ 0.00
situated as follows:
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:
Si ature T d or rinted name anal residence
~-yy, Lynn M. McKinney, 8 Honeysuckle Drive, Mechanicsburg, PA 17050
Form RW-02 rev. 10.13.06 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
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
~~ /
-For the Register
Signature of Penl~onal Representative
Srgnature of Persona! Representative
C
t
Signature of Personal Representative f 3 e~
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File Number: /•~,! - 20p - ~ a '~
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Estate of Stephen W. Moore , Decg~ed ~,,~ ~` , ~'
~ _ -r~r
Social Securi Number: 282-48-4027
ty Date of Death: December 2, 2004 OD
AND NOW,v 1 fo~~(~iY/ ~oiYVt~,~G~ ~_ 009 . in consideration of the foregoing Petition, satisfactory proof
having been presented before me, I~IDECREED that Letters of Administration
are hereby granted to Lynn M. McKinney
in the above estate
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 ............... $ 20.00
Short Certificate(s) ........ $ ! 2.Oc~ ~'
Renunciation(s) .......... $ 10.00
Automation Fee $ 5.00
JCS Fee $ 23.50
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $~,(~5~'
Attorney Signature:
Attorney Name:
Address: Keefer Wood Allen & Rahal, LLP
635 North 12th Street, Suite 400
Lemoyne, PA 17043
Telephone: 717-612-5801
Form RW-02 rev. 10.13.06 Page 2 of 2
Supreme Court I.D. No.: 41274
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA ~ m
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Estate of Stephen W. Moore °'
Deceased
I, .Betty Mathers-Moore , in my capacity/relationship as
(Print Name)
mother
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Lynn M. McKinney
/~ ~i~ ~0 9
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
(Signature)
4323 South Megan Court #3
(Street Address)
Independence, MO 64055
(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
purpo es stated within on this l l_.y~-1`, day
of ~ o2DD~
No Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
Form RW-06 rev. 10.13.06
NOl'ARIAL SEAL
CYNTHIA J. RULE, Notary Public
Lemoyne Boro., Cu;nberland County
My Commission Expires February 3, 2012
Z~-oq- Il ~~
RENUNCIATION
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REGISTER OF WILLS ~~ N
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COUNTY
PENNSYLVANIA ~ r~i
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Estate of Stephen W. Moore
Deceased
I, Susan C. Moore
(Print Name)
in my capacity/relationship as
surviving svouse of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Lynn M. McKinney
~~ ~~ ~ ~
(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
(Signature)
61 Windsor Way
(Street Address)
Camp Hill, PA 17011
(City, State, Ztp)
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 f l.P~l-~. day
of ~- of a D ~
Not Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OIF PENNSYLVANIA
NOTARIAL' SEAL
CYNTHIA J. RULE, Notary Public
Lemoyne Boro., Cumberland County
My Commission Expires February 3, 2012
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
• P 15692700
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly :filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filingtE~
G~ 1~ ~ U
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Local Registrar, Date Issued
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~ Itrz~s COMMONWEALTH OF PENNSYLVAMIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ ""'
PmNr IN
*I~ CORONER'S CERTIFICATE OF DEATH
1132-163 (See instructions and examples on reverse) STATE FILE NUMBER
t. tame a Deaeen IRreL made, rd, wax)
Stephen W Moore z. sdr 3. soaei seaany NunMr 4. Dde a Deem (Momh, day, yrr)
S.Aa(lmlamwe,~ Unde, uroe a Dated&~ T Male 282, - 48 ~ 4027 December 2, 2009
end emh « own) M. Plea of 13eeM (CMa one)
51 Yrs wwww °." Hw.. rvwre Sep, 21, 1958 Hapihc oMen
Detroit MI ^bpedent ^ER/purpMrm ^DDA ^arnr-spady
' BE. Crony a DesM M. CIIY. Trop. Deem Btl. F ^ Home Rridence
shy Name Ih not retlhdan, ghe etraN ea rumba) 9. Wu Decedent d Hrpenk Ongin7 .~I. No ^ Vu 10. Race: Ameicen Inden, Bleok, Nine. etc.
Cumberland East Pennsboro 61 Windsor Way (Kyee,epecMVCuben, (spearM
Mexicen, Perm Rican, em.) White
11. DecetleMa lkeel ~ d w«k done moat a We. Do rot Bleb mtl 12. Wee Decedent aver In Me 73. Decedem's Edbetbn (Spealy ony hghest grade conpleled) 14. Marnel Shtue: Marrbd, Nevi Mairied, 75. Survivkq Sitouse (M wife. give mamen name)
KM d W«k Kktl d Buesee 7lntluslry U.S. Armed Farces? Elementary /Secondary (a-72) Conega (td or 5+) Widowwd, Daorced ISwPM1
President ^~ ~&~ 3 Married Susan Biros
16. lkoederN'e McAkp Addeo (Sava. cn1' /town, doh, ZIP ode) Deadenl'e
61 Widsor Wa Asgel Rentlena 17a. srh PA1 D1d °~°~'
Y T~ m o 17c. Yu, Decedent Lived b - E. Penncbprp Twp.
Camp Hill, PA 17011 t?E, coany__CunthPrl and nd.~NO, Deader,l l;,~w;gw,
ta. femora Nero (Bret. made, rat aulPoc) Amin Leak d City / Boo
19. Motltere Name (Fxat mane, meben aunme)
William E. Moore Betty Mothers
Zoe. Imm~rimn', Nor RYPe /Print) tab. hdonwlre krBitp Addre (Strad, dY I mwn, err,
Susan Moore 61 Windsor Way, Camp Hill, PA 17011
21a. Memod d D'nPalhon i ^ ( ^ pp~ 21b. Doh d Orpoeltla (Marts, my, veer) 21c. Pha d DrPaldon (Name d
Burl ^ Rerrnvd none Stem i Wr Qertlon «DOrIeBm AaE«1rd arat«Y, aenlary a olMr pleoe) '21d. Loatlon (Clry I town, elate. Zip ado)
^ i EYMedkelEaererryCaaw? ^ye,pNO December 7, 2009 Gate of Heaven Cemetery Mechanicsburg, PA
' 2h a FIeeN Y1E. Lkdue Nuroe 22c Name enaAddme a rvdny
14819 Myers-HarneilFlmera1701a1-1e Inc.
Conprr Vern 23ec Day when oedyelg 23a. To tle bee d my bgxNOpe, deeM ooarretl et tlw sme, dale end pre dertl. ISigemra en0 tPoel
. PMT r not evaeeer a tmr d aeeM b 23b. Lmenae Number 23c. Date Signed (Monts, day. year)
gray sew d drm.
' hen 2M28 muel M aarlDrted by perwn 24. Time d Death pTX , 25. Dar PtaraunM Deed (Mash, aey yrr) 26. Wu Cer RdaneO m Medical EKeminev / Coroner for a Rueon Omer Man Cremation or Donation?
""°P'°"°"0e6"°'h' 1:00 P. M. December 2, 2009 ~V.e ^Na
CAUSE OF DEATH (eaa Ntehuctlone end examples) t Appmxbrta knervel: Pan 11; Eae otMr
Men 27. Pan I: Enw me -tlseur, njrars. «mrplnliona - tlW dramy cauaetl the drM. DD fqT eMr termkW wen sum u certnec arrest, 2B. Dp Tobacco Use Camribae b DeaM?
N~qA ~R+MY arrrl, «veMiaAer nbrnrnan wiBpa ahowkp th etbbgy. tint only on aw at eatll Ina. ~ and m DrM bd rwl resumg b Me urMenykig aw gived in Pen I. ^ Yu ^ Probeay
a«dYai nda~tli~r duM) « ~ ^ Na ^ Urduawn
-•> a. HanQinQ
Dab (p r a aaMegUMa op. , 29. H Femeb:
AM aandtlPrle. M airy, b ~ ^ Nd pregnant wmnn pad year
b Dew Ord a is e. , ^ Pregtlanl et time d Outs
~IIIIDEMYMB CAUSE Dam (a u e wieegrence d):
ikMNe or?.Mal'n ~kYWMO?w c. r ^ Nd pregnant bu Pre9nent wnhn 42 days
meuerq ~ ~Sr. Due m (« as a argequena a); i of tleaM
tl. i ^ Nd pregnant. w gegnent 43 days b 1 yrr
r belae death
' 30s. Wr r Aaopsy 3ab. Wen Aumpey Fedrpe 31. Mmie d Deets 32e. Der d m' ^ Unkmwn n preprint wiMin Me peal year
Pedanad? AvWhle Pn« b Careaeda Nry 1MOmn, day, Y•el 32b. Deea6e How Inhey Ocnmsd 32c. Pre d Mjury: Home, Farm, Sheet Fad«y,
acewaoeaM? ^"a"'~ ^l+anPide Dec.2,2009 Intentional Hanging 0ete&i1u"gd`t~"~'I Home
^ Vas (~No ^ Vr ^ No ^ Amt ^ Peldmp InvaMlpeYUn 32d. ran d Inhxy prx . 32e. MuY al Wang 321. n Treneponefbn kqury (bpeaYp) azg. Laatlon a mpry sMd, clry / mwn, rote)
^D01bNo16BDNi'"'e1etl 1:00 P. M, ^vr ~JNO ^°'n'e`yDp•reta ^Pesewge ^Petlearian ~dindsor Way, Camp Hill, Pa.
xr Comfier (darA say ace) ~Ar ~ 3Pe~Y
San. sipumre en
• Cedhyhq PEY~1r (PEY•Wsn C•mk/bg Dew a dwm when snow phyeitlen nee Prorleurned aaeM end conYaded nom 23)
Tames.etdmrrnwraw.aeetno«unda»mh»awp)ebawaw..awd~---.--- ^ ~ --~~ Coroner
-------------------------
• ~ ~Yhq PMwmrrr (Physiden ban pranunYq tlrm alts anhyeq b else d drhl)
To Ilr MeldmY bnwrdge, deem aecutM etlM tre,der, erW Pros, end duemthe errlsl snamwwrerl,d------------------ ^ 33e. Liam NUr6ar aid. Date Sipwd (M«IM, deV,yrr)
M.awErraasyceaw December 3, 2009
On tlw Err d eaemrrtlorl end I «mvrtlpetlen, r my aphtbn, dMh atxvrtM N the rtr, Mh, and Pre, end dr m tle are(el end aenrer r acted- }~l
34' NweaMldtrery,glt pe~~ WlpCorroMW S ae d (Item 27~ Type / Print
35. Regrtrers era Drab) 1 L. LVUrY'1 (.oronEr
Iri11 ~ I~ I ~ I~ I ~ Mahh'tliy' 6375 Basehore Road, Suite $1
1 Mechanicsburg, PA 17050
DlsPositbn Perron No. nri7~2 ~6