Loading...
HomeMy WebLinkAbout03-25-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of ~~ r~ ~' ~~'1// !~!~' ,Deceased ESTATE NO: 21- - ' ''~ a/k/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 applicable: ~A. Probate and Grant of Letters Testam.:ltary or pAdministration c.t.a., or d.b.n.c.t.a. (complete Part C, also) and aver that Petitioner(s) is/are entitled to the aforementioned Letters ,y~~ i the last Will of the above-named Decedent, dated under I1-f7,~.--.T~~ and codicil(s) dated ~_ ~~-.,~~ j (State relevant circumstances, e.g. renunciation, death of executor, etc.) Except as follows, Decedent did not many, 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): ~._ ^ B. Grant of Letters of Administration (Itapplicable, enter d.b.n., pendent lite, durante absentia, durante minoritate) C. 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 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. 332 § 3~, except as fellows: -~~ ~.O __.r ..~., , .,_, Name Address ' ~°" ' ' =~ bi t ceden~ ' ~> ; ,_ M1 .: _ _~ -_ ~ t_~~ , j i . ~ - L _ USE ADDITIONAL SHEETS IF NECESSARY 3 _m " ~lj ~,,. ~ e ~ THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last famil or principal residence At ~ ~ ~ /~iYol/C-~t.2 S~c,~.r~-rs ~~ , ~~ ~ ~ ~/ (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then ~_ years of age, died .3 ~18~ ~/~ at ~~s~ (Month, Day, Year of death) (C~ty and State wh re death occurred) Estimated value of decedent's property at death: 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 $ - Total Estimated Value $ --~~---~-.~ a ~j Location of Real Estate in Pennsylvania: (Provide full address if possible.) Signature(s) Name(s) & Mailing Address(es) ~~/ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con'ect 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 affir:~~ed and sul;scribed be ire me the ~ ~' J _ day of ` , ~ ~. ~. I ~J Signature ojPersonal Representative --.-•> '~ Signature ofPer~i,al Repres ntative .~ © - _ ~.'..~.~ _,. •~ ,. ~_ . ~~ t~ ' ~) :x - For the Register Signature ojPersonal Representative _r-_. •~~_'' -~ f__.J -~-~ ,. __ ._.. File Number:_ r_-~ ~ - ~' _ `~ C~ ~ . ~ ~ ~..~; G _ ~-:~~ ~,, Estate of _ ~~l .i ~~~ ~ ~~%- \/ 1 1...) Deceased Social Security Number: ~ ~ ~~~ ~ ~? - ~ ~ ~j Date of Death: ;_~ ~ (~ - ~(~ ~ i ~ ~ AND NOW, _ d~.~~..( ~ .~ ~ ~=~ ~ ~n ~ (~ ~~ , in consideration of the foregoing Petition, satisfacto roof having been presented before me, IT IS DECREED that Letters - ry p are hereby granted to E '' 1 _1~ 7j L~:6' ~ ~ (.. ~ ~~ /~~ j'l ,, , , i r , < [ in the above estate and that the instrument(s) dated __ (~ - ~ ~ - j Cj' ~~ (~ ~~., ~ _ ~ J .- ~ ~,: ~,, described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ............... $s--'~',1:, (7 ~~ Short Certificate(s) . I ...... $ Renunciation(s) .......... $ ~,~~~ 1 ... $ i J ~ .v ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ ~~~' t-C1 Form RGV-UZ rev. lU.I3.U< Attorney Signature Attorney Name lam'---~~ ~.` Register of Wills'' C~~/~ Cr/. // ~ ~C (- ', -~`~ L 1(a ~ -~~ ~ f/•~ -T Supreme Court I.D. No.: 2 ~~~ Address: ~ ~'~/~ ~ ~ ~~ ,~,~ ~- ,l.G. •~~ Telephone: ~~..-~Y ~ ---`? ~ Page 2 of 2 .OCAL REGISTRAR'S CERTIFICATION OF DEA'°'I- 1NI~-RNiNG: It is illegal to duplicate this copy by photostat ar ~~hotog~al~~l~~. ~'l'~' j:)I~ Rfll'~ i.~L.'l19'itialt `g!T-I )I ____P _~..7_~1.5~58 ~~er1il~i~~.)tiftrl '~l.~r)~~~1L~i~ H105-143 REV 1102006 TYPE /PRINT IN PERMANENT BUCK INK C a 0 U 0 w J d 0 w w 0 O w z ---- ~~irrr,raiii•.., %Itr `~H DF p ~ ~ llti ti 'tI t t~'!'~ i~ '''. Ill' illf(11-illa(l~I)II ~tt'Ct r.'.iLiwll 1`+ ._ ~~1~~P ------- ~y ~ ~, ~ ~sf ~ ul-rc~L)I~ ~t.3~~)~ .r , ,.; ~~ t ri;.rir~<)l C ~~tifi~~)[~ ~:,1 Deatr) . /'~o~ `~l Ic` r ~' t~t~l~~ il(t_i ~~)t~ ~i~, i ~` ;l~ )~~~t,~tit_dir. ~~t~ /1r!,in~~l ~~i ~r(IIi s i ~ d~ `~ ~ri l ~ ~ , ~ + ~. i~~ tri_ c~f tf1 t )~ ta(e ta ~~V~ v ~~ ~~~~ ;iCa'{1(~jti- (~ )f~'l~':' t.,~~l~'~~11 ~I~1C;~r T ._._- ~' M fNT ~~ < --- _ ~ ~•i ;l~ ' ~_ C i ~ _:.-_ ' a ~-, ~o ~~~ r z .~ ~: ;: ~ ~.~ s% Ct7 ~ Cl": - ) _Y ~~1 (~ ...,.,~ r ~ T .~ ~ - ~~ .+.: r --, T~'i --rz COMMONWEALTH OF PENNSYLVANIA • t~EPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) ~r,,.< <„ ~ ,,,,,,,,~„ 1. Name of Decedent (Frst, middle, lest, suffix) 2. Sex 3. Social Security Number 4. Date of Death (Monet, day, year) Ruth E. Nevius Female 174 _ 05 _3278 March 18,2011 5. Age (Last Birthday) Under 1 ar Under 1 da 6. Date of Birth Month, da , ar 7. Birth ce C' and state m forei coon 6a. Place of Death Check on one MonMa Days Hours Minutes Hos Ital: 91 1 1/ 1 6/ 1 91 9 Chatham, NJ p other: - YrS. ^ Inpatient ^ ER /Outpatient ^ DOA [~ Nursin Hcxne ^ Residenc ^ Otl S if g e rer - pec y: 8b. County of Death fk. City, Bcxy,Twp. of Death 6d. Facility Name (If rat institution, give sheet and number) 9. Was Decedent of Hispanic Origin? ~ No [] Yes 10. Race: American Indian Black White etc , , , . • Cumberland Carlisle Qfyea,specityCuban, (~M Chapel Pointe At Carl i s 1 e M exican, Puerto Rican, etc.) y ' 11. Decedent s Usual Occu lion Kind of work done duri rtast of world INe. Do rat state retired 12. Was Decedent ever in the 13. Decedent's Educatbn (Specity ony highest grade completed) 14. Marital Status: Marred, Never Martieo', 15. Surv'roing Spouse (If wde, give maiden name) Kind of Work Kind of Business/Industry U.S. Amled Forces? Elementary /Secondary (0-12) College (1-4 or 5+) Wxlowed, Divorced (SpeciyJ it l H os a PN ^ Yes LPNO 2.5+ widowed 16. Decedents Mailing Address (Street, crry /town, state, zip code) Decedent's Did Decedent Pennsylvania A l R ctua esidence 17a. State Uve in a 17c. ^ Yes, Decedent Lived in - Twp 7 7 0 S . Hanover S t . Cumberland Township? r~I Car 1 i s 1 e , PA 1 7 01 3 17b. codnty 17d. I:J No, Decedent Lived within C' 1 ~ a r Actual Umits of _ R P City/Born 16. Father's Name (First, middle, last, suffix) 19. Mother's Name (First, middle, maiden surname) Clarence Johson Carver Anna Zinn 20a. Informant's Name (Type / PrinQ 20b. Infamrant's Mailing Address (Street, city /town, stele, zip code) Cher 1 L. Ke 70 Meade Dr. Carlisle, PA 1701:3 21a. Method of Disposition r ^ Cremation ^ Donaton C~ Burial ^ Removal rrom sl t ~ 21 b. Dale of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory m other place) 21c1. Lcxxtion (City /town, state, zip code) a e was cr«n.tan a Donaton Authorized ^ other - S r by Medical Examiner/Camrrer? ^ Yes^ No March 2 2 2 01 1 , Westminster Mem o r i a 1 C'a r 1 i s 1 e , PA 1 7 01 3 22a. Si~neture of Funerel Service Licensee (a person aclirg as such) C ~ 22b. License Number 22c. Name end Address of Facility - - .~.:,~ , 011589E HollingerFH&CrematoryMt° Ho1lySprings,PA 17065 Complete kerns 23ac onty when certlfying physician is rat available at time of death to 23a. To the best of my ge, death occurred et ,date and place slat (Signature and tltlel 23b. License Number 23c. Date Signed (Month, day, year) certify reuse d death. ,~~ R~ a 3 sQ~ ~ ~ p ~ o,i Items 2426 must be completed by person • who pronounces dears. 24. Time of Death Q. ~2 25. Dot , ' 'Dead (MQonth, day year) ~ 1 n ~~~ 26. Was Case Refen~edyto Medical Examiner /Coroner for a Reason Other than Cremation or Donation? • /l • M. (((( ~ yV{~C~•'l ~ OW ^ Yes 'CJ No CAUSE OF DE ATH (See Instrudione and examples) r Approximate interval: Pad II: Enter other;~gnificLLnt mruiitione contributive to r)gg(p, 28. Did Tobaan Use Contribute to Death? Item 27. Pad I: Enter the chain of events -diseases, injuries, or complications -that directly caused the death lb NOT enter terminal events su h d , c as car iac arrest, r Onset to Death but not resutiing in the underlying cause given in Part I. ^ Yes ^ Probably respiratory artest, or ventricular fibrillatbn without showing the etiokxfy. List only one cause on each line. ~ ^ No ^ Unknown ` IMMEDIATE CAUSE IFlnal disease or ~ ~ ~ condition resuhing in death) ~ ~i ' , 'L9. If Female: Due to (or as a oq: ~ -- ^ Not pregnant within past year Sequentialty list conditlons,rf arty, b. ~ ~ ^ Pregnant at time of death leading ro the cause listed on line a. Enter the UNDERLYING CAUSE Due to (or as a consequence of): ~ -- ^ Not pregnant, but pregnant whhin 42 days (disease or injury Met initiated hie c. r of death events resulting in death) LAST. r Due to (or as a consequence ot): r -- ^ Not pregnant, but pregnant 43 days to 1 year r before death • d. , r ^ Unknown if pregnant within the past year 30e. Was an Autopsy 30b. Were Autopsy Endings 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Ferm, Street, Factory, Pedomred? Available Prig to Completion ~ OKce Buildin (Specify) of Cause of Death? Natural ^ Homidde g, etc. ^ Yes ~ No ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. If Transportatbn Injury / 32g. Location of injury (~'~treet, sty /town, state) ^ Yes ^ No ^ Yes ^ No ^ Driver/Operator ^ Pa a PedesMan ^ Suicide ^ Could Not be Determined M ^ aver - speciry: 33a. Certifier (deck onty one) 33b. Signature a of e ~ • CMffying physician (Physician certirynrxl cause d death when arather physician has pronounced deaN and corrMleted Item 23) To the best of my knowledge, death occurred due to the cau•e(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ p • Pronouncin amt tl i h ki - t` ~ /`~ ~ v g cer ry ng p ys an (Physician both pronoundrg death antl certih4rg to cause of tleath) To the beat f k led 33c. Llcens Nu r 33~i. Date Signed (Month, day, year) o my now ge, death occuned at Me tlme, date, and place, and due to the cause(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Medical Examiner/Coroner p1 (~ ~ (K - L `J ( J -~ ~ ` ` ( ~ On the basis of examination end / or Investigation, In my opinion, death occurred et the time, date, and place, and due to the cause(s) and manner es stated_ ^ 34. Name and Address of Person Who Completed Cause of Death (Ite m 27) Typo /Print 35. Registrar''/~~'?°~~re~en~d Dy`tt(\'J`y,.,.!~I1~wr y `yam ~ I ~ ~ I ~ ~ 36. to Filed (Monts, day, year) - - 1 (~ ~-r""`^'~ti mil' ~ \ ~r l J t~ - - J~l1J~~ Disposition Permit No: •~ ' 1. 7 ~n ~ ~ ~~ ^ r ` ~ ~(/,~ ~ ~ ` r . e , _ 9 @ • s--- o t~ a e ® i~ I ®~ p C`' ~ ---=~ e ~_ ~' ~~~' :.~., I, RUTH E. NEVIUS, of the Borough of Mount Holl~- -,-- ~? ~ E _...~ : ~ i .~'_ `~ Springs, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. T. I direct that my funeral and burial shall ~~~~ conducted in accordance with prearrangements which I havE~ made with the Gibson-Hollinger Funeral Home of Mount Holly Springs, Cumberland County, Pennsylvania. II. I bequeath all of the tangible personal property owned by me and found at my death in my home to my step-scon, RAYMOND D. NEVIUS, JR. III. I devise and bequeath all the rest, residue, and remainder of my estate of every nature and wherever situat:c~ in equal shares to such of my adult children, THEOS E. VEROW, CLARK C. DUNKLE, BEVERLY A. RIFE, and CHERYL L. BRETT, as shall :~~urvive me by thirty days. Should any of my said children predecease me or die on car before the thirtieth day following my death, I~ devise and bequeath the share of such child or children to his or her issue per stirpes living on the thirty-first day fol l o~;r~~ng my death; and in default of any such then living issue, such share shall be added to the share or shares for my other child.rE=:n.. IV. I appoint the PNC BANK of Mount Holly Springs or its successor in business, guardian of any property which passes _.h~~ .,1 ~l9 either under this will or otherwise to a minor and with x~espect to whom I am authorized to appoint a guardian and have :nai:. otherwise specifically done so, provided that this appo:int:ment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possibl e t:o the rn:inor. or to another for the minor's benefit. Such guardian shall, have the power to use principal as well as income from time to time for the minor's support and education (including college edur.~ation, both graduate and undergraduate) without regard to his or- her parent's ability to provide for such support and educatic-I1, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. V. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary esi~at.e as a part of the expense of the administration of my estate. VI • I appoint my sons, THEOS E. VEROW and CLARI+C C'. DUNKLE, co--executors, or the survivor of them executor of this my last will. VII. I direct that my executors and guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdictrion. IN WITNESS WHEREOF, I have hereunto set my hand this ~~ ~~ "'-day of November, 1996. r ;. , -v RUTH E. IUS ~~ The preceding instrument, consisting of this and two +~ther typewritten pages identified by the signature of the testatrix, RUTH E. NEVIUS, was on the day and date thereof signed, published and declared by RUTH E. NEVIUS, the testatrix therein na:m.ed, as and for her last will, in the presence of us, who, at her. request, in her presence, and in the presence of each other have subscribed our n es~ as witnesses hereto. a ~~ .° ~' a / .r/ ! i' ~.., jA ~' ..•/~ -t r-. '"f/° .... //// .._. f'f ~ `fie /, . _~ =-~ C~ `-r~'_ S AJ `"p . t "T- ~"~ ~~`~~~ SOLE CODICIL TO LAST WILL NOVEMBER 12 199. -~ RUTH E. NEVIUS, MOUNT HOLLY SPRINGS I, RUTH E. NEVIUS, of Mount Holly Springs, Cumberland County, Pennsylvania, declare this to be the sole codici7L to my last will dated November 12, 1996. I. I hereby revoke Article II of my Last Will and in lieu thereof provide as follows: I bequeath such items of tangible personal. property belonging to me and found upon my death in my home to my adult children, RAYMOND D. NEVIUS, ..~.~ ,- , ; .. `~.~ ;...J :. ~ -, i .... ~~~ ~.~.~ ~ JR., THEOS E. VEROW, CLARK C. DUNKLE, III, BEVERLY ~; cr r -, i,,,1` A. RIFE, and CHERYL L. -~~~ ~~ y. ` 7 .~s~ ~ as they shall so `~" v ryr select and amicably agree among themselves without strict regard to equality in value. I direct that the remainder of said tangible personal property `~ shall be sold at ublic or P private sale, with t:he ~,,~ ~;~ proceeds therefrom being applied to my residuar,Y '~,~ f estate. II. I hereby revoke Article VI of my Last Will and in lieu thereof provide as follows: ~., ~_ ._~ I appoint my son, CLARK C. DUNKLE, III, and ~' ~ 7 ~ / my daughter, CHERYL L. ++a~ co-executors, or ~~' ~'' .__~~~ the survivor of them executor of this my Last Will. III. In all other respects, I hereby ratify, confirm and republish my Last Will dated November 12, 1996, together with this Sole Codicil, as and for my Last Will. IN WITNESS WHEREOF, I have hereunto set my hand this ~~ day o f L~ /~ '~ .lam` SEAL ~ ~ ~ ) RUTH E. NEVIUS Signed, published and declared on the date thereof by the above named RUTH E. NEVIUS as and for the sole codicil to her last will dated 11/12/96, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our name a witnesses hereto. ,~ J' - ' ~, fr // , ,~,~ ,, ~, J ~, --~ -~ v'` _ ., ~-- I- .~ : ~ ~. t o ~ O Register of Wills of Cumberland County OATH OF NON-SUBSCRIBING WITNESS Estate of ~ f', ~-- {~~~~//~~' No. Also known as L /~F DeceaseZi (eac}~a subscriber hereto, (e~ being duly qualified according to law, depose(s) and say(;s) that S' ~ s familiar with the signature of ~~t ~,~( L='. ~/L%li/ L(S , testat /~~i '~ f (eye-ef~n; subscribi~~tne$s~s_~i) th codiciUwill resented herewith and that,S~ believe/believes the signature on the codiciUwill is in the handwriting of ~f~ ~~ /`~j~Y/ Gls' to the best of knowledge and belief. Sworn to or affinneci and subscribed Before me this ~..")~ ~ day of Zoe ~c 'stet l p `/~ ~ ~ ,. /1 Deputy ~~ ., ~ f 'P .~.~'i ~ ~:i-.~ S, ~~~ ~ t~I~J~Q ~, ~ ~~ ~~ ~~ ~g~t~. €~~~ . ~ ,~ .j,~ ' , ^ (Address) c.-~.z.~c~~s'~ ~ ~f~ ~~,~13 (Name) (Address) i ~~ ~ (}J~ . _. ..a ~; ~~'..J J ~ .-., _-~ __ .._ ~`° -~~-` ~~_. -~ ~- ~ OATH OF SUBSCRIBING WITNE SS(ES) r ' .. ~ ~ '~ '~' ~ _ . ~ Y ~~ =`' -~ ~ `~ ~ `~ .~ REG STER OF WILLS ~~ ~~~!a-~+/ -_ _. c_~ ~_, ~,,.Y ~ f' , COUNTY, PENNSY VA ~ NIA ~ ~- , _...., ~ Estate of ~~ ~'~_ %~/~ ~j/~ S' Deceased (Print Names) ~ ~~a subscribing witness to the J~ Will 'Codicil(s) presented herewith, (each) being duly qualified accordin to law cie ose g p (s) and say(s) that sh / he they was / ~e present and saw the above 'for/ Testatr' . i~. sign the same and that she he they signed the same~and that. she they signed as a witness; at the re uest of q the ~~~ /Testatrix in she /his presence and in the presence of each other. (Signature) (Street Address) (City, State, Zip) ~ ~~~ `~ ,~~~~~ ~~ (Sigi:ature) // C (Street Address) T (City, State, Zip) Executed in Regi'ster's Office Sworn to ~~r ~ffirmefl and subscribed before.;.ne this _ ~~'~~ day of ~ ~ ;., l Executed otct of Register's Office Sworn to or affirmed and subscribed before me this ,day of --, Deputy for Register of Wills --- Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's C;ommission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Fornr RW-03 rev. !0.!3.06