HomeMy WebLinkAbout09-17-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Rosalind M. Calhoun
also known as
Deceased
COUNTY, PENNSYLVANIA
File Number ~ ." ~ ~-' ~". ~~ `.~ ~ ~ ~.a ~~~
Social Security Number 493-24-9684
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 Executors
last Will of the Decedent dated February 17, 1993 and codicil(s) dated (none)
(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 instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^ B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante mir~oritate)
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) an~heirs: (If
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Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) C
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Decedent, then 97 years of age, died on September 8, 2010 at 3605 Kohler Place, Camp Hill, PA ]t 7011
Decedent at death owned property with estimated values as follows:
(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
$ 10,000.00
situated as follows: (none)
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:
John R. Calhoun, 5016 Ravenwood Road, Mechanicsburg, PA
' 1/' yn ( j _ ~ Suzanne K. Davis, 735 Capri Circle, Lewisberry, PA 17339-9583
named in the
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(COMPLETE INALL CASES:) Attach additional sheets if necessary. `.~~ -~ iV -- --
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
3605 Kohler Place, Camp Hill, Hampden Township, Cumberland County, Pennsylvania 17011
(List street address, town city, township, county, state, zip code)
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 arm(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 " '~ ~ '' ""'' ~ '------..
r --{, Signatu e of Personal Representative
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before me the i 3 day of ~
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Signature
P oral Representative
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Estate of Rosalind M. Calhoun ,Deceased
Social Security Number: 493-24-9684 Date of Death: September 8, 2010
AND NOW, ~_:~-'T~ ~~` 1~~,1.~~ ~~` 1~ , < ~- ~ ` , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to John R. Calhoun, Ronald J. Calhoun and Suzanne K. Davis
and that the instrument(s) dated February 17, 1993
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters ............... $ ~,~ ~ ~'-: `'
Short Certificate(s) ........ $ ,~ ~ (~~
Renunciation(s) .......... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~'l~ -;.J~,~ 0.00
in the above estate
_ - Re 'ster of Wills ~.~ .,1 "fit,;: r~.~l rY~,~~ /;:
Attorney Signature: ~ " 1~--~.~~`'^~-~°~-~
Attorney Name: J es M. Robins n
Supreme Court I.D. No.: 84133
Address: 129 South Pitt Street
Carlisle, PA 17013
Telephone: (717) 245-9688
Form RW-02 rev. 10.13.06 Page 2 of 2
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OF
RO S AL I ND M _ CALHOiJN
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I, ROSALIND M. CALHOUN, a resident of Lower Allen Township, Cumberland County,
Pennsylvania, do hereby make my Last Will and Testament and revoke all prior Wills.
FIRST: I give and bequeath the sum of One thousand ($1,000.00) Do:Llars to each
of my grandchildren living at the time of my deatf~. I name my daughter,, Suzanne K.
Davis, guardian of the estate of any minor grandchild. Should Suzanne K. Davis not
be living at the time of my death, I name her husband, George T. Davis, III, guardian
of the estate of any minor grandchild. I authorize said guardian to use principal
as well as income for the care, maintenance, education and welfare of si.~ch minor.
SECOND: All the rest, residue and remainder of my estate, real anti personal,
I give, devise and bequeath in equal shares to my children, John R. Calhoun, 1270
W. Lisburn Rd., riechanicsburg, Pennsylvania, 17055, Ronald J. Calhoun, :LO1 Meadow Hill
Dr., York, Pennsylvania, 17402, and Suzanne K. Davis, 735 Capri Circle, Lewisberry,
Pennsylvania, 17339. Should any of my children not be living at the time of my death,
I give the share he or she would have received to his or her issue, if ;any, and if
none, to my issue. Should my daughter, Suzanne K. Davis fail to survive me, T name
her husband, George T. Davis, III, guardian of the estate of any minor ~~hildren who
may receive an interest under the terms of this, my Will, or otherwise by reason
of my death. I authorize said guardian to use principal as well as inc~~me for the
care, maintenance, education and welfare of such minor.
Witness:
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THIRD: I name my children, John R. Calhoun, Ronald J. Calhoun and Suzanne K.
avis, or the survivor or survivors of them, executors of this, my Will:
FOURTH: In addition to and not in limitation of the powers conferred upon exe-
tors by law, I authorize the exercise of the following:
(a) To hold, or to sell at public or private sale, without order of court,
~r to lease and exchange any real or personal property composing my estate.
(b) To compromise claims.
(c) To make distribution in cash or kind.
FIFTH: I direct that my executors and. guardian shall not be required to enter
security in any jurisdiction in which they may act.
IN WITNESS WHEREOF, I have hereunto sett my hand and seal to this, my Fast Will
end Testament, this /'~~- day of ~~--~~~`~~'{~`-~~`~~-~' 1993.
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fitness:
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COMMONWEALTH OF PENNSYLVANIA:
:ss:
COUNTY OF YORK
We, Rosalind M. Calhoun,
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~. r=_ ,,~ ",,~ ~,~,~ ,.~/ `~.~~~~,~_.~_,~x the testatrix and the witnesses, respectively,
whose names are signed to the attached or foregoing instrument, being f:~rst duly
sworn, do hereby declare to the undersigned authority that the testatrix signed
and executed the instrument as her last Will and that she had signed willingly,
and that she executed it as her free and voluntary act for the purposes herein
expressed, and that each of the witnesses, in the presence and hearing of the-.testatrix
signed the Will as witness and that to the best of his or her knowledge the testatrix
was at the time eighteen years of age or older, of sound mind and under no constraint
or undue influence.
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Subscribed, sworn and acknowledged before me by Rosalind M. Calhoun, the
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testatrix, and subscribed and sworn to before me by ' -~// ~.~- ~.
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and ;.~, "•~+._~ ~t`.a<.~_ ~'~x ~---~"~u.~~-~- witnesses, this ~ ~?-h. day of ..%~~' <'~'~-'~~-~"~ ,<~
1993.
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Notary Public. - ""
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1~~AlA 1. YORTOtfF, NOTAtIf MIeUt
YORK aTY, Y0~ COYIln
MY ~SStON EXMRES MOrH11ER 1 !!!S
.~i,L REC,~ISTRAR'S ~ERTIIFI~.~-TION p~ DE'L'I-M
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
1. Name of Decedent (First, middle, last, suffix) 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year)
Rosalind M. Calhoun Female 493 - 24 ~- 9684 September 8, 2010
5. Age (Last Birthday) Under 1 year Under 1 day 6. Date of Birth (Month, day, ear) 7. Birthplace (C' and state ar fo re n country) Ba. Piece of Death (Check onl one)
Months Days Houn Minutes Hospital: Other:
97 Yrs. December 15, 1912 Harrisburg, PA ^In anent ^ER/Out atient ^DOA
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^ Nursing Home ~~ Residence ^Other - Specity:
8b. County of Death 8c. City, Boro, Twp. of Death 8d. Facility Name (I} not institution, give street and number) 9. Was Decedent of Hispanic Odgln7 ®No ^ Yes 10. Race:.Amedcan Indian, Black, White, etc.
Cumberland
Hampden ~P .
3605 Kohler Place (If yes, specify Cuban,
Mexican, Puerto Rican, etc.) (Specify)
white
11. Decedent's Usual Occu lion Kind of work d one d udn nest of world IHe. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Specity ony highest grade comp leted) 14. Marital Status: Married, Never Marred, 15. Surviving Spo use (If wife, give maiden name)
Kind of Work Kind of Business /Industry U.S. Armed Forces? Elementary! Secondary (0-12) College (1-4 or 5+) Widowed, Divorced (Specify)
Re istered Nurse Healthcare ^Yea ®Np 12 6 Widowed
16.Decedent's Mailing Address(Slreet,city/town, state, zip code) Decedents Penns lvania Did Decedent Ham den
State y Live in a 17
Actual Residence 17a
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3605 Kohler Place .
c.
es,
ecedent Lived in
Twp.
Township?
Camp HI 11, PA 17 011 17b. County Cumberland 17d. ^ No, Decedent Lived within
Actual Limits of city !Boro
18. Father's Name (First, middle, last, sunix) 19. Mother's Neme (Flret, middle, maiden surname)
Joseph Spier Catherine Yanko
20a. Informant's Name (Type / Prlrn) 20b. Informant's Melling Address (Street, city /town, state, zip code)
Suzanne K. Davis 735 Capri Circle, Lewisberry, PA 17339
21 a. Method of Disposition ^ Cremation ^ Donation 21 b. Date of Disposition (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 21 d. Locedion (City 1 town, state, zip code)
® Burial ^ Removal from State ~ Wes Crometion a Donation Authorized S e t emb e r 13
2 010
P Ro 11 in Green C erne t e r
g Lower Allen Zta PA 17 011
^ Other -Specify: lay Medical Examiner / Cororror? ^ Yes ^ No , Y P
22a. Signature I Se nsee or person acting as such) ?2b. Ucense Number 22c. Name and Address of Facility
- FD 012 848 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
Complete Items 23a-c oMy when certifying 23a. To the best of my krawledge, death occurred at the time, date and place stated. (Signature and title) 23b. License Number 23c. Date Signed (Month, day, year)
physician is rat available at time of deem to
certify cause of death.
Items 24-28 must be conpleted by person 24. Time of Death 25. Date Pronounced Dead (Month, day, year) 28. Was Case Refered to Medical Examiner /Coroner for a Reason Other than Cremation or Donation?
who prontances death. M, ^ Yes ~No
CAUSE OF DEATH (See instructions and examples) r Approximate Interval: Pan II: Enter other sitmiticent conditons contdbtrtirlg to death, 28. Did Tobacco Use Contribute to Death?
item 27. Part 1: Enter the chain of events -diseases, injuries, or compll~ations -that directly caused the death. DO NOT enter terminal events such as cardiac arest, t Onset to Death but not resulting In the underlying cause given in Part I. ^ Yes ^ Probably
respiratory arrest, a vernricular fibrillation without showing the etiology. Ust only one cause on each Ilne. ~
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^ No ^ Unknown
IMMEDIATE CAUSE (Final disease or
conditbn resulting in death) ~'' r 29. If Female:
Due to (or as a consequence o(1: ~ ^ Not pregnant within past year
Sequentialyy list conditions, H arty, b r
leadin
to the cause listed on Hite a
r ^ Pregnant at time of death
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.
Enter the UNDERLYING CAUSE Due to (or as a consequence of): r ^ Not pregnant, but pregnant within 42 days
(isease or Injury that initiated the c ~
events esuning m death) LAST. , of death
Due to (or as a consequence of): , ^ Not pregnant, but pregnant 43 days to 1 year
d. ,
before death
^ Unknown n pregnant within the past year
30a. Was an Autopsy 30b. Were Autopsy Endings 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Descnbe How Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory,
Performed? Available Pnor to Completion
^ Natural ^ Homicide Office Buildin ,etc. S
9 (pecrfYl
of Cause of Death?
^ Yes ~ No ^ Yes ^ No ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 321. It Trensportation Injury (Speciry) 32g. Location of Injury (Street, airy !town, state)
^ Suiade ^ Could Not be Determined ^ Yes ^ No ^ Driver /Operator ^ Passenger ^ Pedestrian
M. ^ Other -Specify:
33a. Certnier (check only one)
• Certif
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To the best of my Imowkdge, death occurred due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~~-^ r
• Pronouncing and artHying physician (Physican both pronouncing death and certitying to cause of death)
To the best of m
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^ 33c. License Number 33d. Date Signed (Month, day, year)
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• PAedkel Examirror /Coroner - / ~~ ( U
On the basis of exeminetbn and I or Investigation, In my opinion, death occurred at the time, date, end place, end due to the cause(s) and manner ss ateted_ ^ yq Name and Address of Person Wpp~Comp~letCed Cause of eat `Item 27) Type /Print
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