HomeMy WebLinkAbout05-03-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of _~ ~_-.tt-- ~1~ ~k- ~I'~`~ ,Deceased
a/k/a:
a/k/a:
._- .~.,
ESTATE NO: 21- -~ ,° ~, ~ - ~-j ~ ~-~L.
a/k/a: SS NO:
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.)
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(8):
~ 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, 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(8), except as follows:
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USE ADDITIONAL SHEETS IF NECESSARY
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THIS SECTION MUST BE COMPLETED: ~ ~~'~ `~`~
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principalresidence
At ~~{ ~~ ~z~~~, ~v~~ lei ~ ~,". ~~.,~~ br:,- ~.,.,tiz ~~-, 1~ lo`7c~ ~N~.t-- ~~. -ti r«~; (.,,.~ ~3~,,i~
(Street address with Post Office and Zip Code, Municipality: Township, Bo~,rfough, City)
Decedent, then Ll ~ years of age, died ~ ' ~ ~ ' 2 ~ 11 at N ~,,'~~ ~- i-` °'` ~Q ~~ ~~* Z ~j~-
(Month, Day, Year of death) (City and State where death occurred)
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
Total Estimated Value
Location of Real Estate in Pennsylvania: (Provide full address if possible.) ~ ~iV~ ~ ~`' ~~ ! V i,~'/ ~/"~ ~'~'G+` `"vv? ~`~ ~ 7`~' w
j Signature(s)
Name(s) & Mailing Address(es)
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Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court
All personal property
Personal property in Pennsylvania
Personal property in County
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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.
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Sworn to or affirmed and subscribed '~ ~ '~ ~
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before me this f~ ' ~ ~ r_,~
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For the Register ~~ ~~ -~-~ ,~~ j
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LETTER - ~ ~ ~-" o
DECREE OF PROBATE AND GRANT OF S~ ~~~ --~,
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Deceased File Number: 21- ~ - ~~~`1
Estate of ~ -}~ ~ n ~ - -~-~ -~
AND NOW, this ~ n day of ~ y ~i t .~ ~ G j ( , 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 anolicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.)
the above estate and that instruments( ated described in the petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.
in
~ ,~._ ~~
Glenda Farner Strasbaugh, ~~~~' ~~~~~ ~,(,,~,. ~Cr,r1 tr~;~?
Register of Wills
FEES:
Letters .................... $ ~ !'~ y~~,~
Will .......................
Codicil(s) .............. .
(~~) Short Certificates ~! ~ ~ ~
( )Renunciations.......
Bond ............................
Other ............................
Automation FEE......... 5.00
JCS FEE .................. 23.50
TOTAL ................$ ~`" ~ t7L
Signature of Counsel Required to Enter Appearance
Atty's Signature
PRINTED Name:
Supreme Court ID No.: _
Address: _
Phone:
Fax:
Interim Form RW-02 revised 1226.] 0 Uy Cumberland County pending action by the Court Page 2 of 2
.®~AL REGISTRAR'S CERTIFICA,TIt~~I )F E~,`~-
VN~,RNINGR It is illegal to duplicate this co!~s~ h~ ~phr~ltc}slat. '~r phOtot~~a~~lw_
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REV 11!2006
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d`~` APP 2 ~ 2011
A
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
C7 ,~.-_;
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1. Name of Decedent (Flrst, middle, last, suffix) 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year)
Scott M Dowling Male 166 - 62 '-4730 A ri]_ 18, 2011
Age (Lest Birthday)
5 Urtder 1 ear Under 1 da 6. Date of Birth Month, da , ear) 7. &rthplace C and state a fora country) 6a. Place of Death (Check on one)
. Days Han Minnee Hospital: Other.
43 Yrs. anuar 25 1 8 Renovo , PA ^ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home Residence ^Other - Spedty:
County of Death
6b 8c. C' Bo Twp. of Death 6d. Facgity Name (If not instkution, glue street aM number) 9. Wes Decedent of Hispanic Odgin? ®No ^ Yes 10. Race: American Indian, Black, White, etc.
.
.
Cumberland
New Cumberland (If yes, specity Cubarl, (Specify)
434 Reno Avenue Mexir;an,PuertoRicam,etc.) . White
11. Decedent's Usrtel Oceu Lion Kind of work d one dud rtast of work IHe. Do rat state retired 12. Was Decedent ever In the 13. Decedents Educatbn (Spedty only highest grade completed) 14. Marital Status: Married, Never Monied, 15. Surviving Spouse (If wife, give maiden name)
ecif
)
Divorced (S
Widowed
Kind d Work C
„(QgQgt~~ippsa ~~t s U.S. Armed Forces? Elementary /Secondary (0-12) College (1-a or 5+) p
y
,
Warehouse Su erviso O
D tri UtiOn ®vee ^"° 12 Divorced
16. Decedents Mailing Address (Street, city /town, state, zip code)
434 Reno Street Decedent's Did Derxsdent
Adual Residence 17a. state Pennsylvania Live in a ,7°. ^ Yea, Decedent Lived in Twp.
New Cumberland, PA 17070 Township? 17d. ®No, Decedent Uved wkhln
17b.Counry Cumberland ActualUmltsof New Cumberland city/soro
1 B. Father's Neme (First, middle, last, suffix) 19. Mother's Name (Flret, middle, maiden sumartre)
Earl Dowlin Sr. Ella Marshall
20a. Informant's Neme (Type / Pnnt) 20b. Infomant's Mailing Address (Street, city /town, state, zip code)
Nick T. Dowling 118 Buttercup Lane, Wellsville, PA 17365
21 a. Method of Disposition ®Cremation ^ Donation 216. Date of Dlsposkbn (Month, day, year) 21 c. Place of Disposiion (Name of cemetery, crematory or other place) 21 d. Location (City !town, state, zip code)
' ^ Burial ^ Removal Fran State ~ Was Cromatbn or Donation Authorized 2 011
A r i 1 21
P Evans Cremator
Y S c ha e f f- e r s t own , PA 17 0 8 8
^ Other • SpeGty: i by Medical Examiner I Coroner? Yes ^ No ,
' 22a. Signetu Fune I Servk:e a or pe ng as such) 22b. License Number 22c. Name and Andress of Fadlity
. ~ FD 013 340 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland PA 17070
Complete Items 23a•c only when certltyfng 23a. To the bast of my knowledge, death occured at the time, date end place stated. (Signature and tltle) 23b. License Number 23c Date Signed (Month, day, year)
physician is not available at time of death to
certify cause of death.
' hems 24.26 must be completed by person 24. Time o1 Death 25. Date Pronamced Dead (Month, day, year) 26. Was Case Referred to Medical Examiner /Coroner for a Fleason Other than Cremation or Donation?
Yes ^ No
~ who proraunces death. A rX • /{ : 00 P , M• A r i 1 18 , 2 011
CAUSE OF DEATH (See Instruetlons and examples) r Approximate interval: Pan II: Enter other significant condltions conbibutlnq to death, 28 Did Tobacco Use Contribute to Death?
Item 27. Part I: Enter the chain of events -diseases, injuries, a complbatlons -that directly caused the death. DO NOT enter terminal events such as cardiac arrest, r Onset to Death but not resulting In the uMenying cause given in Part I [] Yes ^ Probably
respiratory ertesl, or ventricular fibnllation without showing the etiology. List Doty one cause on each line. ~ ^ No [~ Unknown
r
IMMEDIATE CAUSE (Flnal disease or r
Pending Investigation ~
corxlition resulting m deatn)
a
29. It Female,
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.
Due to (or as a consequence of): r year
pregnan
w
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[] Pregnant at time of death
Sequentially list condtlions, M any, b i
feeding to the cause listed an line a.
~ [] Not pregnant, but pregnant within 42 days
Due to (or as a consequence of):
Enter the UNDERLYING CAUSE
of death
r
' (disease a injuryry that initial the c
~
T, r
events resuking 1n death) LA
Due to (or as a consequence ot): r
r [] Nat pregnant, but pregnant 43 days to 1 year
before death
• d. r ^ Unknown it pregnant wahin the past year
30a. Was an Autopsy 30b. Were Autopsy Flndimgs 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Nome, Ferm, Street, Factory,
Office Building, etc. (Specify)
Penonned? Available Prior to Completion
of Cause of Death? ^ Natural ^ Homicide
Yes ^ No
^ Yes ~ No ^ Accident ~ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 321. If Transportation Injury (Specify)
^P
^ P 32g. Locatlon of Injury (Sreet, city /town, state)
-'
^ Suidde ^ Could Not be Determined
^ Yes ^ No _ n
^ Driver /Operator
assenger ~
M Other • Specify:
33a. Certrfrer (chedr only one) 33b. Signature and er
• CertHying phyNNan (physidan certHying cause of death when another physidan has pronounced death and completed Item 23) -
death oeeumed due to the cause(s) and manner as statad_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
To the best of my knowbdga , a Co r one r
,
• Pronoundng end csANylrtg physician (physidan both prorauncing death and certllying to cause d death)
^ 33c. License Number 33d. Date Signed (Month, day, year)
To the beet of my knowledge, death oxurrsd at the time, data, and place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A r 11 19 , 2 011
• Medical Examiner /Coroner IffG~~tt
On the bests of examination and I or invastigatton, in my opinbn, death occurred et the time, data, and place, and due to the ceuee(s) end manner es statxL t/~
. ` ~ ~ ~ d P ,o yVho Canplet Cause of Death (Item 27) Type !Print
~o~c~ ~. ~c~cenro~e, Coroner
35. Registrar's Lure and Distd ~
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Disposition Permit No. t7~¢ ~ U 2~