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HomeMy WebLinkAbout07-05-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of Wendy K. Royer also known as COUNTY, PENNSYLVANIA ;~ FNe Number 21 - ~ - +.. ~ ~ .~~, ,Deceased Social Security Number 536.72-7310 Robert P. Royer Petitioners}, who islare 18 years of age or older, apply{ies) for: (COMPLETE :4' or `B' BELOW.) ^ A. Probate and Grant of Letters Testamentary and aver that Pettioner(s} is/are the named in the last Will of fhe Decedent, dated and codicil(s) dated State reteiaM dreumsfances, e.g., renunciation, death of executer, 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: X B. Grant of Letters of Administration (lf applicable, enter, c.t.a.; d.b.n.dta.; pedente life; durance absentia; a4eanle mrnorifatel Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survived by the following spouse (rf any) and heirs (rf Administration, c.La. or d.b.n.c. t.a., enter date of X11 on Section A above and complete lisf of heirs); was not the victim of a killing; was never adjudicated an Incapacitated person; and was not a party to a pending divorce proceedrng wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323 (g), except as follows: Homicide by known assailant Robert Liddick Name Relationship Residence See attached schedule _'= ~'~~ v ~~ ~~' ~ _ ~_: -; _ ,~~ _~ (COMPLETE INALL CASES:) Attach additional sheets ifnecesssry. ~ ~ `, -~-f ~` ~-'~~ Decedent was domiciled at death in Cumberland.. county, Pennsylvania with his !her last principal res~nce at "`~` `~ a c.~: ~~ 940 S. 30th Street. Camq Hill. Cumberland. PA 17011 (List street address, town/city, township, courrfy, state, zip code) Decedent, then ~_ years of age, died on 06!151201.1 at Decedent at death owned property with estimated values as follows: (If domiciled in PA) (If not domiciled in PA) (ff not domiciled in PA} Value of real estate in Pennsyvania situated as follows: All persona! property $ 2.000.00 Personal property in Pennsylvania $ Personal property in County $ Wherefore, Petitioner(s) respectfully request(s) fhe probate of the last Witt and Codial(s) presented with this Petit'ron and the grant of Letters in the appropriate form to the undersigned: I Signature Typed or printed name and residence Robert P. Royer 922 iMltdifF Drive ' ~~' n Mechanicsburg, PA 17050 Form RW-02 Rev.1&2s-201o trnterim tam, pendra~ actia, by tna court! Copyright (c) 20~ form software ar~ly The laclaier Group, Inc. Page 1 of,2 `~ `\~,.a 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. Sworn to or affirmed and subscribed beftirs me this ~ ` _ day of i. For the Register otPersonalRepresentative RaberEP.Royer Signature of Persona! Representa5ve /^~ '=, 0 ~~ - _,> rTi ~ ~~,~ ut '~~~ -, File Number: 21 t.. [::~ ;.~, . - ..~ --~, .:.~7 Q -rt Estate of Wendy K. Royer ,Deceased Social Security Number. 536-72-7310 Date of Death: 06/15!2011 AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED fhat Letters of Administration are hereby granted to $g,~~ P. Ro~/~~ 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 Certifcate(s) ....................... $ ~• 68 Renunciation(s). ........................... $ TOTAL ................................... $ Regisferof des Attorney Signature: C/ ~ Attorney Name: Gary L. Supreme Courk l.D. Na.: 27752 James, Smi~Di~rick 8~ Connelly, LLP Address; 134 Sine Avenue Hummelstown. PA 17036 ' Telephone: 717!533-3280 E-Mail: glj@jsdC.com Form RW-OP Rev. 70.13-2006 Gopyright {c) 200(3 form software only The Lackner Group, lnc Pape 2 of 2 PETITION FOR PROBATE AND GRANT OF LETTERS (Con#inued) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of _Wendv K. Royer File Number 21 also known as ,Deceased Social Security Number 536-72-7310 Name Relationship Residence Brandon Liddick Child (Minor) 922 Wiltcliff Drive Mechanicsburg, PA 17050 Connie L. Royer Mother 922 WiBcliff Drive Mechanicsburg, PA 17050 Michael E Royer Brother 73 East Carlton Road Carlton, PA 16311 Robert P. Royer Father 922 Wi[lcliff Drive Mechanicsburg, PA 17050 Betsy J. Suggs Sister 275 Walton Street Lemoyne, PA 17043 JUN 2 1 2011 t 17~5~909 ,- ,. ~,~~/~~ ~ ,, ,. ~ c_ rr T_ r..~ ~ C= ~ i _ T ~ ~ ~ 1"_" -lam -'~'~m i ~ :: ~ --~ . __ ~.•7 ~ D REV nrzoo6 ,_ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS -TZ ~ /n4PnNIEM" - CORONER'S CERTIFICATE OF DEATH tcKINK See instructions and exam les on reverse P STATE FILE NUMBER 1. Name of Decedent (First, mitltlle. lest, sufllx) 2. Sex 3. Social Securtty Number 4. Date of Deam fMOnth, day, Year) Wend K Ro er Female 536 - 72 ~- 7310 June 15, 2011 5. Age (last Birthtlay) Untler 1 year Under 1 day 6. Date of Birth (Month, day, year) 7. Birthplace (City and slate or forei n arntry) Ba. Place of Death (Check only one) MonelS Days nwn Min,nm Hospital: Omer Kodiak AK ' , ,~ g ^omer Residence Specify December 20 1974 ^mpafiem ^ER/Ou tiant ^DOA ^Nursin home 36 Yre 8h. County of Death Bc. CTy, Bor Twp of Death Bd. Facility Name (If not institution, give street and number) 9. Wes Decedent of Hispanic Origin? ®No ^ Yes t0. Race. American Intlian, Black, White, etc. (If yes, opacity Cuban, ;SpeciM1~ Cumberland Ham den 3924 Brookrid a Drive Maxlcan,PuertpRican,e".) White DecetlenYS Usual Occu Non KinO o1 woM done dunn most of world Itte. Do not state refired 11 12. Wes Decedent ever in the 13. Decedents Education ISpecily only highest grede completed) 14. Marital S18N5' Marded, Never Marred. 75 Surviving Spouse (If rode, give maiden name) . Kind rk Kin I Bu ness (Intlustry x ~o k ~ ~ Offi U.S. Armed Forces? Wltlowed, Divorced (Speci/}q Elementary / Sewndary (0-12) Colle a (7-4 or 6+) ~ Never Married r er ax a ri ce ^YB5 ~Np 16. Decedent's Mailing Adtlress IStreet, Dry !town. state, zip cotle) Decedent's p A Did Decedent Uve In a , 7° ^ yea Decadent Lived in - 9 4 0 S . 3 0th Street , Actual Raabenpe , 7a. SYate Township? ,wp. Cumberland ,7d~7N°,DacadantLlvadwhn,r Camp Hill Cam Hill PA 17011 17hCounty Actual Limits of Ciry /Burp 16. Earner's Name (First. middle, last, suffix) 19. Mother's Name First mitldle, maiden surname) ( Robert P. Royer Connie Lame 20a. Informant's Name (Type / Pnnq 20b. InfomtanYs Mailing Address (Street, caY /town, state, zip coda) Robert P. Royer 922 Willcliff Driv 21 a. Methotl of Disposition [Cremation ^ Donation 210. Date pf Disposition (Month, day, year) 21 c. Place of Disposttion (Name of cemetery, crematory or other place) 21 d. Locaton (Ciry I tarn, state, ziD code) ^ Budal ^ Removal from stela was Cremetlon or Donation Authorized [~' ^ • June 21 , 2 O 1 1 H o 1 1 i n g e r Crematory Mt . Holly Springs, PA 17065 Yes No ^ Other - Speciy: ~ by Medical Exemlrter I Coroner. 22a. Signature d Funeral Service Licensee (or parson acting as such) 226. Ucense Number 22c. Name and Adtlress M Fadlity FD 012774-L Richardson Funeral Home Inc. 29 South Enola Drive Enola, PA 17025 • ~ ,,, Complete Items 23ac only when cer0fying 2 me best pt my knowletlge, death occurred at me tlme, date arW place sued. (Signature antl title) 230. License Number 23c. Date Signatl (Month. day. year) physcian is not available of lime ct tleath t° certtty rouse of tleath. 24 Time of Death 26. Dale Pronounced Dead (Month, day, year) 26. Was Case Referted to Medical Examiner! Coroner for a Reason Other man Cremation or Donation? hems 24-26 must be completed by cerson • Yas ^"° whopronopncesdeeth_ A rX. 1 :00 A. M. June 15, 2011 CAUSE OF DEATH (See Inatructlona end examples) t Approximate interval: Pan II'. Enter other Signlflcanl contlttions contnbutine tp tleam, 26. Did Tobacco Use Contribute to Death Item 27. Part I: Enter the chain of events -diseases, injuries, or complications -that direcfty roused me deem. DO NOT enter terminal events such as cardiac artesl, i Onset to Deam but not resulting in Ne underlying cause given in Pan I. ^ Yes ^ crpbably respiratory artest. or ventricular fibrillation wahout showing me etlology list only one cause on each line. t t ^ N° ^ Unknown IMMEDIATE CAUSE Final disease or i conemon resul6rg .n ~eath) _~ a Mll 1 t i p 1 e Gunshots 29. It Female. ^ N t Due to (or as a consequence of)~. ot pregnant rococo past year ^ Pregnant a~ time of deaM Sequentially Ilst conditions, if any. 0 leadingg to the cause listed on line a. Due to (or as a cronsequence of): ~ ^ Not pregnant, Out pregnant within 42 days Enter (he UNDERLYING CAUSE (disease or injury that InNated the c t of deaM events resulting m death) LAST. ~ t [J Nat pregnant Cut pregnant 43 Days to' year ): Due to (or as a consequence o before deaM d ^ Unknown II pregnant within the past ear . y 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Deam 32a. Date of Injury (Month, day, year) 32b. Desaibe How Injury Oaurted 32c, Place of Injury: Home. caret, Street Factory, Pedormed? Available P°nr tp comple°°° o' Cause of Death? ^ ~ Natural Homkitle ~ June 15 2011 Shot b known assailant oaipe Bcildmg, etc. rspeclylHome Yes ^ No 'Yes ^ Nc ^ Accident ^ Pending InvasOgatlon 32d. Time of Inlury Aprx 32e. Injury at Work? )• 321. If Tmnsportabon Injury (Spedty) ^P d t i l O ^ P ^ 32g, Location of Injury (Street. city /town, statel TTT""""` ^seiada ^cpuldNotbaDatarminad pl ^rea fPl"o assenger e es r an Ddver perator 1:00 A.M ^ ~ty aher - s Brookrid e Dr. Mechanicsbur , PA 33a. Certttier (check only one) 33b. Sgnature and Titl • Cenitying physician (Physioan cenifying cause of death when arwmer physician has pronounced tleath and compleletl ttem 23) ~ O T O n e r death occurred due t° the cause(s) end manner n ateted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ To the beat of my knowledge , • Pronouncing entl certdying physcian (Physk;ian both pronouncing death antl certttying to cause of deem) ^ 33c. Ucense Number 33d. Date Signed (Month, day, year; To tie beat of my knowledge, deaM occurced et the tlme, date, and Dlece, entl due to the eaux(a) and manner ae rdMed_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medcal Exeminer /Coroner ~-,r June 16 2 O 1 1 On th heals of ezeminadon and I or inveatigetbn, in my oplnbn, death acurced at the tlme, dale, and Dlece, and due to Ma cauae(e) end manner es stated_ IYJ 3p Name antl Address of Parson Wlw Completed Cause of Death (yarn 27) Type / Pnm Coroner Eckenrode Todd C Registrar'e signature iatnm Number1.y~ / ~ I ~ I r I ~I ~ I ~ ~~ta / ~y j , . 6375 Basehore Rd., Suite ~~1 . : I ~ ~ ~ v Dispositlon Pertnlt No, /,~] /a ~~~ RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Wendy K. Royer ,Deceased C7 S C~y , ' :~1 ;-~, ~ . ~ ._ . . ,~ -_-. _ Connie L. Royer in my capactya'~fa~tinnshr~ as _ -_~ nn ame ~--~ ~ , _ Mother of the above Decedent, t~reby renounce tHe~i~t to administer the Estate of the Decedent and respectfully request that Letters be issued to Robert P. Royer ,~ „Jr/ ~~ ~i ~ (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills 922 Willcliff Drive (Street Address) Mechanicsburg, PA 17050 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunYciation for the purp9ses stated within on +his ~ day of//1r~,t1C ~ t' . ~^ (Votary Public !/ My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) COMMONWEALTH OF PENNSYLVANIA_ _ Notarial Seel Denise M. Long, Notary PubUc Deny TWp., Dauphin County My Commission ExplrcS May 25, 2015 MEM ER, PENNSYLVANIA ASSOCIATION OF NOTARIES "`, -> (signature) Connie L. R`6yef Form RW-OB Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc.