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HomeMy WebLinkAbout09-02-10FOR PROBATE AND GRANT OF LETTERS PETITION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVA al ~0 0~7~ No. Estate of Raymond T. Dell ,Deceased Social Security No. 202-42-6212 also known as ears of age or older, applY(ies) for: Petitioner(s), who is/are 18 y (COMPLETE "A" OR "B" BELOW:) rant of Letters and aver that Petitioner is the executrix named in the Last Will of the Decedent, dated A. probate and G and codicil(s) dated (State relevant circumstances, e.g., renunciation, death of executor, etc.) not marry, was not divorced, and did not haveersond born or adopted after execution of the instrument(s) offered for probate; Except as follows, Decedent did was not the victim of a killing and was never adjudicated an incapacitated p B. Grant of Letters of Administration ~d,b.n.c.t.a.: Dendente life; durante absentia; durante minorttate) OUSe (If any) after a proper search has/have ascertained that Decedent left no Will and was survived by the following sp Petitioner(s) and heirs: ~ Residence Name 112 Wesley Drive Uncle Mechanicsbur , PA 17050 Henry Keefauver 219 Fox Drive Cousin nn ~hani~sburq PA 17050 Bruce A. Keefauver Cluoad `='' 1045 Country ~_ Cousin Camp Hill, PA 17 ^ ~ ~-~ , Craig W Keefauver '~) ~ 7? ~ ~ 'Z ~~~,r~ N, and Street (COMPLETE IN ALL CASES:) Attach additional sheets if necessarY• Ivania, with his last principal residence a~ ~!~ Decedent was domiciled at death inks srt eetladdress, t wn/c'tySt wnship, county, state, zip code) r )`~ ,, ~ Wormle sbur PA 17043 ( ;. _ :. died Se tember 1 2009, at Hol S irit Hos ital 503 N. 215` Street Cam PA 17 _. , ., !~' Decedent, then 57 years of age, Location> - with estimated values as follows: $ 20 940.27 Decedent at death owned property All personal property $ (If domiciled in PA) personal property in Pennsylvania $ (If not domiciled in PA) personal property in County $ 35 250.00 (If not domiciled in PA) $ 56 190.27 ....... Value of real estate in Pennsylvania ...:.....................................'.."............................. Total.......... Real Estate situated as follows: 301 N. Second Street Wormle sbur PA 1704 ith this Petition and the grant of Letters in the appropriate Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented w form to the undersigned: _ __~ Qci~o~rP W Craig W• Keefauver 1045 Country Club Road Camp Hill, PA 17011 Pane 1 of 2 Form RW-02 rev. 70.15.08 '',. ~~ ,t 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 the estate according to law. Sworn to and affir d and subscribed G~.~ S~ re of Personal epresentative before me thi~ day of 2 0 For Register File Number: d 1-/~ ~ ~~7V Estate of Raymond T. Dell, Deceased Social Security No: 02-42-6212 Date of Death: September 1, 2009 r ~ AND NOW, , 2010, in considerationofthe foregoing Petition, satisfactoryproofhaving been presented before me, IT IS DEC EED that Letters are hereby granted to Craig W. Keefauver in the above estate. C7 F.-.~ FEES h~~ Letters ........................... $_~~"~ Short Certificate(s)......... $ Re unciation(s) .............. $ ' ............... $J, ice........ $~_- ~j} P. , C. ~ cn r-:-, -o s ~_ T ~ ~.sR <--, Attorney Signature: iu Attorney: S nne S. Frida Es ire Supreme Court I.D. No: 201873 Address: 200 N. 3d Street. 18`h Floor Harrisburg, PA 17101 TOTAL ................ $ ~• ~ Telephone: (717) 236-3010 Page 2 of 2 Form RW-02 rev. 10.13.06 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 correctly copied from an original Certificate of Deg duly filed with me as Local Registrar. The origit certificate will be forwarded to the State Vi Records Office for permanent filing. P 15690203 Certification Number SEP 0 ~Z00 __ _- Local Registrar Date Issued r_a l'-~~ ~ I `~ ~~ N - ~' C i t~ "~ ~ -,-T ~ ;-) ~ ~„ 3 PR NT NU06 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ --- ` RMANENT CERTIFICATE OF DEATH ""` ACK INK (See instructions and examples on reverse) CTATF FII F All IIJHFC t. Name of Decedent (First miMNe, test sWlix) 2. Sez 3. Social Seadry Number 4. Dale of Deem (Monts, day, year) Ra rid T. Dell male 202 - 42 - 6212 9-O1-2009 5. Aga (Last SlMlday) Untler 1 ar Udder 1 8. Date d Bits , da , r 7. BI ace C' aM stale or o ' n coon Se. Place of Dam Check one Monea DaYS Hours WnUes Hospital: Other. 58 y,6, 6-23-1951 Harrisburg C~Inltetient ^ ER / OlApatierlt ^ DOA ^ Nursing Home ^ Residence ^ oMar. Specify: fib. Canty of Death Bc. Ciy, Sono, 7wp. of Deem fid. Faddy Name (II not instNufion, give street aM number) 9. Wes Decedent of Hiapanc Origin? No ^ Yes 10. Race: Am•rkan IrMian, Bock, Whne, etc. Ctunberland Hill Camp Hol S irit Hos ital (II yes, spedry Cuban, (Spep~ y P P Mexican, PuaM Rican, etc.) Wh1te 11. Decetlent's Usual Oa tlon Kind of work dwre duns most of wrorltl Ne. Do trot state tea 12. Was Decedent aver in the 13. Decedent's Edlrcatim (Spedty only highest grade completed) 14. Memel Status: Martied, Never Martied, 15. Surviving Spouse QI wde, give maitlen name) Kind of WorN Kind of Businasl Inductry Clerical. Stevens Human Re- U.S. Armed Forces? Widowed, Divorced (Spealy/ ry Elementary I Secondary (042) Cokege (1~4 or 5t) ^ Yea LS~No 12 never maTTled r6. Decedent's Mailing Adtlress (Street city /town, state, zip code) Decedent's Did Decedent Pa 301 N. 2nd. St. Actual Residence 17a. State ' Live in a 17c. ^Ves, Decedent lived in Twp. Wormleysburg Pa 17043 Cumberland Tpwrrshlp? ,7d.®NO, Decedent lived wimin 17b. County WOrmleysburg , . Actual Limits of Ciry l Boro 18. Fathefs Name (First midde, last sugix) 19. Momer's Name (First middle, maiden surname) William J. Dell Arlene Keefauver 20a. InlormanYS Name (Type I PMQ 2~. Inlamant's Mailing Atldras (Sheet dY /town, stet, zip code) Crai W. Keefauver 104 17011 21a. Method of Dispoeibon I [~Crematon ^ Dawtlon 210. Date of Dispositlon (Monts, day, year) 21c. Pbce of DoposPoon (Name of cemetery, wemarory or other place) 21d.loceyyl (GIWJpxxstal4~ode) I ^ Banal ^ Removal frwn Stets 1 Wee Crematlon or Doru6on AuMOdzed Odlar. 1 Medcel E:aninerlCOronar? es^No 9-6-2009 Con-O-Lite Crematory t' V ISO .3 Schaaf ferstown Pa . a. ~ L (or it9 as such) 22D. License Nurturer 22c. Name and Adtlress of Facility 1 34 N. 2nd . St . ~ FD 013945-L Neumyer Funeral Home Inc. Harris Pa. 17102 Compote items 23a~c Doty when cerlitying 23a. To the best of rtry kn ,des occurred at the time, dale and place statetl. (Signature and title) 23b. License Number 23c. Date Signed (MOnm, day, year] physihan is not avaNable al tine of death ro cerlMy cause of deem. Items 2x26 must be competed by person 24. Time of Deam /, " 25. Date Pronounced Deed (Month, day, year) 26. Was Casa Relenetl Coto McNC•I Examiner / Corarer for a Reason Omer Than Cremation or Donation? who pronwlnoes tlealh. ~ , ,~ J M. > .z U 0 cj ^Ves YJ No CAUSE OF DEATH (Sea inatruetlons an examples) I Approximate interval: Pad II: Enter other s5onifi ant conditions con ' lino to • h 28. Did Tobacco Use Contribute to Death? Item 27, Pan I: Enter the chain of evente - dseases, injuna, or corrlplMSfiolb • mat dlremty caused file death. W NOT enter terminal events such as cardac artesl, 1 Onset to Deelh but trot resuhing in the undenyirg cause given in Pan I. Yes ^ Probably respirelory arrest, or ventnWlar Nrnllation without showilg the etkzogy. List Doty one cause on each line. ^ No ^ Unknown MIMEDIATE CAUSE Final disease w /~ }~ p caldNan rewkig in ~eaml _,~ a, (~ ~ l` Dt /-~'C.+ ~' Ql~ ~ S ~ ~ ~~ I^ N Duero (a as a consequenceroQA:' ,r s r entlelly lot mtMhrons, it arty, b. V G'7 i a i G v ~ A R ~ f~ G N yG.q n D r q I o pregnant within past year ^ Pregnant a1 time of deem ^ o ro the cause Ibted an Noe a. t Oua ro (a as a o0: Na pregnant, but pregnant wimin 42 days / Emer UNDERLYING CAUSE (Caease a iWry met hkNetad me c ~G~I C' "' ~R ~~ D' !~~~ evens reeWNrl m dam) UST ~ ~ ~ of deem ^ g . Oue to (a as a consequence of): Na r nanl, but Peg pregnant 43 days to t year 1 d. i before Beam ^ Unknown if pregnant wimin me past year 30e. Wee an Auopsy 36b. Were Autopsy Find'mgs 31. Manner of Deem 32a. Date a Ilqury (Monm, day, year) 32b. Describe Fbw Injury Occurted 32c. Ptece of Injury. Home, Farts, Street, Factory, Penamed? Available Pna to Completion ~ Nabrel ^ Ficrndtle Ollice Bui IOinq, etc. (Specify/ of Cause of Deem? ,}}~~, ^ Y u N ^ Y ^ N ^ Aaident ^ Pentliq Irnestigeaon 32d. Time d Injury 32e. Injury at Work? 321. It TrensponaNOn Injuy (Specify) 32g. Location of irqury (Street cdV I town, state) o es es o ^ Suicko ^ Could Not he Determined M ^ Yes ^ No ~ Dm•r/Operelor ^ Passenger ^ Pedestrian . Omer ~ SPep~ry. 33a. Certlfcer (Mack aaY one) 33b. signature and d Cerdfler • CertHying phyklen (Physicbn c•dityiW cause of deem when anohler physi:ian tees pronounced deem and completed Item 23) To the batdmy Mlwwkdge, death OC191Ired due to the auae(e)and mannM ee ebbd_______________________""'-"-' ^ ~~~, Pronoundng end Isnllyln9 phyaola (Physiden both pronaKroirg deem and cemtying to cause of deem) T h h d k ba d n d th l d d l d d t th d d ^ 33c. Lcense Nleroer 33d. Date Signed (MOnm, day, year) o t e at my now g., ar occurre n e t me, eb, en p ea, en ue o e awe(s) a manner as etMe _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • kNedkal Ezaminsrl Coroner nil ~ y 3 ~ 7 6 o ~ o Z L ~ a `~ On tlr• bob d ezamfnelbn and / w inwatigMlon, in my oplnbn, death oaurrod al me lima, date, and plea, and due to the cauae(e) arts manner u etated_ ^ 34. Name and Adaess of Person Who Compebd Cause of Dam (Item 27) Type /Print R7 H ~ I S l S j ~ E ~ 7 1i AD 1 A 5 AL3 J 3 l 36. Regievara wre and Diet ~ ~ l"1Ii I"ZI ~ I I 36 a Nee ( m, my, rear) ~' ~ L v v .. ~ h ~Arl~' t~ (>,~ N i7 l/ - 7 S.:~jOl , l , v Dispoeaion Palm;, Np. - 0332631 Register of Wills Cumberland County, Pennsylvania RENUNCIATION In Re: Estate of Raymond T. Dell, deceased. I, Bruce A. Keefauver, in my capacity/relationship as first cousin of the above Decedent, hereby renounce the right to administer the estate of the Decedent and respectfully request that Letters be issued to Craig W. Keefauver, first cousin, of the above Decedent. ~~ ignature) Typed Name: Bruce A. Keefauver Address: 219 Fox Drive Mechanicsburg, PA17050 Before the undersigned personally appeared the party executing this renunciation and certified that he executed the renunciation fq~~the purpose stated ithin on this (pad of , 2010. Notary lic ~~ ~ f`~©~ ~~ My Co fission Expires: COMMONWEAI.fiii 01: I'IrNN5YLVANIA NOTARIAL SEAL CHERYL R. GARMAN, Notary Public Camp Hill Boro, Cumberland County My Commission Expires May 20, 2012 c> ` c~ `~ _ ~ v :~ ~ T C7 "'L: ~m r., _~-mac; -n _, c. -~ _- - , Register of Wills Cumberland County, Pennsylvania RENUNCIATION No. ~ ~ ` ~ ~"r ~7~ In Re: Estate of Raymond T. Dell, deceased. I Henry Keefauver, in my capacity/relationship as uncle of the above Decedent, hereby e the ri ht to administer the estate of the Decedent and respectfully request that Letters be renounc g issued to Craig W. Keefauver, first cousin, of the above Decedent. ~ ~?~/L- (Signature) Typed Name: Henry Keefauver Address: 112 Wesley Drive Mechanicsburg, PA17050 Before the undersigned personally appeared V xecuting this renunciation and ~-; r the party e rtified that he executed the renunciation `- ~ cn. ce for the purposes stated ithin on this ;'c~ t_? `rim ~ ~(p`~da .of v v r , 2010. ~' ~ ;? r.~ ,. , ~_ :^ r_-~ -v f ~ :~`l t.~/ ~~ i~l r ~ ~~ _ .,z yr~ -~) -~' '~.~ ~ ~p~ c~--- Notary u is -' ~ My Commission Expires: / " l~ ~ "'- NOT~u"- ~"" public GARMAN, Notary CHERYL R• 20~ 2012 Cep Hill Boro, Cumberland Coun My Commission Ex~~~s MaY_____--