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HomeMy WebLinkAbout03-24-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Dorothy M. McNiss ~ ~ ` 1 ~ ~ ~'~~~ ~ Estate of File Number also known as ,Deceased Social Security Number 211-12~-6594 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 executrix named in the last Will of the Decedent dated 9/11 /2007 and codicil(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 of the instrument(s) offered for probate, was not the victim of a killing, was never adjudicated incapacitated, and was not a party to a pending divorce proceeding at the time 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 (If applicable, enter: c. t. a.; d. b. n. c. t. a.; pendente liter durante absentia; durante minoritate) cedent then 86 years of age, died on 3/18/2011 at HOIy Splrlt H North 21st Street Camp Hill Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (nf 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.) _r 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 $ 110,000.00 TOTAL: $110,000.00 situated as follows: 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: Signature Typed or printed name and residence ~ -~ ~ 1, . ~ ~~ ~~ Linda J. Grable 517 East Coover Street Mechanicsbur PA 17055 Form RW-02 rev. 10.13.06 Page 1 of 2 ~~ F .~ w (COMPLETE INALL CASES:) Attach additional sheets if necessary. ~ -!_i ~ ~;~ ~'~w~ Decedent was domiciled at death in Cumberland Coun ,Pennsylvania, with his /her last principal residence at 517 East Coover Street Mechanicsburg PA 1055 Borough of Mechanicsburg (List street address, town/city, township, county, state, °ip code) Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY pF 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) willl well and truly administer the estate according to law. ~ ~' ~ - ' - ' _ -~' ~C~U~ Sworn to or affirmed and subscribed .. ~; - ~ _ - ~ ~~ tgn ture of Personal R resentative ~ ~ ~.~ ~- t'om'`" =-~~' ~~ ~~ Y , ~' da of before me the ~ ~' y t tz r~ .f :.. ~: _~:~ .~ Signature of Personal Representative - ,-~-~ -_y..t .. . Si nature o Personal Re resentative For the Register g f p Z" E`.:~ ``~ , ~ ~. File Number: .-~ ~ _ ~ ~ - L:`~ ~~ Estate of DOrOthy M. MCNISS ,Deceased Social Security Number: 211-12-6594 Date of Death: 3/18/2011 AND NOW, V ~ r~~ C~~.I~ ~~~~ ~ -~ ~ ,~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Linda J. Grable _ in the above estate and that the instrument(s) dated 9/11 /2007 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES '' I ~ ~ ~ ~ "~ ,~ • ` Register of i Letters ............................. $ - t~ C, C'"C r . ~ Short Certificates .•.••.••••.. $ ~~~ CZ% -- () Attorney Signature: Renunciation(s) .••••••••.•••••• $ ` ~~,,, ~ ~ $ ;; ~~~~ Attorney Name: DaVld H. Stone; Esquire =~~ ••~~ $ ~~~ `"'~"~ Supreme Court I.D. No.: 39785 ~ ~ ` ... $ Address: 414 Bridge Street ~~~~ $ New Cumberland .... $ .... $ PA 17070 ~~~~ $ 717-774-7435 $ Telephone: TOTAL ............................. $ ; 1-~~ J_. Form RW-02 rev. 10.13.06 Page 2 of 2 t3~'AL REGISTRAR'S ~ERTII=IC;ATI{HIV IC~1= ~ lN~f~NING: It iS illegal to duplicate tl~tis c~~ay h{~ pl~olc~~>~~t c:$i~ ~,~~?#a~l~ac:t~; ~~e,.~ liar this ~.t•rliti~~~1t~•. ~(~.i){) P 1,_72~848_~ ___ C'crtit~~i~at~tm dtm:h~. 143 REV 112006 'E /PRINT IN 'ERMANENT BIACK INK ,irr iii ~v%. ~ ll''- ~ ~ t,~z- I~9 ('(~I X111(!)1 ~~ f '~(G .~ 11 mtr r~~,~. ~~~t-, ~ r, i '_ ~ ._ :. ~ ' t l l ~ '~ L 1 i 1 (I •. l i 7 i 1 "1111 ~~~~ <.~ .3 11` '. C-, it 91 I~.l'~°1r11~~1' ~'tt_' /'9 _'111;11 =,~' v ~~ t1-~~, ~1~t ~ , (,i~ 41 ~t+ illti° Ii11~° ~'1!~11 \c~,a` ~~ 1a `) 1` _'~ tmi~1~ i ,~' ~ „i'.'il" Mlii?)~. * `i ~ ,; , ._ ~ a~~ S '" "• a..- 1 1 // d ', I 7, ,. ~ ,'.,? L y ~ y:~ t.ttT-`l 11, 4JX~IC ll .,w._ `` ~~ ~. ~~:. , _ ~ ,_, . <= 1 ~~i ~. t"" 4 ~ .. ~ r -~ G ~~~=-- ; -©~ ~ ``~ ~~„ h~ ~. COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE FILE Nl1MHER 1. Name of Decedent (Frst, mklde, last, suffix) ° ~oRrn-~r M. Mc Nlss 2. Sex ~ 3. Sodal Security Number a2i~ - l -Gs~~ 4. Date of Death (Month, day, year) i~If~~~cN ~~, a~~~ 5. Age (Last Birthday) Under 1 ar Under 1 de 6. Date of Birth Month, de , ar 7. Bd lace C' and state or tor e count fie. Place of Death Check on one - Q ~ t~nMs Days Hours Mirxnes p ~S ~ ~ ~ R Y ~~ ~ ~ ~ O ~ E RS A„y~ ~ Hospital: Other v Yts 7 " i ' Ji~~~ .~ ~ Inpatient ^ ER / 0 tlent ^ DOA utpa ^ Nursin Hoare g ^ Residence ^ Other -Specify: 8b. Cormty of Death Ek;. City, Boro, Twp. of Death fid. Facility Norte (If not Institution, give street and number) 9. Was Decedent of Hispanic Odgln? No ^ Yes 10. Race: American Indian, Black, White, etc. G`~.l M G,E/Q l_FI N L` '~ C)/a/nP 1~lL,t ~CJL.y 5 /~/ft i T l-/O,S Ai i /~ L (If yes, specify Cuban, Mexican, Puerto Rican, etc.) (Specil}~ Gt1 F# i TC 11. Decedents Usual Lion Klnd of work done d udn most of work) Iffe. Do not state retlred 12. Was Decedent ever in the 13. Decedent's Educatkn (Spotty Doty highest grade comp leted) 14. Marital Status: Monied, Never Married, 15. Surviving Spo use (If wife, give maiden name) K¢d of Work ~ R A r'T I rJ G C~E~K Kind of Business/ Industry ~ELL71LEPlfanl E ~c5, U.S. Armed Forces? ^ Yes ~NO Elementary /Secondary (0.12) %2 College (1.4 a 5+) Widowed, Divorced (Specify) rwJ/L'/I~,vF.l: 16. Decedents Mailing Address (Street, city /town, state, zip code) Decedents Pe-. N Did Decedent N S'Y LU HN I N A t l R id 17 St t 7 ^ Y ~~ ~ ~~s,.r CCJQ L ~~ n~~-1. .J c ua es ence a. e a c. es, Decedent Lived in T- Tw . Township? 1 P MECµgnr ~ crSt3 UQG Pq / ~ 0,~$' 17b. Coun Cui'» /3k~ILAND 17d.~No, Decedent Lived within ty Actual Limits of ME"Gkkp Nl C S Q u~G Cityl Boro 18. Father's Name (First, middle, last, suffix) 19. Motlter's Name (Flret, middle, maiden sumamg) Gv i.L~, i i9 •~~ A ~n10 ~.- b N0~ A H ,C S`!.~/C E-~ 20a. Informants Name (type I Print) Lii/~~ '~,/, ~'l~A~t-E 20b. Informant's Mailing Address (Street, city /town, state, zip code) s>~ ~sr c.e,~c~>~~2. SrR~°t' MEe~iaNrest~u~e f'A ~~~.~5- 21a. Method of Disposition r Cematon ^ Donation 21b. Date of Dispositon (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21d. Location (Ciryltown, state, zip code) r ^ Budal ^ Removal from State r Was Crematlon or Dorradon Authorized M A,ee,N ~ 9 ,air ky ~ C 2~ 8 ~ f# r ~ a ~ g' G ~s + - ~ ^ Oar. S r by Medkel ExamlrrerlCoroner? Yas^ No 1 fmaro i- 1 i .~, r u ~, as s ch) Funeral Servke Licensee (or pe n a~~ 22b. License Number 22c. Name and Address of Facility „Zry 4 ~ m ~~~~ ~.r')/ .~:~ u~ ,,,,,, - - C.O'1.~~ la ~-L- . /k1. D~'ui~~.~' >C~~~mCL FuN~7_A~c /,tiiin~ c. I~FA~'seu~ PA i Z s r, s Complete he 23ac ony when certifying physkian is rat available at time of death to 23a. To the be f my knowled~ ath gaGuned at the tlme, date and place staled. (Signature and tPoe) / ~ , ` 23b. License Nu~ r r / ~ • 23c. Date Signed (Mj~, year) certify cause of death. . JI /,( ~'i 'U_ ~ ~ L~/ V / v ~ v+ ~ ~_ 3 ~ hems 24-26 must be completed by person h d th 24. Time of De ~ ~ yr 25. Date P Dead onth, day, year / a ~ ~ 26. Was Case Refened to ical Examiner /Coroner for a Reason Other then Cremation or Donation? ^ w o pronounces ea . M. - ~ Yes o CAUSE OF DEATH (See Instructions and axampbs) r Approximate interval: Part II: Enter other 1lmificant conditlons crontnbutlnq to dl.Eth. 26. Did Tobacco Use Contribute to Death? Item 27. Part I: Enter the chain of events -diseases, injuries, or compfxrefions -that drrxdly caused the death. DO NOT enter terminal events such es cardiac arrest, r Onset to Death but not resuling in the undedying cause given in Part I. ^ Yes ^ Probably respiretory artest, or ventricular flbdltatkn without showing the e' .list Doty one cause on each line. ~ ~1 r ^ No ^ Unknown IMMEDIATE CAreSE (Flne~dsease or y1 ~ p ,~ r 29. If Female: condifion resultir In death _~ a j ~t~ ~,.._ ~ ^ N Due to or ue o : r Sequentieliv Ilst conditlons, h any, b r r ot pregnant within pest year ^ Pregnant al time of death ^ lea ing to cause listed an line a. r d the Enter Hte UNDERLYING CAUSE Due to (or as a consequence og: r Not pregnant, but pregnant within 42 days of death r (disease or injury that initiated the c r events resuhin m death) LAST ^ g . r Oue to (or as a consequence oQ: r Not pregnant, but pregnant 43 days to 1 year before death d. , ^ Unknown if pregnant whhin the past year 30a. Wea an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Inryry Occurted 32c. Place of Injury: Home, Farm, Sheet, Factory, Pedortned? Available Prior to Completion of Cause of Death? ^ Natural ^ Homicide Office Building, etc. (Spec/IyJ ^ Y N ^ Y ^ N ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. If Transportation Irqury (Specity) 32g. Location of injury (Street, city /town, state) es o es o ^ Suicide ^ Could Not be Determined ^ Yes ^ No ^ Driver / Operetor ^ Passenger ^ M• ^ Other - SpecNy 33a. Certlfier (check Doty one) 33b. Signature and Title of Ce ' r - • CsrtHying physkfM (Physician certifying cause of deaN when arather physk:ian has pronounced death end completed Item 23) To the beat of my knowNdge, deeM occurred due to the noos(e) end manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ - • Pronouncing end artlfying phytkian (Physidan both pronouncing death end certhyky to cause o1 death) To the beat of my knowledge, death occurred at the time, date, end plea, and due to the cause(s) end manner se steted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Number ir..t r1f~ 33d. Date Si ( t day, year) 3~r,Q • Medical Examiner/Coroner 1_ V 1J III U On the bash of examination end / or ImesNgetion, In my opinion, death occurred at the lima, date, end plea, and dw to the ause(a) and manner sa ateted_ ^ 34. Name d Address of Person Who Completed use d Death (h 27)1'ype / Pdnt / e O ~ A /, Z ~ SAS.} ~ ~ l ~ J ' V /~~ 35. R SlgnaWre e ~ ~ 1 ~ l a?i ~ ~ ~ 1 36. k led Mon ,day, year) 7 / ( 1 ; ~ ~ 1 / ~~'~' n-K,~ ~j c"~1 ~ T CGz.~-~/~ 1-I-,-- .P~4 - . ,. O ~ lG l J ~' Dispositon Permit No. ep\wi11s\MCNISS,COROTHY ~ , ~ 1 - . s [~} LAST WILL AND TESTAMENT ~"'~~' -~' -_ DOROTHY M . MINI S S ~~'~ ~ ~ 1. ~ ~ rw~ „ • , ~ .. ~. ti I, DOROTHY M. McNISS, of the Borough of Mechanicsburg, ~~ Cumberland County, Pennsylvania, declare this to be my lest. will and revoke any will previously made by me. j ITEM I: I devise and bequeath all of my estate of every nature and wherever situate as follows: A. One-half (1~) thereof to my son, CHARLES H. McNISS, provided he survives me. Should my son, CHARLES H. McNISS, fail to survive me, his share shall be added to the share herein c:-reated in Item I (B) . B. One-half (1~) thereof to my daughter, LINDA J. GRABLE, provided she survives me. Should my daughter, LINDA ~J. GRABLE, fail to survive me, I devise and bequeath her share equally to the following named grandchildren, JENNIFER L. ADAMSKI an~~ NICHOLAS C. GRABLE. ITEM II: I appoint my daughter, LINDA J. GRABLE, Executrix of this my last will. Should my daughter, LINDA J. GRABLE, Fail to qualify or cease to act as Executrix, I appoint my grandd~~ughter, JENNIFER L. ADAMSKI, Executrix of this my last will. Page 1 o f 4 ITEM III: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of he.r duties in any jurisdiction. IN WITNESS WHEREOF, I, DOROTHY M. McNISS, have hereunto set my hand and seal this da of ' ,,_ ? '% e ~ art' ~ ~" ~~. // ~" DOROTHY M. McNISS Page 2 o f 4 SIGNED, SEALED, PUBLISHED and DECLARED by DOROTHY M„ NIcNISS, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence arld i.n the presence of e ch ther, have subscribed our names as witnesses. ,~ ,•, _414 Bridge St New Cumberland, PA Witness '__.~ Address ~~ ~' ~ 414 Br id~c St., Ncw Cumberland, rA Witness Address COMMONWEALTH OF PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND I, DOROTHY M. McNISS, the Testatrix 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 tlziti~ instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ., t > ''~ ~ ~ ; y;~i f'~ .~, ~~A~, DOROTHY ~ ~McNISS Sworn to or affirmed to and acknowledge ~•~efore me b' DOROTHY M. ~~ McNISS, the Testatrix, this / da f ~, ~~~ ~;~ _ ~, 2007. CC3MN1f'~N'WEAL~~-i C~~ ~'I rJt~i~Y,~~IANIA NOTARIALL ~Er.l_ DANIEL M. NARTMA~I, Notar, !=~;~i~lic New Cumberland Boro.~ Cur~zt~ercd~~i1 Co. My Commission Expires Jan. 21, 209 ary rublic Page 3 o f 4 COMMONWEALTH OF PENNSYLVANIA . SS. COUNTY OF CUMBERLAND . . ,~ _ W e , ~ ~ '-~ -~~~-~. and '4.~. l- ~ ~-~ ~, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the ir,.~>trument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound rr~ind and under no constraint or undue influence. ,- ~, ~ ti.~ . Wit ~ '' ~, Witness Sworn to or affirmed to and ackn~v~edged before me by -.... ` ~ ~. `~. . ~, witnesses, this day of COf~' :,, ~~r ~~~~ C?F R~NN~~`LVANIA _ ~` ~ ~ ~ SEAL ~} .e~' °~ Notary Public New C.v ~. ti.,t~t ~ :pan. 21, 2009 My Co+, ~ :~. and Page 4 of 4 '~~ 2007. y Public COMMQNWEA-L~F~ ~>F N~t~fN~'r~`r_1i~NIA NpTARIAI. SEAL DANIEL M. HARTMA,N, Nty~ary public New Cumberland Boro., Gr~rr~berland Co. My Commission Expires Jan. 21, 2009