HomeMy WebLinkAbout02-22-11PETITION FOR PROBATE AND GRANT OIL LETTERS
REGISTER OP WILLS OF cUMB>JRLAND
COt1NTY, PENNSYLVANIA
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Estate of WAYNE R. McLAUGHLIN file Number 21 11 (~$9-
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McLAUGHLIN
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' OR 'B' BELOW:)
,Deceased
Social Security Number 191- 4 6- 4 813
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the
last Will of the Decedent dated and codicil(s) dated
named in the
t~ `_'
(State relevant circumstances, e.g., renunciation, death of executor, etc,1 [ 7 ,-~
Except as follows. Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of#I~e-ctistrurrietrt(s) offered
for probate, was not the victim of a killing, was never adjudicated incapacitated. and was not a party to a pending divorce~oceeding,~ the t~rrie ~~
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of death wherein grounds for divorce had been established as provided in 23 PA C.S. section 3323 (g): ~~" ~ `~'~
B. Grant of Letters of Administration
(/f applicable, enter: c. t. a.; d. h. n. c. t. a.; pendente life; durante absentia; durante mrnoritate)
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.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his lr last principal residence at
2504 Rolo Court, Mechanicsburg, PA 17055 Upper Allen Twp. Cumberland Co.
(List street address, Ioivn,%tn•, toienshi~, county, state, =ip code)
Decedent, then 5 4 years of age, died on 1 / 19 / 2 O l 1 at
2504 Rolo Court, Mechanicsburg, PA 17055
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 8, 500.00
(If not domiciled in PA) Personal property in Pennsylvania $ 0 . 0 0
(If not domiciled in PA) Personal property in County $ 0.00
Value of real estate in Pennsylvania $ 0.00
r./a
situated as follows:
Continued on a Separate Page
Wherefore. Petitioner(s) respectfully request(s) the probate of fl4~7~~~~oiti~,7~(~~it~lth~this Petition and the grant of Letters in the appropriate forrn to
the undersigned:
Signature Typed or printed name and residence
- /J,_
~~` LEO C. McLAUGHLIN
29 Rollie Rid e Drive Milton PA 1?847
Fnrm K11~-D' rer. I0.13.0< Pa~e~ Of
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(COrY1PLETE lNALL C'ASES:) Attach additional sheets if necessary.
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CiJMBERLAND
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. ~
Sworn to or affirmed and subscribed
;; Signature of
before me the ~- ~~~ ._ day of
Attorney Signature:
February _ , ~ 011 Signature of Personal Represenlatrve = ~7 -''~ ~`~-~ ~`_~
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~f''`' ~Or t}le ReglSteC Signature of Personal Representative ~ U~ ~:~ ~
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1~ ile Number: 2111- 0 0 c"
Estate of baAYNE R. McLAUGHLIN
Deceased
Social Security Number: 191- 4 6- 4 813 Date of Death: 1 / 19 i 2 011
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AND NOW, r ~~Z,/1~ =~;~~~~ ~-~'1l/~-1S'.~' ~ 2011 , in consideration of the foregoing Petition, satisfactory proof
<, ~~ of Administraticn
having been presented before me, I'T` IS DECREED that Letters .~___
are hereby granted to LEO C . McLAUGHLIN
in the above estate.
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FEES
Letters •••••••••••••
Short Certificate(s)
Renunciation(s)
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TOTAL
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Attorney Name: Richard M. Mohler
Supreme Court I.D. No.: 06373
Address: 14 S. Main Street
Lewistown
LEO C. McLAUGHLIN
FA 17044
Telephone: (717) 248-5462
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TYPE/PRIM IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions and examples on reverse) srnrE FILE NUMBER
1fJL-4Y1
,. Name of Dewdem (Frsl, middle, last, suRixl 2. Sex 3. Social Security Number , 4. Dale of Death (MOmh, day, year)
Wa ne R McLau hlin Male 191 -46 -- 4813 Januar 19 2011
5. Age (Last einndayj Under 1 year Under 1 tlay 6. Date of Binh (MOnin, day, year) 7. Binhplaw (City and slate or loreign country) Ba. Place of Death (Check only one)
MwOM oars Nwrs MI"Nes HOSpII°. Other.
54 Yrs. November 10 1956 Carlisle, PA ^mpanem ^ERlompatiem ^DOA ^NUming HOma Residence ^Other~Specify.
Count' of Death &. Clty, Bo Twp of Death
6b Btl. FacilAy Name Ilf not institution, give street and number) 9. Was Decedent of Hispanic Origin? ~NO ^ Vas 10. Raw: American Indian, Black, While, etc.
. (Ii yes, specify Cubari, ISpacM
Cumberland U er Allen 2504 Rolo Court Mexican, PUeno Rican, etc.) 1^hli
11. Decedent's Usual Occ i'lon Kind of wone done dodo most of w°rkln lee. W rpl state retired 12. Was Decedent ever in the 13. Decedent's Educalbn (Specify only highest grade wmpleled) td. Marital Status: Marred. Never Manied. 15. Suviving Spouse (If wife, give maiden name)
Dlvometl (Specify)
Widowarl
K tl W Work Kind dBusiness / Intlustry ,
U.S. Armed Forces? Elementary! Secondary (D-12) College (1-4 or 5f)
Assessor Count Government ^Y°° Q"°
1 fi. DecetlenYS Madinq Address (Street. city r town, stale, zip code) Decedent's Did Dacetlenl
Decedent owed In Upper Allen Twp.
A ova in a 77c
C~ Yea
2504 ROlO Ct . ,
.
Actual Raiicenca 17a. Stale
rnwnanip?
Mechanicsburg, PA 17055 17a ^ Nn, Dewdem Lwea w;tnm
,7b count' Cumberland Amuelumiteel GlylBam
18. Father's Name (First, mkldk, lass, suFix) 19. Mother's Name (First, middle, maiden camerae)
Ral C. McLau hlin 1Jo o h J. 1 '
zoe. Imom,anrs Name (Tyne r Prim) lob. mlamenea Manmg atlarees jstreel, crv r town, state, tip <ode)
Leo McLaughlin 29 Rollin Rid a Drive
21 a. Meinod of Dispwitron ~] Cremsibn ^ Donation 21 b. Dale of Disposition IMonih. tlay, year) 21 c. Place of Dlsposilion (Name of cemetery, crematory or other place) 21 d. La:aAat (City! town, slate, tip axle)
^ Burial ^ Removelfrom5tate ~ WasCromatpnorDOnatbnAUMOrized
• Jan. 24, 2011 Hoffman-Roth Funeral Home & Carlisle, PA 17013
^ Other ~ Specify by Medical Examiner / Coraner4 ®Yes ^ No
2ze. signewre 9 Funeral seN a see (a rspn acurg as eprh) zzb. uwnae Number 2z°' name aria Address °' Facility Hof fman-Roth Funeral Home & Cremator
. ~ 138504 219 Nor h H t
Cmrolele Items 23ac n ceaityin9 23a. To ihP best of my knwdetlge, death ottuned at me Gme, dale and place stales. (Signawre antl title) 23b. L'Kense Number :?3c. Date Slgnea (Month, day, year)
physician rs rid a al lime of deem to
wmty wu ealh.
Time of Death
24 25. Data PmnWnced Oeatl (MOnm, day, year) 26. Was Case Relerted to Medical Examiner I Coroner !or a Reason Other loan Cremation or Donetbn?
Hems 2426 must be cnmpkletl by person . Yea ^Np
wlioprong11CQ$~'b A rx. 1:00 A.M Januar 20, 2011
CAUSE OF DEATH (See Instructions antl examples) r Approximate interval: Pan II: Enter wher ~igniYCanl oxldT tlib ijDq.IgggalB. 28. Did Tobacco Use ConwbWe to Dsam?
Item 27. =an I'. Enter the main of events - tliseases. Injuries, or complications - That tlirectly roused the death. W NOT enter terminal events such as cardiac arrest, Onset to Death but not resulting In the undedyirg wu riven in Pen I. ^Yes ^ Probady
respiratory anes6 or venMcelar fibrillation without showing the edobgy. List onty one cause on each line. ^ No ^ Unknown
IMMEDIATE CAUSE Foal tlisease or
ca,anron rewungm~eath)
Hypertensive Cardiovascular Disease
a
Diabetes Mellitus 29. If Female:
nMn
ast
ear
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Due to (or as a consequence oll-. p
y
0
pregnan
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^ Pregnant al lime of deem
Sequenbalty list con0lans. It any, n
.
leading lp the rouse lisletl on Ime a
f
^ NM pregnant, but pregnant wimin 42 days
t:
Enter the UNDERLYING CAUSE Due to (or as a consequenw o of death
(aieeaee or injury mat initiated the
c
ven6 rewMng m tlealhl LAST.
Due to (or as a consequence ory. ^ Nol pregnam, Om pregrent 43 tlays lv 1 year
before deem
d.
• ^ Wknown H pregnant wnnin the pest year
3Da. Was an Autopsy 30b. Were Auopsy Fndilgs 31. Manner of Death 32a. Dale of Injury (Month, day, year) 32b. Dewrlbe How Inlury Ocwnetl 32c. Plac °I inryry: Mane, Fenn, Sreel, Factory,
Office Building, etc. (Specyly)
Pedormetl? Available Prior to Completion
of Cause of Oealh? Natural ^ Hominde _
y,q ^ A~aent ^ Pentling Investigelion 32d. Time of Inlury 32e. Inlury at WoM?' 32f. If Transporlalion Inlury (Sped/yJ 32g. La:alim of Injury (Street, city' I town, stale)
^ Yes IXl No
T1 ^Yes ^ No icide ^ Cvuld Nol be Determined
[] S ^Yes ^ No ^ Driver! Operator ^ Pesselger ^Pedesldan
u M ^Olher - Specy:
33e. Center (check a,y one)
t
elt
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etl
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d 33b. Signature and edifier ~rt /
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To me xatmm ~
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Chief Deputy Coroner
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• Pronoutxinq antl wntlying physician (Physkian born pmnounnng tlealh and cenilyinq m cause of death)
^ 33c. License Number 33d. Date Signed (Month, tlay, year)
To the heal o} my knowledge, Beath occurretl et ate time, date, rind place, and due to the cause(s) and manner ee stated_ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ January 21, 2011
• MeeiwlExamirwr/comner
On me basis of exeminatlon alM I a inrestigetlon, in my opinion, deem aanee M the Ilme, date, and place, and tlue to Ina cause(s) and manner es stated- ~' ~ Name aM Address of Person Who Gmgleted Cause of Death Qtem 27 Type I Print
Chief Deputy Coroner
Stoner
Matthew S
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