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Home My WebLink About06-03-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF _ CUMBERLAND Estate of Clair Luther Lybrand also known as COUNTY, PENNSYLVANIA File Number 21-10__ ^~j((r~~ ,Deceased Social Security Number 194-44-9703 Nanc L brand Petitioner(s), who islare 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 codlcll(s) dated State relevant circumstances, e.g., renunciation, death of executor, etc. !'~J Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ~~ strumerr~s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: _ _ -r C7 :~ ' ~_ r-- ~i~~ f i ^X B. Grant of Letters of Administration ~" '•-~ apprca e, enter: c.t.a.; .b. n. c. t. a.; pe ente liter urante a senha; urante mmontate `-~ ~ _... 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 Relationship Residence Carl Lybrand Son 199 Leaper Farm Road Gardners, PA 17324 Eric Lybrand Son 46 Franklin Street Cril PA 171 Nancy R Lybrand Spouse 199 Leaper Farm Road i._-r_,...., on ~~~7~ (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 199 Lea er Farm Road Gardners Cumberland PA 17324-8825 (List street address, town/city, township, county, state, zip code) Decedent, then ~_ years of age, died on 4/10/2010 at Frederick County VA d t t death owned property with estimated values as follows: /~,~ ~"'' Dece en a (If domiciled in PA) (If not domiciled in PA) (If not domiciled in PA) Value of real estate in Pennsylvania All personal property Personal property in Pennsylvania Personal property in County situated as follows: ~r 100.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Netltion ana cne grant or ~eueis ~~~ ~~.C aNNi~p~~a~c the undersigned Signature Typed or printed name and residence Nancy Lybrand 199 Leaper Farm Road ,-~ S ~ ~ Gardners, PA 17324-8825 Copyright (c) 2006 form software only The Lackner Group, Inc. Page t or Form RW-02 Rev. fo-13-2006 v 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. 1 ,~ Sworn to or affirmed and subscribed Signature of Personal Re sentative N cy Lybrand .~, `~' ,- ~ r . before me this __~_ day of ^- ` Signature of Personal Representative n ` ~.-t~~__, % Cpl ~~ - --- - ~ ) ~ ~ ~J ' ~~ Signature of Personal Representative ~~ -~,. F~ jhe Register ;'~. -~ _..., ?J rte) -, . [ ~; File Number: 21-10 _OG~ Estate of Clair Luther Lybrand ,Deceased Social Sec(u~rity Number: 194-44-9703 Date of Death: 04/10/2010 AND NOW, ~ "~ ~ ~-l-n~ `~~" I ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to N n L r n 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)......1+~.~...... ... $ 16.00 Renunciation(s) ......................... ... $ JCP $ 23.50 Automation Fee $ 5.00 $ $ $ $ TOTAL .............................. ..... $ 64.50 ~, _ , ~.C~~~~ r ~~," Register of Wi _ _. ~. ~• _/ ~~..~ ~~ ~. ~_.....~ Attorney Signature: Attorney Name: Adam R Schellhase Esq. Supreme Court I.D. No.: $2648 Salzmann Hughes, P.C. Address: 79 St. Paul Drive Telephone Chambersburg, PA 17201 717-263-2121 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 Form RW-02 Rey io-i3-zoos , 4=.. ; COMMONWEALTH GF VIRGINIA <_? ~, cc_..-_- Department of Health (_~ Bure:Au of Vital Records and Health Statistics _,--; .~~.~ CERTIFIED COPY OF DEATH RECORD ='I -+ + - , ~; ~N~ L; ; ~ ` t; COMMONWEALTH OF VIRGINIA -CERTIFICATE OF D~~CYH ;,:~ ~`, t , DEPARTMENT OF HEALTH -DIVISION OF VITAL RECORDS -RICHMOND ~ - cGPV A --- FOR DIVISION OF VITAL RECnROS cERTIFICnTe e. ~ REGISTRATION NUMBER - +° AREA NUMBER ~-~~~ •< MEDICAL EXAMINER'S NuMTrEI--RILE CERTIFICATE _ DECEDENT 11. FULL NAME inret) middle) (last) 2. SET( I male remale I OF DECEDENT Clair Luther Lybrand ~ ^ 3 . DATE OF (mo.) (day) (year) q. AGE IF UNDER 1 YEAR _ IF UNDER 1 DAY urs - r mlRUleS h 5. DATE OF (mU.) )day) (year) BIRTH 6. WAS DECEDENT a na EVER IN U.S. Q DEATH April 10, 2010 56 o I fPOnInS ; days I I years) I I I September 15, 195 ARMED FORCES? Out Pal. COUNTY OF DEATH ~.'.f independent B cit y leave blank) PLACE OF 7 . NAME OF HOSPITAL OR INSTITUTION OF DEATH (II none, so state) I I DDA Emer Rm Inpatient . DEATH None ; ^ ^ ^ Frederick County Inside City Ur Icwn limits? 10. STREET ADDRESS OR RT. NO. OF PLACE OF DEATH 9. CITY OR TOWN OF DEATH y85 2431 Wardensville Pike Winchester ^ ~ 12 COUNTY OF DECEDENT'S RESIDENCE (if independent city, leave blank) USUAL 11. STATE (OR FORGEIN COU NT RV) CF DEG EDENT'S RESIDENCE RESIDENCE Penns Ivania y Cumberland ~ OF DECEDENT Insitle cny Uf IUWn Itmlts! 14. STREET ADDRESS OR RT. NO. OF RESIDEN~E ZIP CODE 13. CITY OR TOWN OF RESIDENCE yB9 er Farm Road 199 Le ~ 17324 Gardners ^ ~ p __ rERS'~'" 15. NA'+IE OF DECEDENT'S FATHER _ DATA Norman D. Lybrand, Sr. DECE;: 1 - 17. r.ACf. OF iJECEDENT 18. OF HISPANIC OR!GIN? II yes. specify Cghan, f Puerto Rican, etc. ~ ° ^ yes Caucasian but not resulting in the underlying cause given In Part I. w o 20. Cli IZr 'J OF WHAT COU NTRV 21. BIRTHPLACE (state or country) 22. NEVER MARRIED I l DIVORCED ^ L-J 23. IF (if divorced leave blank) - E tJSA Pennsylvania MARRIED ~ WIDOWED^ Nanc L brand ~I ? al `o - _ - cr`,-~ SECURITY NUMBER \I 25. USUAL OR LAST OCCUPATION 2fi. KIND OF BUSINESS OR INDUSTRY 27. INFORMANT - OR SOURCE OF INFORMATIO N -RELATIGNSFiIP 0 E m _ _ -_ .i 2q . 194-44-9703 Pipe Fitter Construction Nancy Lybrand wife o - __ CAUSE '= LEATH -~ PART 1. Enter the diseases, inj ~ yarres uries, or complications that caused the death. Do not enter the mode of dying, such as cardiac or respirator t, shock. or head /allure. INTERVAL BETI^/EEN ONSET ANC DEATH o ~ _ . Lst°nlynnecauae°n ea°hline Atherosclerotic Cardiovascular Disease u, ° ' v iMf.~EDIATE CAUSE (Final disease or A --~~ O a ' w condition resulting in death) DUE TO (OR AS A CONSEQUENCE OF): - `Y ;I ~ TO a r ~ ti t Sequentially list conditions, if any, leading (B XAN '<E,+.: a C to immediate cause. Enter UNDERLYING ~ cqusE (Disease or injury that initiated - ~ C nplet~ nd sign events resulting in death) tAST i D =deel :.e ,rican°n z p pgRT II. Other sgnfcarS contlt ohs contributing to d. m281 .~.d give all ~ ccpa= funera I irectoi - ~ soon as U - Trssiblr iYer ire: ur y' LL ~ 28b. IF FEMALE, WAS THERE A PREGNANCY ~ IN PAST 3 MONTHS? - W n ^ k ^ ^ ~ ~ now un ng yes NO TE ~. - " Q U 28e. TIME OF INJURY (mc.) (day) (yea PendinS r, ust be indieates'~tifyregls- ° 201 9:03 AMgM April 10 tray of bnal decson ~ , P.M. as soon as possible. , 28i. I CERTIFY t t I took charge of the malrls descnb ACCIDE T U '. S NATURAL CAU ES ~I i FUNERAL DIRECTOR REGI:.TRAR a AUTOPSY? ~ a AUTHORIZED 6V IF EXTERNAL CAUSE. IT WAS 28d. DESCRIBE HOW INJURY RELATING TO LEATH OCCURRED PRIMARY ~ or CONTRIBUTING TG CAUSE Of gEATN Heart Attack while ~t work above, viewed the :IDE ^ ~~'HC ACTUAL ~ ,,, ~ -r.~_ ~\4 SIGNATVRE ~~^-----`~~'www~~--- NAME OF MEDICAL EXAMI ER (Type or Print) Jordan J. Cry tion, Jr.,~ ~o ni iv~ni RFMOVAI CREMATION D. PLACE 2RED 28g. PLACE OF INJURY (home, farm. I 28h. I ~lty or town) (county) (stage) factory, street, oKwe bldg., etc.) ngtwhile Field ' Frederick County, VA at work ~ I ady, made inquiry and In my opinion death resulted at or about (AM (PMl tram. CIDE D UNDETERMINED ^ PENDING ^ _ _ - -- ~ ATE SIGNED. '-~ AD1R80 Babbs Run Lane Winchester, VA 22603 ~_ t I V " OF BURIAL, ^ ^ ~ REMOVAL ETC. D (Signature or funer 1 drector or p n legal) it g this certlf~ ate) I- ~ feral Service Licensee / NeM of Kin' .re..a:.!i%!~/ ~"'"""~V ~_ ~ '~;~ ~ kESER'JED FC' KEtsSSTR:~R'S l.!$E MOTHER Joyce Beam 9. EDUCATION (Specify only the highest grade cempletedl Elementary/secondary (a1z) 12 college (1-a ors +) MARRIED OR `VIDOWED NAME OF SPOUS= (name of cemetery or crematory) (city or county? ~=~="=i Fun~.~al Home-Crematory, Inc. Shippensburg, PA NAME OF FUNERAL Omps Funeral Home HOME AND ADDRESS 1600 Amherst Street, DATE RECORD FILEp*~~ 7y' f I~,~7 ~ T / Al ~ .~$ XI i nls Is to c~rUty thst th)s Is a true and c~~rre~ct reproduction of the origi ?i reco I'ed with the FREDERICK.-',~iINCHESTER DEPARTMENT OF HEALTH, WiN;';NESTER~RGI'~IA, %26 1. 1 `~ ,~I _ f ~_ ~. Date issued' ~' ~ I ~ ~ _ ~~~~~~ ~ ~ ~~-~ ,Registrar (Seal) ~J ANY REF':ODUCTION OF THIS DOCUh".ENT IS PRC)HIBITED BY STATUTE. nn nlnT nr.r.FPT I INI FSS IT BEARS THE IMPRESSED SEAL OF THE FREDERICK-WINCHESTER CEF'ARTMENT OF HEALTH CLEARLY AFFIXED. REGISTER OF WILLS OF RENUNCIATION CUMBERLAND COUNTY, PENNSYLVANIA Estate of Clair Luther L brand ,Deceased -: -r? r~.._ ~-~- -' 7 .: ~~ c... ~. Carl L brand in my capacity/relatti3rt5~ip a~"d (Pent Name) ~ ~ ~ ~ , of the above Decedent, here'~y`renounc~.~the right.to Son ~.~ administer the Estate of the Decedent and respectfully request that Letters be issued to Nanc R. L brand ~--~ ~ J (Date) ~} (Signature) Carl Lvbr nd 199 Leaper Farm Road _ (Street Address) Gardners PA 17324 (City, State, Zip) Executed in Register's Office Sworn to or affirm(e~d aid subscribed before me this-~-'~, \y~-- ~~ Deputy for Register of Wills Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the re ation for the purposes stated within o11n~.~~~tnl~pay N ary ublic My Commission Expires: ~~(fi~l~Uf~- (Signature and seal of Notary or other official qualified to administer oaths. Show date of ex iration of Notary's commission.) Notarial Seal Kristen Smith, Notary Public S. Middletc n, Cumberland GouM~- INy Commbsbn Expires ZH9t~Ot4 Form RW U6 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. • __ _ ~,. ~, r / ~~ ' ~ t `~ RENUNCIATION REGISTER OF WILLS OF CUMBERLAND _ COUNTY, PENNSYLVANIA ~_ ? , D~eased Estate of Clair Luther L brand - •--~ ~_~ c.:.~ _~ ,~-- - ~, `~ ~ ~ , ; --i i Eric L brand in my capacity/re#ationship ysti - (Print Name) L'~' Son of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Nanc R. L brand `c> C` ~- - ` ~i (Date) (Signature) Eri ~/ r~ 46 Franklin Street (Street Address) Carlisle PA 17013 (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renun iation for the purposes stated within o~n~tn;~-~~~:1c day of ~..~ ~--Y1.~ , ~1LA~+- ~~~ ~,~ Notary Public My Commission Expires: 11- ~~~-~- ~~ (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) Form RW-OB Rev. 10-13-20176 Copyright (c) 2006 form software only The Lackner Group, Inc.