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Home My WebLink About12-27-10IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of ~ (~ \/ I ~ ;~ ~ U W ~ (~~ ,Deceased ESTATE NO: 21- ~ (,, ~- ~ ;r,~<~~C a!k/a: alk/a: a/k/a: Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as ap licable: ~A. Probate and Grant of Letters Testamentary or ^ Administration c.t.a. or d.b.n.c.t.a. coin lete .Part C al _ ( p so) and aver that Petitioner(s) is/are entitled to the aforementioned Letters ~~~ e S~ ~ ,~ t under the last Will of the above-named Decedent, dated r~1~i; C 1~ /5 ~i ~ and codicil(s) d ed (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 instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as defined in 23 Pa. C.S.A. § 3323(g): t ~ S JV L r ~L ~ ^ B. Grant of Letters of Administration (If applicable, enter d.b.n., pendent lite, durante absentia, durante minoritate) C. Petitioner(s), after a proper search, haslYiave 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 and complete list of heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(g), except as follows: gnarl -b ;3e ~w~ 3t~..5 (~.~ ~ Si /~~~~ ~, ~~ .''fie ~: - C ~.. .F ~ ~ ~~ rr•~r ~`~ ~".~~ c..~ ~ ~.3 T l1SE ADDITIONAL SHEETS Il' NECESSARY <- ~~ ~ } +~ THIS SECTION MUST BE COMPLETED: ~~ ~ ~"` ~~' ~~~ Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family 6r opal r~iden ~,n C'r :+txe! (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) ~° _`7 Decedent, then `~ `f' years of age, died DEC , I'1 ~o 1 a at _ I.- C ~ ~ y n; ~ ~A (Month, Day, Year of death) (City and State where death occurred) Estimated value of decedent's property at death: _ _If domiciled in PA All personal property $ ~ l:U; `;~~ _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 Estimated Value $ ~ Tc~c.~~~ Location of Real Estate in Pennsylvania: (Provide full address if possible.) ~ ~ ~ ~-{ ~? R Nt,~ n) ,~ V~ ~ ~ ~ u N'(' ~i~ Signature(s) Name(s) & Mailing Address(es) ' * ^~ Name Address Relationshi to Decedent nter~m Form RW-02 revised 12.26. i 0 by Cumberland County pending action by the Court Page 1 of 2 OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania ~ SS County of Cumberland The Petitioner(s) herein named swear or affirm 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 affi~rr~Pd and subscribed r~ ._ be~}fore ;:ne this . ;~ Z day of va q " r ~'~ ~' ~/ ~~ r-°~:s ~~ ~' C'" s For the Register ;~' c~ ~~',-, -~ ra ~~ s~ DECREE OF PROBATE AND GRANT OF LETTE~~~ -~ ~ ~ ~,. Estate of k ,~~~~~ ~~~~ (` v~ -~.~ ~,~ ,Deceased File Number: 21- ~ ~ 4 U -~~;i _ ~ ;""'-'1 T"~.'"t ,~''f ~ _ <:.~') _x ~ ,_~~ ~= ::.n ~ AND NOW, this~~ day of ~~ti~~ C ~C G~` , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary of Administration are hereby granted to: (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) ~~ . t the above estate and that mstruments(s) dated % ~ ~ ~? c ; ~ ~~ described in the petition be admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. Signature of Counsel Required to Enter Appearance FEES: Letters ....................$ ~ ~ ~j~l Will ....................... t ~=~ car Codicil(s) .............. . (%} Short Certificates ~ Cf - ~.C.'~ ( )Renunciations....... Bond ............................ Other ............................ Automation FEE......... 5.00 JCS FEE ................... 23.50 TOTAL ................ $ hs~~ ~ ~ (~ :~, ~ Glenda Farner Strasbaugh, ~~ r (~j ~'~_c~; L;~~. '~7, "~ _,~~~ chi„~::~. Register of Wills Atty's Signature PRINTED Name: Supreme Court ID No.: Address: Phone: Fax: Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 oft ~ ~ ~ ~: i# i~ illeq~~l ~~ a~~xpiic~t~~ ~l~is ~~~~~~~ i.:~t~ ril~cak~;~~~t ~_' pOtOCi~a~:~i~. __P __1704588 j I _ ~?': FiF ,,.,., j )l~ r ~. flit t,9 #Ilt+t)~)1)1lliC'll ~~h IL ~,!1'~~l'1) lti /~~a ~~ r ~ ,-, , 1'til t: wt Uf 1":.'_)l~iilt ~L{)l~lL' ll+._?)~ F)l'~i1h t'`E ~~~ ~ ~ nor rte. ~ ! . .~ ,m 1. ... , ~ 1~L~wl~7l,.ir. "I~)t ~~t~trj)~al ~' '~ ,~ ~ ~~ ,-tljlt..,.. ~ ~ :,~ ,f-cI~'t_l ttf (1~~~ `st;Ut' l''~tal ~, . -_ #, t t}, t ;, ~, s }t, ~,. DEC z ~ 2o~a ~, t , j _ .~, .~ .. x , yr y ~ rh , ~ ~~ ~~ ' ~ ~ ~~ ~ r )t~C" ~~ti>E~(~ +fµy;~ C +";.""1 ~~ ~ C.;r3 ~ L~ t- ~ ~ ~ _J-.~ ~ ~ /~y /y~ ~_.~ ...M. y. ~.,.,ti,~ .~..r• -~v REV 11/2008 PRINT IN AANENT CK INK 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, suffuc) 2. Sex 3. Social Security Number 4. Date of heath (Month, day, year) David R. Powell male 053 --20~-2086 5. Age (Last Birthday) Under 1 year Under 1 da 6. pate of Birth (Month, day, year) 7. Birth lace and slate or fore) coon ) 8a. Place of Death (Check Doty one) Mo Days Hours Minutes Hospital: Other: 8 4 yrs D e C . 1 9 , 1 9 2 5 Jamestown , NY npetiant ^ ER 1 Outpatient ^ DOA ^ Nursing Home ^ Residence ^Other -Specify: Bb. County of Death 8c. City, Boro, Twp. of Death Bd. Facfliry Name (If not instilutlon, give street and number) 9. Was Decedent of Hispanic Origin? No ^ Ves 10. Race: Amencan Indian, Black, Whae, etc. (If yes, spedfy Cuban, (Specif}~ Cumberland East Pennsboro Holy Spirit Hospital Mexican, Puerto Rican, etc.) white 11. Decedem's Usual Oce tbn Kind of work d one dud most of worlds Itie. Do not state retired 12. Wes Decedent ever in the 13. Decedent's Educatlon (Spedty only highest grade completed) 14. Marital Slafus: Married, Never Mamed, 15. Surviving Spouse (If wife, give maiden name) Wid d d i Di S Kind of Work Kind of Business /Industry U.S. Armed ForcesT Elementary I Secondary (0-12) College (1-4 or 5+) owe , vorce ( pec ryq n/a state govt. ~ ^N" 12 4 divorced 16. Decedent's Mailing Address (Street, city /town, stela, zip code) ~ecedenYs p e n n s 1 va n i a Did Decedent y Live in a t 7c ^ Yes Decedent Lived in Twp 432 Herman AVe. , . , Adual Residence 17a. Slate CUm er an Township? 17d.~DIo,DecedentLivedwehin Lemo ne PA 17043 1b~~°"n''" ActualLlmitsol Lemoyne CitylBOro 18. Father's Name (First, middle, last, suffix) Arthur Ralph Powell 19. Mother's Name (First, middle, maiden sumeme) Edna Mae Walker 20a. InfomranYs Name (Type / Prlnt) R. Jeffrey Powell 20b. Informants Mailing Address (Street, city /town, state, zip code) 305 N. Barbara St.,Mt. Joy, PA 17552 21 a. McMod of Disposition ~ Cremation ^ Donation 21b. Date of Disposition (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) lid. Location (City /town, state, zip code)1 ^l O 6 5 ^ Burial ^ Removal from State ;Was Cremetbn or Donation Autnorized 21 2 01 0 Dec H o 11 i n g e r Crematory H o 11 y Springs P A t ^ Other - Specity.~ by Medical Examirrer / Corwrer9 Yes ^ No , . . , 22 turg of Funeral S (or person ailing as such) 22b. License Number 22c. Name and Address of Facll'rry FD-013163-L Musselman FH&CS,324 Hummel Ave.,Lemoyne,PA 17043 plate kerns 23ac only when certifying 23a. To the best of my knowledge, death occured at the time, date and place stated. (Signature and tltle) 23b. Lcense Number 23c. Date Signed (Month, day, year) physician is rat available at time of death to certify cause of death. Items 24.26 must be completed b1' person 24. Time of Death 25. Date P aced De (Morrth, day, year) 26. Wes Case Referred to Medical Examiner !Coroner for a Reason Other Than Cremation or Donation? wfa pronounces death. ~~ ~ ~ Q ~. M. ! ~ ~ ? a `Q ^ Yes No CAUSE OF DEATH (See Instructions and examples) r Approximate interval: Part II: Enter other gjg-niticant conditions contributing, o death, 28. Did Tobacco Use Contribute to Death? hem 27. Part I: Enter the chain of events -diseases, injuries, or complfrations -that diredty caused the death. DO NOT enter terminal events such as cartfiac arrest, ~ Onset to Death bW not resulting in the underlying cause given in Part I. ^ Yes (~ Probably respiretory arrest, or vemrkular fibrillation without showing the etiology. List only one cause on each Ifne. r r ^ No ^ Unknown IMMEDIATE CAUSE (Fine disease or ~ i condition resuking In ath~ _-~ a ~' ~ Z'D (,~L )'~ lZR.4 5 ~ 29. I1 Female: t i hi ^ N r Due to (or as a consequence of): r SequenBelly I'tst conditions, M any, b. ~ ~ C V D i pregnant w n past year t o ^ Pregnant at time o1 death leading to the cause listed on line a. Due to (or as a consequence of): ~ Enter the UNDERLYING CAUSE ^ 'Not pregnant, but pregnant within 42 days of death (dsease or injurryy That hritiataadd the c r r events resuldrgln death) IAST. Due to (or as a consequence of): r ^ Not pregnant, but pregnant 43 days to 1 year d. r before death ^ Unknown i1 pregnant within the past year 30s. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Deam 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory, Office BuiMing, etc. (Specrfy) Performed? Availade Prior to Completion of Cause of Death? ,,~~//~~~~ tural ^ Homicide ^ Yes No ^ Yes ^ No ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. N Trensportatan Injury (Specify) 32g. Locaton of Injury (Street, city /town, state) ~ ^ Suicide ^ Could Not be Determined ^ Yes ^ No ^ Driver/Operator ^ Passenger ^Pedestrian M ^Other • Specify: 33a. Certifier (check Doty one) d I 2 33b. Signature and Title of Certifier `"~ r ( ~ tem 3) Csrtfying physician (Physician certifying cause of death when another physician has pronounced death and complete darth xcurred due to the cause(s) end manner ea stated., _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ _ _ _ _ _ _ _ _ ^ To the best of my knowledge ~~ ( ' ,,,, ~ - , , Pronouncing end certifying phyekian (Physidan both pronouncing death and cartitying to cause of death) ^ 33c. Licens umber 33 . Date Signed (Month, day, year) To tM boat of my knowledge, death Decocted at the time, date, and place, and due to the cause(s) end manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ .. _ _ _ ,.. l i f C M i ~ M> ~~~~ 5 s E ~ z i~ f z v i o oroner Ezm ner . ed ca On the basis of examination and / or I estigatlon, in my opinion, death occurred et the time, date, and place, and due to the cause(s) end manner as stated_ ^ 34 Name and Address of Person Who Completed Cause of Death (Item 27) Type /Print 35. Re ist s nil u / ~ 36. Date Flied (Month, day, year) i Dispostion Permit No. ~ 3 y a, 3 0 9 ',> ~ C O ~~~: tom. ~ ~D r-- WILL O F ~ ~~{''~ V ^ ~ (`"~~-~' • ~ ~ `-'-' '_-~ t.~t ~ A~-..~ DAVID R. POWELL ~ L l {=~:~ ~ ' rn c ~ c";~~, ..._.? S -:~ - s N . ,- r . I, David R. Powell of Cumberland County Lemoyne ~~~ ~ ~~ , , Pennsylvania, declare this to be my last Will and hereby rev oke all , ~.r~ a prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows: A. I direct that 75% of my estate go to my daughter, Jill Ann Powell. This provision is intended to be in compliance with and satisfaction of paragraph 4 of a "Settlement Agreement" dated April 30, 1980, between myself, my wife, from whom I am now divorced, Marie M. Powell and my daughter, Jill Ann Powell. B. I direct that $5,000.00 go to The Nature Conservancy located at 4245 N. Fairfax Drive, Suite 100, Arlington, Virginia 22203. C. I direct that the remainder of my estate go to Lisa M. Sandquist. D. Should my daughter, Jill Ann Powell predecease me, I direct that her share shall go to Lisa M. Sandquist. LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 4. I appoint R. Jeffrey Powell, as Executor of this my last Will. Should R. Jeffrey Powell predecease me or cease to act in such capacity, I appoint Arthur Powell as alternate. -., . _~~~ ~~ 5. The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. IN WIT ESS WHERE ~ ave h unto set my hand this a of ~ , 2010 dy .~ David R. Powell (~-~~ ~~" ~, ~. LAW OFFICES OF STEPHEN J. NOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 The preceding instrument consisting of this and two other pages was on the day and date hereof signed, published and declared by David R. Powell as and for his last Will in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. WITNESS WI E S ``~ LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ACKNOWLEDGMENT State of Pennsylvania County of Cumberland ss I, David R. Powell, the Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. - ~~ ~ ;~ _ ~.1~ ~ David R. Powell /~ ~ ~y p ~ p _,._...i ~'4e1~ i~ ~C~96~a ~l~'~T~, F ~ d. ~~$ • ~ ~~, Notary Public/Attorney ~' ~~,~.~.~~:.~ ~,~:~ ~:A~f~ I D AV I T Sworn to or affirmed ~d acknowle d before e by David R. Powell the Testator, this ~ day of ;~, ~~ , State of Pennsylvania County of Cumberland ss We, bacrc~ -~a~~- and~~4 ~~ ~ ~, ,the ~. witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Will as a witness; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. .4 ..._ 1 ~ r , ~~ LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 w rn to or affir and sub ibed to efore me by witnesses, this day of 2010. .~ ~~.. ~.~...,, r, Carlf~ ~ ~ ~ j '--~ ~f~ota ~, ~~~ ~ ,~ Public/Attorney ~ CARLISLE, PA 17013