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Home My WebLink About06-27-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND _ COUNTY, PENNSYLVANIA -- _ __ _ _ - Estate of Charlotte E. Horton File Number 21-11 also known as ,Deceased Social Security Number 183-12-4764 Beverly J. Myers Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE `A' or '8` BELOW) ^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the named in the last W!II of the Decedent, dated and codicil(s) dated State relevant circumstances, e. g., renunciation, death of executor, etc. After the execution of the documents offered for probate: Decedent did not marry; was not divorced; 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); did not have a child born or adopted: was not the victim of a killing; and was never adjudicated an incapacitated person, except as follows: B. Grant of Letters of Administration tirappucabie, enter c.ta.; d. b. n. c. t. a.; pedente liter durante absentia: durantE: minoritate) 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 on Section A above 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 divo~ce had been established as provided in 23 Pa. C.S.A. § 3323 (g), except as follows: Name Relationship Residence Beverly J. Myers Daughter _ 203 Lancer Court Kill Devil Hills, NC 27948 Charles R. Myers Grandson Post Office Box 309 James R. Myers Grandson Post Office Box 70~c~ ~ ,_;~ ;._, N 915 -z; -~' r-~ '~' - ~, (COMPLETE /N ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her 924 16th Street, New Cumberland, New Cumberland Cumberland PA (List street address. town/aty township. county, state, zip code) Decedent, then ~_ years of age, died on 11/18/2010 at Decedent at death owned property with estimated values as follows A..J ~~ rr..l ~~- v ~ last principal rsSydAr~e at '~ _-, J -fin b r~ -~- ---J - ~ -'r `=~~. ~7 (I*domiciled in PA) All personal property $ - 1,600.00 (I` not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ i Value of real estate in Pennsylvania $ _ 20,000.00 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 Utters in the appropriate form to the undersigned Signature Typed or printed name and residence Beverly J. Myers 203 Lancer Court ~~ " ~~, ~j1,~ ~ ~~ A Kill (Devil Hills, NC 27948 Form KVV-VL Rev. 12-26-2006 linterim form, pending action by the Courf) Copynghl (c) 2010 form software only The Lackner Group, Inc Fade ' of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF 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) will well and truly administer the estate according to law. Signature of Personal Repre nta l Beverly Myer c -~ ~ri C p ~7 ~~ ~~ ~ ~ ~; -;_, tit Signature of Personal Representative ~p. r._.. ~ N - ~ :-~_~ z = ~ ~~ - Signature of Personal Representative '.-;•.. `~. - ~ ~- ~ -vim h.- n ~i w File Number: 21-11 -~~ ~n Estate of Charlotte E. Horton ,Deceased Social St~ecurity Number: / 183_-12-4764 Date of Death: 11/18/2010 AND NOW, ~~t~, ~~ ~L~ ~~! r-)L--~' ~ ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to Beverly J. Myers in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ........ ................................ $ ~(` ~ , ~" ~•. Short Certificate(s) ....................... $ ~ j j . ~ l~ Renunciation(s) ............................ $ L, t~ ~: (l l C~ ~ %611 w $ L~. C~ (~' $ $ $ $ $ TOTAL ................................... $ ~ ~' ~~ C~'t 6~' Register of Wills _ _~ ~,,ti. > L., t, Attorney Signature: Attorney Name: Michael L. Bangs Supreme Court I.D. No.: 41263 Address: 429 South 18th Street Camp Hill, PA Telephone: 717/730-7310 Form RW-OY Rev. f0-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 Sworn to or affirmed and subscribed before me this "~~ ~`~ day of ORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES N. C. VITAL RECORDS Registration CERTIFICATE OF DEATH District No. ®~~ Local No. DECEDENTS NAME (First, Middle, Last) SEX DATE OF DEATH (Month, Day, Year) Charlotte Evelyn Horton 2F 3 11/18/2010 SOCIAL SECURITY NUMBER AGE--Last Birthday DATE OF BIRTH (Month, Day, BIRTHPLACE (County and State 183-12-4764 (fears) 89 Months Days Hours Minbtes vea~/21/1921 orFOreignCountn~1 4• 5. 5b. 5c. 6, 7 Franklin, PA '•WAS DECEDENT EVER IN U.S. 9a. PLACE OF DEATH (Check only one) ARMED FORCES? (Yes or No) NO - 8• HOSPITAL: ^ Inpatient ^ ER/Outpatient ^ DOA OTHER: Nursing Home ^ Residence ^ Other (Specify) FACILITY NAME (I/not institution, give street and number) CITY, TOWN, OR LOCATION OF DEA H INSIDE CITY LIMITS? COUNTY OF DEATH ~ ~ Britthaven Nursin Center (resorNo) 9b. g gc Nags Head sd. No 9e Dare MARITAL STATUS-Marded, Never SURVIVING SPOUSE (lf wife, give maiden name) DECEDENTS USUAL OCCUPATION (Give kind of wok KIND OF BUSINESS/INDUSTRY Married, Widowed, Divorced (Specify) done during most of working life. Do not use retired.) 10. widowed 11. 12a-Crossin Guard 1zbSchools RESIDENCE~STATE COUNTY CITY, TOWN, OR LOCATION STREET AND NUMBER 13a. NC 13b. Dare 13c. Kill Devil Hills 13d. 103 Lancer Court INSIDE CITY LIMITS? ZIP CODE Was Decedent of Hispanic Origin? (Specify yes or RACE-Amedcan Indian, DECEDENTS EDUCATION S (Yes or No) No-lf yes, s Cuban, Mexican, Puerto Rican, Black, White, Etc. (S (pacify only highest grade eta) ^ Yes No (Specify) NO PeofY) completed) Elementary/Secondary (0-12) College (13-17+) No 27948 White 12 13e. 13t. 14. 15. 16. FATHER'S NAME (First, Middle, Last) MOTHER'S NAME (First, Middle, Maiden Surname) Howard Monighan 16 Grace Kepner 17. INFORMANT'S NAME (Type/Print) MAILING ADDRESS (Street and Number or Rural Route Number, City orTown, State, Zip Code) DATE AMENDED •• Beverl ers 19a. y ~' 19b 103 Lancer Ct. Kill Devil Hi11s,NC 27948 Part 1. nter ttte diseases, injuries, or compl ons that caused ttre a not enter the mode o d 19C' ying, such as cardiac or respiratory arrest, shock or heart Failure. Approximate Interval It appropriate, enter tobacco, atcotal, or drug use. Dst oMy one cause on each tine. (PAINT or TYPE) Between Onset and IMMEDIATE CAUSE -~ Death (Final disease or a, 5 4 F, +f~ >~j~/ G~-1L(J ~1.~-L n L~,~-r ~t..J. (tom ~ ~ i~r~ condition resulting DUE TO (OR AS A CONSEQUENCE OF): in death) Sequentially list conditions b. I ~Cf~ts='K~ c, (~~h-rt-y~r aM ya(~/.1-~~f~-F' c~~j~y.~'- it any, leading to immediate DUE TO (OR AS A CONSEQUENCE OF): • cause. Enter UNDERLYING ~ CAUSE (Disease or injury that initlated evems c. resulting in death) LAST. DUE TO (OR AS A CONSEQUENCE OF): -- 20a. d, PART II. Other sign'rficant conditions contributing to death but not resulting in the underlying cause given in Part I, such as tobacco, alcohol, or drug use; diabetes, etc. 20b. AUTOPSY? (Yes or No) tf yes, were findings considered in determining cause of death? Was case referred to Medical Examiner? {Yes or No) TIME OF DEATH 21a. ~ 21b. 21c. dx~~ 22. M. NOTICE: STATE LAW REQUIRES THAT ALL DEATHS DUE TO TRAUMA, ACCIDENT, HOMICIDE, SUICIDE, OR UNDER SUSPICIOUS, UNUSUAL, OR UNNATURAL CIRCUMSTANCES BE REPORTED TO, AND CERTIFIED BY A MEDICAL EXAMINER ON A MEDICAL EXAMINER'S CERTIFICATE OF DEATH. ANY DEATH FALLING INTO THESE CATEGORIES IS W ITHIN THE MEDICAL EXAMINER'S JURISDICTION REGARDLESS OF THE LENGTH OF SURVIVAL FOLLOWING THE UNDERLYING INJURY. SIGNATURE AND TITLE F E/tRTIFIER//~) DATE SIGNED (Month, Day, Year) NAME AND ADD ESS OF ERSON WHO COMPLETED CAUSE OF DEATH (ITEM 20) (Type or Prim) 24. ~rai's^t 6~ rr LJ ~ 1.• 'Y' ~.'0k (~~` ~ t~3 ~-t: Lam. ~ ~ cr G ,Z `_7 `~ '~ "'~ driF~fHOD OF ISPOSI ON PLACE OF DISPOSITION (Name of cemetery, crematory, or other LOCATION -City or Town, State, Zip Code ~ • • • urial ^ remati ^ Removal p/ace) 25a. ^ Do ion Other 25b, Rolling Green Memorial Park yrs. Lower Allen Township, PA 19382 NAME AND ESS OF FUNERAL HOME NAME OF FUNERAL DIRECTOR LICENSE NUMBER Gallop Funeral Services,Inc.6917 S.Croatan Hwy. Nags Head,NC Courtney N. Gallop 2384 DHHS1872 26aP7959 26b. 26c. Re~vtew 3/~ REG~~IS((T~~RAR'S SIGNATUR DATE FILED--(77MOnth, Day, Year) NAME OF`Et$~ey N . Gallop LICENSE t~l~~~t VITAL RECORDS 27. ~V`-~ ~-~~ r 28. 1 ~..ZL:~~ ~~ 26d. 26e. t•., c~ ~ Q ~. ~7 N(7RTH CAROLINA-DARE COUNTY~~~~ c.._ r~; `-7 t C'1 :I2"1 (I'Y'1'1IE FOREGOINGINSTRUIVIENTTO I~ ~ ~~~~ ~ - c~ 131: ;1 I ~tl!E CUPi~ .5~: C014;PARED W[TN'I~HE ~~" +~.! r, f'i:lC~l'~n(.ON t~i .F fN'1'I"I[. OFIICE. ~~~~ -_• `-' ,'~?Q'n ?~'.' ,~ V,~~;L(i! L;A Lic~iLJIL:;~ ;J ' ~ ~`= C7 BY: _._ IlG '1'V fn t c'rnn t .c n nr~r..-.~ -