HomeMy WebLinkAbout04-01-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of CAROLYN M. SPRAGLIN
a/k/a:
a/k/a:
a/k/a:
address
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 Testamentary or ~ Administration 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 under
the last Will of the above-named Decedent, dated and codicil(s) dated ~? ~ .
:..~ .~
(State relevant circumstances, e.g. renunciation, death of executor, etc.) _''" ~~'~} _I
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted aft~rie~e~'ti tion of the
instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated p~rgat~ d wnot a
party to a pending divorce proceeding at the time of death wherein grounds for divorce had been es'ta'thed as~:efined~inti`
23 Pa. C.S.A. § 3323(g): ~ -~ "' ;-_:._.: ~--~
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D B. Grant of Letters of Administration RENUNCIATION FOR MONECIA R. CLARY ATTACHED HERETO
(If applicable, 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. § 3323(g), except as follows:
N/A
Name
Deceased ESTATE NO: 21- ,-r'(~ ~, ~ ~" ~f--i,~~
SS NO: 204-28-2321
MONECIA R. CLARY
742 VIA MEDIA, CYPRESS, CA 90630 ~~~
DAUGHTER
RICARDO D. SPRAGLIN 60 LAKEWOOD ESTATES, NEW ORLEANS, LA 70131 SON
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THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence
At 341 H STREET, CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA 17013
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then 75 years of age, died 3/23/2011 at
(Month, Day, Year of death)
Estimated value of decedent's property at death:
If domiciled in PA
If not domiciled in PA
_If not domiciled in PA
_Value of Real Estate in Pennsylvania
CARLISLE, PENNSYLVANIA
(City and State where death occurred)
All personal property
Personal property in Pennsylvania
Personal property in County
RelationShi to D
25,000.00
$ 160,000.00
Total Estimated Value $ 185,000.00
Location of Real Estate in Pennsylvania: (Provide full address if possible.) 341 H STREET, CARLISLE, PENNSYLVANIA 17013
Signature(s)
Name(s) & Mailing Address(es)
'~'~ ~ RICARDO D. SPRAGLIN, 60 LAKEWOOD ESTATES, NEW
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Papa i „f~
.lent
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 affirmed and subscribed
before me this 5+ da of
i I , l~
`"ate ~ ' ~,~~~`~7~ ~ y ~
(If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.)
RICARDO D. SPRAGLIN
For the Register
Estate of
CAROLYN M. SPRAGLIN
AND NOW, this ~~ d y of
the reverse side hereon, satisfactory proof
Testamentary x of Administration
the above estate and that instruments(s) dated described in the petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent., ~,
Glenda r~arner 5t
Register of Wills
FEES:
Letters ....................$ 260.00
Will .......................
Codicil(s) .............. .
(1 )Short Certificates 4.00
(1) Renunciations....... 5.00
Bond ............................
Other .............................
Automation FEE......... 5.00
JCS FEE ................... 23.50
TOTAL ................$ 297.50
DECREE OF PROBATE AND GRANT OF LETTERS ~~
in
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Atty's Signature -~-l~rW- ~J .
PRINTED Name: ROGER RWIN
Supreme Court ID No.: 6282
Address: 60 WEST POMFRET STREET
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Deceased File Number: 21- -
Signature of Counsel Required to Enter Appearance
CARLISLE. PA 17013
Phone:
Fax:
(717) 249-2353
(717) 249-6354
~~ , in consideration of the Petition on
been presented before me, IT IS DECREED that Letters
are hereby granted to:
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 of 2
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L~C-AL REGISTRAR'S CERTIFICA~'ION OF aE,r"'~-~
~+NRNING: It is illegal to duplicate this copy by photostat ~r K~hotogy~~~,i~.
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H105.143 REV 11/2005
TYPE /PRINT IN
PERMANENT
BIACK INK
1. Name of Decedent (Prat, middle, last, sunfix)
Carolyn M. Spraglin
5. Aga (Lest BirihdaY) Under 1 Un
Mohan Days Hours
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
2. Sex 3. Sodel Security Ntsriber 4. Date of Death (Month, day, year)
F 204 -28 - 2321 March 23, 2011
de 6. Date d BMh Month, ar 7. Birth ce C' and state or forei coon Sa. Place d Death Check on one)
Mmules
/b Yrs. 11
9b. County of Death 8c. Clry, Boro, Twp. of Death
C~nberland South Middleton
Kind of Work Kind of Business/Industry
Quality Control S Piezo Crysta
15. Decedents Mailing Address (Street, city /town, state, zip code)
341 "H" Street
Carlisle PA 17013
18. Fathefs Name (First, middle, last, suffix)
Willimore Au stis• Wells
20a. Infrxmant's Name (Type / Print)
Ricardo S ra fin
21a. Method of Disposition r ~] Crematon ^ Donation
^ Burial ^ Removal from State i Was Cremetlort ar Donetlon
^ Other - S ' by Medical Examiner/Coroner?
22a. signs ~ rnaee (or person acti
Complete items z3ac any when certllying 23a. To d
physidan Is rat availede at time of death to
certiy cause of death.
""'N'"~. Other:
2 2 19 3 4 Chambersbur , PA inpatient ^ ER / oatpafient ^ DoA ^ Nursing liortre ^ Reaiderxxr ^ other . seedy:
ad. Facairy Name (If not insfitution, give street and number) 9. Was Decedent d HI
~}~,,., Ana ~"? ~ No ^ Yes 10. Race: Americen Indian, Blade, White, etc.
[tap (If yea, Cuban,
Carlisle Regional Medical Center Mexican, Puerto R;~,,, eta.)
Back
fired 12. Was Decedent ever in the 13. Decedent's Edtaatiort (Seedy any highest grade cempleled) 14. Marital Status: Married, Never Monied, 15. Survivnrg Spouse (If wife, give maiden name)
U.S. Amled Forces? Elementtyy~ Secondary (0.12) College (1.4 or 5+) WtdOM~~ Dworced (SpacrtyJ
1 ^ Yea ~ "° Widowed _
Decedents PA Did Decedent
Actual Residence 17a. State Live in e ^ ye$, Decedent Lived'm
17c.
Cumberland Township? f~ Twp.
17b. County 17d. l17 No, Decedent Uved within Carlisle
Actual Umns of Cny/~
19. Mother's Name (Brat, middle, maiden surname)
Thelma - Hamilton
20b. Informant's Marring Address (Street, rary I town, state, zip code)
341 "H" Street, Carlisle, PA 17013
21 b. Date of Disposition (Momh, day, year) 2t c. Place of Dispositlon (Name of cemetery, cremato or other ace
ry Pf ) 21d. Location (City/town, state, zip code)
Atdl~aek7 Yea^ No 3/26/2011 Etrans Cremation Services Leola, PA
~~ ~ns• Numb•r 22c. Name and Address o1 Fadnry
FD 012633 L Ekving Brothers Funeral Home, Inc., Carlisle, PA 17013
th time, date and place stated. (Signature and this)
23b. Lae umber 23c. Date Signed (Month, day year)
~ Items 2M26 must ba completed try person 24. ime of Death 25
Date Prono
d D ~~" ~ ~ ,
_
.
urtrxi
ead (Month, day, year)
who pronourxxre deaM. Z
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l / 26. Wes Case Referred to Medical Examiner /Coroner for a Reason Other than Cremation or Donation?
^
Z Lit
/
CAUSE OF DEATH Yes ^ No
. (See inetructlons end examples)
Item 27. Part I: Enter the mein of events - daeases, injuries, ar complications . that dxectly caused the r1eaM. DO NOT enter terminal events such as cardiac arrest
respiratory arrest
or v
t
i
l
fi r Approximate interval: Part il: Enter other
r ~ 28. Did Tobacco Use Conidbute t
D
th?
~ ,
,
en
r
cu
ar
bnllatbn without showing the etiology, List any arts cease an each line.
~ o
ea
r Onset to ~~ but not resulting in the undedyirg cause given in Pert I. ^ Yes ^ Probabl
IMMEDIATE CAUSE IFm~ disease or
I
corxliticn reauaing in m) y
r
~ ^ No ^ Unkrawn
,A
V ~
-~ a.
N
Doe to (or ~;
Seauentiely nst condinoms, n any, b, I V~
laa~ng to the cause listed on line a
"j( l1 ~ r 29. n Female:
r
~ ^ Not pregnant within past year
.
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Enter 9ra UNDERLYING CAUSE Due to (o! as a consequence of);
(drsease or injury Chet initleted the r ^ Pregnant at time d death
r
r ^ Not pre
nant
b
t
~
_ events resulting m death) LAST. c.
Due to (or as a consequence oQ:
• g
,
u
pregnant within 42 days
' of death
r
, ^ Not
re
nant
b
t
p
g
,
u
d.
pregnant 43 days to 1 year
30e. Was an Aut r before death
opsy 30b. Were Autopsy Furdirgs 31. Manner o1 DeaM 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred ^ Unknown d pregnant wtlhm the past year
Performed? Available Prior to Completlan
of Cause of Death? atural ^ f•lorddde 32c. Place of Injury: Home, Ferm, Street
Factory
~
~
^ Accident ^ pendi 32d. Time of I u
^ Yes o ^ Yes ~ ng Imestgetion rn ry 32e. Injury at Work? ,
,
Orfice Building, etc. (Spec/tyJ
32f
If T
J
^ Suitrde ^ Could Nol De Determined
^ Yes ^ No .
ransportation Injury (Specity/ 32g. Location of injury (Street, city /town, state)
r/Operetor ^ Passenger ^ Pedesidan
M
33a. Certifier (check any one) ^ Oaar
SP•c+lY~
• CertNying INrysidan (Physician certlfyimg cause of death when enalher pttysicien has
To the beat of Woraunced death and completed Item 23)
my krowbdge, dsatA occured due to the caws(a) and manner s
M
d 33b. Signature and Ti r
~ 4 ,~ ,~
-
s t
e
_ _
• Prorroundn and art h ----'----------------
9 iMng P ysk•4n (Ptryetden troth pronourakg death and ceralying bcause ddeath) - - - - - - - -
To tM bast of my krawladge, death occurred at the Ume
d
t
d V"
" '
- - 33c. License Nu
o
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w ,
a
a, sn
place, and dos to the cause(s) and manner as atated_ _ _ _ _ _
MrMkalExaminsr/Coroner ----------
on tn
b
i - ^ 33d. Dat Signed (M th, day, year)
- A/1 I. ~p ~
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o ~' t
a
as
s or examination end / o< invest Non, In
J S
kJ• my opinion, death oceumd at the time, date, end plea, and due to the auae(e) and manner as atated_ ^
34
N
d
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ame an
A of Person Who Completed use of D ath (Item 27) ~Ty/pe / Print
35. Registrel ore and District Dyradrar~ [ Y,/~'{1a •t V~ ' • / ..
~ Date Bled (Month, day, year)
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Disposition Permit No~ l 1 ~c~ ~ ~~ ~~
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
C~ ,~Y
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Estate of CAROLYN M. SPRAGLIN
I, MONECIA R. CLARY
(Print Name)
DAUGHTER
Deceased
in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
RICARDO D. SPRAGLIN
~~15 ~/
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunc~a~tion for the
purp ses stated within on this ~~"`'~`- day
of ~ ~?~ c° l
_/
Ndtary Public ~'
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission. )
COMMONWI`P-~~ ~
Notarial Seal
Karen 5. Noel, Notary Pt~blit
~~ pect8 01
MEMBER, PENNSYLVMM ASSOQATION OF NOTARIES
(Street Address)
F+, r /
(City; te, Zip)