HomeMy WebLinkAbout03-25-10Kegister of Wills of CUMBERLAND
County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Luther David Byers No. ~, ~~~~
also known as ,Deceased Social Security No. 185-72-9446
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 and aver that Petitioner(s) is/are the execut named in the Last Will of the
Decedent, dated N/A and codicil(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 adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
® B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente life; 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:
Name Relationship Residence
Lisa A. Rickenbach Mother 1102 Rana Villa Avenue, Camp Hill PA 1701,x,
L. Mark Byers Father 33 Dellville Road, Duncannon, P~~j7020 ~, ~
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~^_; -~ =, ~
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Decedent was domiciled at death in CUMBERLAND "'"' `' •. - ~=t-
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County, Pennsylvania, with his/her last family or principal residence "- ' < ?
at 1102 Rana Villa Avenue, Camp Hill, PA 17011 ~
(list street, number and municipality)
Decedent, then 19 years of age, died March 5, 2010, at the BP gas station at the corner of St. John's and
Simpson Ferry Roads in Lower Allen Township Pennsylvania
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property ................................................................................ $ 0.00
(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 ..................................................................................................................................... $ 0.00
Real Estate situated as follows:
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 a ro riate form to the undersi ned:
Signature Typed or printed name and residence
~i~~~~~ I Lisa A. Rickenbach , 1102 Rana Villa Avenue, Camp Hill, PA 17011
~;,,~,~ ~~;~' ~~ Viers, 33a Dellville Road, Duncannon, PA 17020
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Form RW-1 Page t of 2 (Rev. 9/92)
v
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and 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 tl~ estate according to law.
Sworn to and affirmed and subscribed "rl c.~ fry ,~
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before me this ~-~ day of
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DECREE OF REGISTER "' ~=~<:~ .~ r -,
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Estate of Luther David Byers, Deceased No• ~~-~(~-f~~~ -~,--+ -- __ ;=~-;
also known as "' + `~'
Social Security No.: 185-72-9446 Date of Death March 5, 2010
AND NOW, ' " ~.~~~`"~w n~~~ , 20f~, in
consideration of the Petition on the ev rse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ^ Testamentary ®of Administration
(c.t.a.; d. b.n.c.t; pendente life, durante absentia; durante minoritate)
are hereby granted to Lisa A Rickenbach and L Mark Biers
in the above estate and that the instrument(s), if any, dated N/A
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Re ister of Wills y~~~
Letters ................................. $20.00 9 `
Short Certificate(s) (1)......... $ 4.00
Renunciation ....................... $
Automation $ 5.00
Extra Pages ( ) ................. $
Codicil ................................. $
JCS Fee .............................. $23.50 C:~ ~,~t,(h~f- ~~~ ~~a, ti
inheritance Tax Return ...... $15.00 Attorney: Elizabeth H. Feather
Other ................................... $ I.D. No.: 92618
Address: 3631 North Front Street
TOTAL ................... $67.50 Harrisburg, PA 17110
Telephone: 717-232-7661
DATE FILED: ~ _ ~t~
Fnrm RW-t Paae 3 of 2 (Rev. 9/92)
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee t~:,r this certiiirite. S6.Oti
P 1175903
Certificllion Numher
This iti to certife that the inl~urmalion 1>>`re «iven i,
correctly copied t~;mi an ttri~inal Certificate of Death
duly filed with It;c as Local Re~ri;trar. ~f}?e ori_it;al
certificate ~~il! ye forwarded to ~lte State Vital
Records C>ftice ?~~r rferrl?alTent film;.
MAR 1 2 2010
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Local Rer~istrar i~~atr issued
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Rlv nnlwe COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS •-L~ - - ~'';
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PRINT IN L,
±Af1EM CORONER'S CERTIFICATE OF DEATH .. _
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,K INK (Sce Instructlona and examples on reverse) STATE FILE NUMBER
lk~9-914 _
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1. Name a Decedent (Prat, mMde, last, suffiz) 2. Sex 3. Saclal Seadry Number 4. Date of Deem (MOnm, day, year)
Luther David Byers Male 185 - 72 ~ 9446 March 5, 2010
5. Age (last BirUMay) UMer t UMer 1 deY S. Date a BIM MrxM, de , 7. &rmplep ( aM state a I country) Ba. Place a Death (Check on one)
swnme pay, Nd,e Manuwe Hoapilel: Omer:
19 Yrs Nov. 26, 1990 Harrisburg, PA ^Inpellenl ^ERIOu~aDem ^DOA ^Nursing Home ^Residence Olher~Specity:
BD. Count' of Deam &. City, Twp. Deem Bd Fedkry Name (R not metMutlon, glue street and number) 9. Was Decedent of Hlspersc Orlgln? ®No ^ Yes ~ ,. 10. Race: American Indian, &edc, Whore, etc.
Cumberland
Lower Allen
3635 Simpson Ferry Road (II yea, seedy Cuban,
Mexican,PuenaRicsn,etC.) (Specify,
white
11. Depdem's l1suN Kkld a work d one au mat d Rte. Do not erere ~ 12 Wee Deaedent ever m the 13. Depdent's Educatlon ($teaty only highest grade compl eted) 14. MerRel Status: Married, Never Monied, 15. SurvNing Spo use (If wife, Siva maiden name)
Kmd d Wod Klnd d Sakeea I lndetr)'
i U.S. Anpd Forcea7
Elements /Secondary (0-12)
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Ca (1-4 or Sr) Wkbwad, D~°~ (SP~d11
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Package Sorter Transportat ^ye, ®N° ever Marr
ed
18. DepdenYS MdRng Address (Street sty I town, srere, zip ads) Decedea'c Did Decedem
sees Pennsylvania
t)acedent LNed in Lower Allen Twp
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acwH R.euntce nor
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1102 Rana Villa Avenue ,
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Cumberland nor.^IDe
Camp Hill, PA 17011 m
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18. Famefa Name (First, midde, lest, rush) 19. Homer's Name (Flrtt mHde, meldari sumeme)
Luther Mark Byers Lisa Ann Rickenbach
20a. Iaament's Name (Type / PdM) 20b. InfamenYe Meiling Adders (Street, city I town, elate, zip code)
Lisa A. Rickenbach 1102 Rana Villa Avenue, Camp Hill, PA 17011
21 e. Mettlod a Dlsppitlon ®Cematon ^ Dariatlon 21b. Date a Dlspaaiai (Noah, day, Year) 21c. Place a DlspoaRia (Name a cemetery, crematory a Omer plea) 21d. Locetlan ICIty /town, state, zip code)
~ ~ p Rem°rainansate AaNbd:.a March 11, 2010 Evans Crematory. Schaefferstown
PA 17088
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22a Llceneee (a acDng es such) 22b. Lkenae Nlmlha 22c. Name and Address a FactlRy
~ FD 012 848 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
when pNrying 23e. To ma best a my knoxledge, tlpol attuned at Rte Hme, date and pMce staretl. (Slgnelure end Dtle) 23b. Uanse Number 23c. Date Signed (Month, day, year)
physician re not evaMebh et Nnre of deem Io
artily ease a death.
kerns 21,28 moat be caripaee by person 21. TMIe of Deem p rX . 25. lMte Pronounced Dead (Month, day, year) 28. Wee Case Referred to Medal Examiner / Coroner fa a Reason Other then Cremation or Donation?
~''°a°"°°1CB9dea"' 2:50 A. M. March 5, 2010 Yea ^"°
CAUSE OF DEATH (See Instruetlons end examples) r Appmxlmate Interval: Pad II: Erder omar ' 28. Dltl Tobexo Use CoMdbae to Death?
earn 27. Pad 1: Emer tM chain d avers - dearer, injurka, a canpRCetbns -mat dreclly caused the deem. f)0 NOT enter tannins evems such es cardac arrest, r Octet to Deam Dal rat resuMng In me ulMerying suss given m Pan I. ^ Yes ^ Probably
re~lretory enest a vemrKidar MbrMleaon wlmaut ahowkp th edaoPY. List ony one ease on each Ikte. i ^ No ^ Unknown
IMMEDIATE CAUSE 1Final cheese a r
caMNan reeuNrpmdeelh) _~ a. Inhalation !`. Thermal Injuries r 29. If Fem~:
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Due re (a u e consequence op: ~ a pregnem wlhin past year
^ Pregnantattimeofdeam
segaertRaw~I~ttonama.Rarn. D. Flash Fire ~
le~drg to CeUMe Meted an IYte e. Due tc (a as a consequence on: r
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UNDERLYING CA
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SE ^ Nor Pregnant Dal pregnaa wimin 42 days
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~sid g n ~m ST~e a _ _. _ i
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re a deem
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Due re (a 86 8 CalBegpeflt8 Of]: ^ Not Preptent but Dregnaa 13 days to t r
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d. r before deem
Unknown d pvegrlent witlen die Peal year
30e. was an Autopsy 306. Were Autopsy FlMrga 31. Manner a Deem 37a. Dare d Ir~ury (Hoorn, day, yar) 32b. Deeorbe How Irqury Occurred Flash fire while ~• Pau a Injury ~~ Fa^^~ Street Fin.
Perfoined~'
A ~~,?°'"D"°°"
^Nawrel ^Hamltiae
Mar.5, 2010
um in asoline into vehicle omp ButldYtg, etc. (spearrl
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Yes ^ No Yea ^ No ~ Accident ^ Parting Inveefipatlan 37A Thrle a In~pY•X . 32e. Inury et Wod7 321. N Trartsparetlon Injury (Specfy) 32g. Lacatlon a Irpury (Street. dry l lam. stale)
^ Suidda ^ Caad Not be Detemepd
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50 A ^ Ya ~ No ^ Drlvar / Uperela ^ Passenger ^PedesMen
Simpson Ferry Rd
Cam
Hill
PA
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33a. CeNAer (cheat Doty one) 33b. SlgreNre end TINeT~F6ertlAer-~
• CMXying phyekren (Pnyekian certllYkl9 reuse a deem when erloUrer phyatden nos praaeaed seam eM amplmed Item 23) CO r one r
To the beta my ktlowbdge, dseM OCarred due to tM puee(e)end memernerets4-------------------------------- ^
• Pranounelrp arW attllying phyekhn (Physlden ham prawuridng deem and arlNylrg re~~~e a deelh)
^ 33c. Llpnee Number 33d. Date SigttM IManm, ay, year)
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TO tlN heNa my lawwMdge, deem ocdrnad eltM tlme, deta,eM plop, erM duebeN pueye)end merarrtlaMed_---_--_--_- March 9
2010
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, 34. Name arM Address d Person C,atlpkted Coup d Deem lam 2~ Type / Pnm
Er~enrode
Coroner
Todd C
Reglatrer'a endDistdd ~ t
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6375 Basehore Rd., Suite ~~1
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