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Home My WebLink About07-07-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNS!~L,VANIA , REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Joanne W. Daly ,Deceased ESTATE NO: 21- ` ~ ~~ ~~~,~) a/k/a: ----- a/k/a: a/k/a: SS NO: 204-48-0752 Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' A1Y>:1 "C" as applicable: ^ A. Probate and Grant of Letters Testamentary or ^Administration c.t.a., or d.b.n.c.t.a. (completE~ Fart 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 ~=~e ~ ~ Y~~ ~-: ' '-~`~ :_7~ 1.> f _-~ ('1'1 t .:=_ Ciro ~ '-~..i (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 exec~:~ri of thee' ~=-~;~ instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person aijwas notFa -~ :- ~~ a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been estabti~>eT~as defined in 2 , F `~-~' ~ ~ ~`~ 3 Pa. C.S.A. § 3323(8): ~,~ r -~ .. C7 ~~ ~ 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 (lf Administration c.t.a. or d.b.n.c.t.a., enter date of Will in Section A and connplete 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: ,.,_~_ - -- Huuress Relationshii~to Deced~ Daniel J. Daly 15 Sandy Bottom Road, Carlisle, PA 17015 spouse Colin ). Daly 15 Sandy Bottom Road, Carlisle, PA 17015 minor son Olivia E. Daly 15 Sandy Bottom Road, Carlisle, PA 17015 minor daughter i'SF, ,~nnlTtt7~rai. C~iFFTC iF NFr~CCnnv nt THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At 15 Sandy Bottom Road, Carlisle, Cumberland County, Pennsylvania 17015 __ (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then 42 years of age, died 8/25/2009 at Carlisle, Pennsylvania (Month, Day, Year of death) (City and State where death occurred) Estimated value of decedent's property at death: _If domiciled in PA All personal property $ j t; ~~ _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 $ CI.00 Location of Real Estate in Pennsylvania: (Provide full address if possible.) Signature(s) Name(s) & Mailing Address(es) '~~~ ~ ~" ` Daniel J. Daly, 15 Sandy Bottom Road, Carlisle, PAS 17015 V Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 1 of 2 P' 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 represent,~tive(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 p% day of t ~; ~--~ ---~- i ,rte '- '~ ,;' ~ ~ %' ror the Register r-~, ~~ DECREE OF PROBATE AND GRANT OF LETTERS :.~.? ~ per-- ~'~' -~, w ~. Estate of Joanne W Daly ,Deceased File Number: 21- _ _~'~' AND NOW, this ~ day of ~ ~ ~ ' ~ t ~ in consid eration of the Petition on the reverse side hereon, satisfactory proof havin been presented before me, IT IS DECREED that Letters Testamentary X of Administration are hereby granted t:o: (If applicable, enter e.t.a., d.b.n., d.b.n.c.t.a., etc.) Daniel ]. Daly Inc aouve 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. :~-~ ~r.~ ,~_, T-~~ '~~7 r, '- i"' ~--~w j -.,..., ~.:y... .. cr '_ _-1"} r-'... ~.~ a in ,, ~`~ - ~ ~, Glenda Farner Strasbaugh Register of Wills"` ~' ~'(`~,~;~ ~.~~!.-~`'~ ~,~~1,>~, , ~!~ FEES: Letters ....................$ ~~ Will. ................. Codicil(s) .............. . (~) Short Certificates ( )Renunciations....... Bond ............................ Other ............................ ................................. ................................. Automation FEE......... 5.00 JCS FEE .................. _23.50 ;`~ ~" c TOTAL ................ $ ~-5~6' ~~ ~~CI=-~ Signature of Counsel Required to Enter Appearance ~ Atty's Signature PRINTED Name: Michael A. Scherer, Esquire Supreme Court ID No.: 61974 Address: 19 West South Street Carlisle, PA 17013 Phone: (717) 249-6873 Fax: (717) 249-5755 _, Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court I-'age 2 of 2 105.905 REV.(1/11) This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of~ H.ealth in ac the Vital St ~ cordance with ~ t 'stics Law of 1953 , , ~ , as amended. O v~ ~.s = j ~ t: ~ cv „~ ~RNING: It is illegal to duplicate this cop b h t t _ - .,_. ..~ , y y p ~ C o os at or photograph. vt. _ , , . L.J.__ .._ C:~ ~ `~' t~ ~ ~ --~ U ~ ~,J ' ~~ ~~ Marina O'l~eilly Matthew 4~-' ~r_ ~ Acting State Registrar ~r ~ ~, 620.7951 ~1~~~~~~~1t No. Dare H105.144 REV 11/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE/PRINT IN 079924 BLACKINKT CORONER'S CERTIFICATE OF DEATH ~~32-089 (See instructions and examples on reverse) STATE FILE NUMBER 1. Name of Decedent (Frst, middle, Iasi, sufix) 2. Sex 3 Soc2 oe~ my Number 4. Date of Death (Month, day, year) Joanne W Daly Female - 48_ 0752 5. A e last Birthda Under 1 ar August 2 ~1 , 2 0 0 9 g ( Y) ye Under 1 day 6. Date of &dh (Month, day, year) 7. Birthplace (City and state ortoreign country) 8a. Place of Death (Check only one) - . Meths Days Flours Minutes 42 Yrs. March 12, 1967 Hospital: Other; - Meadowbrook PA 8b. Coun of Death ^ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home Residence ^Other ty 8c. City, Bo Tw f Death 8d. Facility Name (If not inslitulan, give street and number) _ 5pecity: • 9. Was Decedent of Hispanic Origin? [~ No ^Yes 10. Race: American Indian, Black, White, etc. Cumberland Dickinson Church Lane (If yes, specify Cuban, s . . W Q Mexican, Puerto Rican, eic.) (~°il~Jhl t e 11. Decedent's Usual Occu lion Kind of work done Burin most of workin Irie. Do cwt state cell 12. Was Decedent ever in the 13. Decedent's Education (Specify only highest grade wmpleted) 14. Marital Status: Mamed, Never Mamed, 15. Surviving Spouse (If wife, give maiden name) ~ of Work Kind of Business I Indust U.S. Armed Forces? Widowed, Divorced S Chemist ry Elementary/Secondary (0-12) Celle e(1.4or5+) (Peel Paper Company ^ves Q~lo ~+ Married 16. Decedent's Mailin Address Street, c /town, state, zi code Da:n i e l Dal y 9 ( dY P 1 Decedent's pA Did Decedent 15 Sandy Bottom Rd. Actual Residence 17a.State Liveina Dickinson Carlisle PA 17015 17c.®Yes, DecedentUvedin Twp Cumberland Township? 17h. County 17d. ^ No, Decedent Lived wdhin 16. father's Name (First, middle, last, suffix) Actual Limits of - City / Boro 19. Mother's Name (First, middle, maiden surname) - Richard Woodward 20a.lnfomtant'sName(Type/Print) Theresa Mor4en 20h. Informant's Mailing Address (Street, city /town, state, zip code) Daniel Daly 15 Sandy Bottom Rd., Carlisle PA 170:15 21 a. Method of Disposition carnation _ • ~ ^ Donation 21b. Date of Disposriion (Month, day, year) 21c. Place of DisposBion (Name of cemetery, crematory or other place) 21d. Location (City I town, state, zip code) ^ Burial ^ Removal from State ~ Was Cremation or Donation Authorized ^ Other•Specily: yMedical (Coroner? Yes^No August 27, 2009 Hoffman-Roth Funeral Home & Carlisle' PA 17013 ~ 22a. Signatu Fune Service fin as such C r erne t o r 9 ) 22h.UcenseNumber 22c.NameandAddressofFacility o man- of Funeral Home & Crematory ' ~ ~ 138504 219 N, Hanover St., Carlisle PA 17013 Comple a Items 3a-c on rtifying 23a. To the best of my knowledge, death occurted al the time, date and place stated. (Signature and title) physician is not available a rme of death to 23h. License Number 23c. Date Signed (Month, day, year) certity ause of death. ' Items 24-26 must be completed by person 24. Time of Death Ap rX . 25. Date Pronounced Dead (Month, day, year) who pronounces death. 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other than Cremation or Donation? 4:00 P. M. August 25, 2009 Yes ^No CAUSE OF DEATH (See instructions and examples) i Approximate interval: Pad II: Enter other si_gnitir~nt wndihons coniri utin to ath, 28. Did Tobaa:o Use Coniribule to Death? Item 27. Part I: Enter the chain of events -diseases, injuries, or complications - that directly caused the death. DO NOT enter terminal events such as cardiac arrest, r --~-g-~- respiralory artesl or ventricular fibrillation wNrout showing the etiology. List only one cruse on each line. Onset to Death but not resulting in the underlying cause given in Pad I. ^Yes ^ Probably r IMMEDIATE CAUSE (Final disease or r ~~ No ^ Unknown conditwn resulting in death) r -~ a._ Compression Asphyxia - r 29. If Fsmale: Due to (or as a consequence of), r SequentiaNy list centfdions, if any, r ^ Not pregnant wthin past year leadin to the cause listed on line a. b. Tree 0 n Auto r Due to q ~ r ^ Pregnant at time of death Enter a UNDERLYING CAUSE (or as a cease uence o : ~ (disease or injury that inAiated the c r ^ Not pregnant, but pregnant wthin 42 days events resukmg in death) LAST' r of death Due to (or as a consequence off: r d. ~ ^ Not pn?gnanl, but pregnant 43 days to 1 year r before death 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death ^ Unknown if pregnant within the past year Performed? 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Oaurred --- Available Prior to Completion 32c. Place of Iniury: Home, Farts, Stree(, Factory, of CauseotDeath? ^Natural ^Hormicide Aug. 25,2009 Large tree fell on moving vehicle Office Building,et^ Seri) ~~s~dence Yes ^ No Yes ^ No ~ Accident ^ Pending Invesbgafion 32d. Time of InjtAp rx ~ 32e. Injury at Work? 32f. II Trans nation In u S - Po 1 ry (P~IY) 32g. Location of Injury (Street, city (town, slate) ^ Suicide ^ Could Not be Determined 4:00 P _ ^Yes ~No ,~rner (Operator ^ Passenger ^Pedestrian M' Olher~S Church Lane, Carlisle, Pa. 33a. Certifier (check only one) ^ Cart in h sician Ph 33b. Signature and e ' - nY 9 P Y ( Yacian certifying ceuse of death when another physician has pronounced death and completed Item 23) To tfk beat of my knowledge, death occurred due to Me cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ ~ C o r o ne r ----------------- renouncing and certifying physician (Physician both pronoundng death and certifying to cause of death) - _ -- ^ io the beat of my Imowkdge, death occurred at the time, date, and place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ ^ ~ License Num r 33d. Date Signed (Month, day, year) Medical Examiner (Coroner - - - - - - Onthe basis of examination and I or investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as stated_ ~ August ,~ 6 , 2 0 0 9 34, asp Address of Person N(po Completed Cause y(Death Item 27 Type / Prmt 35. Registrar's re,andDi ~be~~~~- t ~ 1Cllael L. 1VOr11S, l.ordneT' ~ l~~ ~ L~1.~ I c~, I ~ I O I DateFaed(Monm,day,year) 6375 Basehore Road, Suite ~~l .~ ~ Mechanicsburg, PA 17050 Disposition Permrl No. {~ l~~ a~ -