HomeMy WebLinkAbout07-08-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of ~ ,~ .-~.~„-, ,~. ~c,(,,,z 1 ~u ,Deceased ESTATE NO:_21- ~ ~ `- 7r~
a/k/a:
a/k/a:
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or ~B' AND "C" as
applicable:
0''A. Probate and Grant of Letters Testamentary or pAdministration c.t.a., or d.b.n.c.t.a. (complete Part Calso)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters under
the last Will of the above-named Decedent, dated 1 ~i _ Wl ~ Y %Z ~ c' ~ 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
(it 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: ~,.; ~~~ O
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal~residence
At C:.l,vrc.~j, ~~ C~~~ No-~n~_ Rio r' MU~th ~~A-,uc~' :-~ S~' ~s~2L,:~l~. ~~/,- r7t,a 3
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then . years of age, died ;~ 3 ::~ v t t at ~-}~,t, 5 ^ ,~- , ~ .~ e ~ ~, -t ~, ~ ~~ ~ , ~ ~ r` P,4 ,
(Mon h, Day, ear of death) (C~ty' and State where death oc rred)
Estimated value of decedent's property at death:
_If domiciled in PA All personal property $
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 $ ~ ~ ~ ~! ,, ~ -
Location of Real Estate in Pennsylvania: (Provide full address if possible.)
_~~ Signature(s) l .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 Page 1 oft
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 af?~r•med at~d subscribed
before -~ tr is _ ~~~ da of
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r~or the Register
DECREE OF PROBATE AND GRANT OF LETTERS --~~ '=='
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Estate of ` .~) ~~ ~,_i~ ~k' i ~~_~~~~ (~ ~ (((~_~ Deceased File Number: 21- ~ ( - ' ,~j
AND NOW, this ~ day of '}
in consideration of the Petition on
the reverse side hereon, satisfactory proof having een presented before me, IT IS DECREED that Letters
/ Testamentary of Administration are hereby granted to:
„~ (It applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.)
the above estate and that instruments(s) dated r-=- `
admitted to probate and filed of record as the 1 t
FEES:
Letters .................... ~ ~
$
Will ....................... ~""
Codicil(s) .............. .
( ~) Short Certificates ~ (~~
( ) Renunciations..... .._
Bond ............................
Other ........................... .
............................... ..
............................... ..
Automation FEE......... 5.00
JCS FEE ................... 23.50
TOTAL ....... $
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court
~ ~ - described in the petition be
ill and Codicil(s) of Decedent.
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Glenda Farner Strasbau h ~
Register of Wills
Atty's Signature
PRINTED Name:
Supreme Court ID No.:
Address:
Phone:
Fax:
Signature of Counsel Required to Enter Appearance
Page 2 of 2
LC1+~~L REGISTRAR'S ~CERTI~I~.~~'I~JN O~ C~Er~~'~-~
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Hlp$ I<3 REV I I/2pQ6 ~`~ ~ ~' 1 _~ '"Tl
nPE i PRINT IN COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS h~ ~ -~ ~'
PERMANENT ~ "d` ~ ~-'
BLACK INK CERTIFICATE OF DEATH -L7 ---i 'V r~•`
(See instructions and examples on reverse) D F'rJJ ~'~ Q
1 Marne d Decedent (Fvst middle, last sudix) STATE FILE NUMBER Mr7
Dorothy J. McColl z $ax ~'
y 3. Soar Sectrey Ntmber ~, Data d Osam (MOnm, day, rear)
Female 195 _ 16_ 7776 June 23, 2011
5 Age (Lass &rmdaYl Urdw t Under 1 da 6 Date d Birth Month, de , ar 7
Faoneu pays FUws karwAa ~ and sUls « br ' QOIYI 8a. Plan d Deim Check one
88 2/19/1923 Philipsburg, pA Hospital: OtMr
Yrs ~~yy
8D. County a Daam &. City, Bono. Trop. d Death ~a^D+tiaN ^ ER /Outpatient ^ DOA ^ Nursiry Homo ^ Residence ^ Odter - Speaty.
• Cumber 1 a n d ~ Fi°I"y' Na`"' („ ~ ~'~' ~° sa.e, area rxrrb.r) 9. Wu Decadent d Hispanic tDrign? . R
E . P e n n s b o r o T w Holy Spirit Hospital (d yea, sprKily cub.n, l~r~ N0 ~ Yes t o. Race: American ,naiar,, Blxk, yVM,, e~
t t Docedenrs usual lion Kind d w«k dorw ~ most d ~ IYe. Do not stave re ~ tz. was Deoedertl ever h tM 17. DacsdrY's Education Mex+carF. Pwrto RKan, ek.) (~M Whit e
Kind d won (SPuitY onh highest grade corrpklaa) 11. MarRr Steax: Married, Nwer Marred. IS Surviving Spouse (If wife,
Kind d Busirwss/ IrWustry U.S. Armed Forces? give ma~tlen narrw
Homemaker E~ntarr / se~orwary (a, z) cw widowed, Div«red (spaary/ )
------ ege(1J«s+(
16. Decedent's Maikng Address (Sboet city! town, sole, zip code)
^ Yes ®No 0 W1dOW -------- ---
8 01 North Hanover Street Gwent t Did Det:ed«>,
Actual Residence 17a.State PA
~ a 17c. ^ Yas, Decedent Lived n
Carlisle , P A 1 7 0 1 3 17b. County (~, t m h p 7- l a n ~ T""r~? 17d ~] No, Decedent Lived wimin Carlisle Trop
16. Father's Name (First, coddle, last, wf6x) AChial ~"~ a Gry i Boro
W i 11 i s m F. H e s s o n g 19. Mothers Nana (F'wsl, coddle, maiden wmama)
20a. Inl«manrs Name (Type !Print) Ruth W 1 S e
Thomas R . M C C u 11 y , J r , zoo. wormanr: "~ Addre>" (street ar / lawn, stag. zq rxrde)
z,a Med,ddaDi 31 5 Hickory Road, Carlisle, PA 1 701 5
sposition r ^ Crertutan _
° ~ BixW ^ Removr from State , Wu Cremation « ~~ A ~~ z t b. Dale d Dispoailbn (MOnm, day. Ywl 21 c. Plata a Disposition (Name d esrtrlary. crematory « odNr place) 21 d. Locatxn (City /town, stall. zip code)
~ °~` . S ' ~Y Medkr Examiner / cortln.r7 ^ y., 0 ,~ 6/ 2 7/ 1 1 Chestnut Grove C e m e t e r 1 7 0 5 3
• 22a. $ignatwe d Funeral ,vice ( - u ~,) ~, ~» Nu,r~.r Y Marysville , P A
< _ , 22c. Noma and Addesa d FacAiry
011825-L Shalonis FH, 206 Maple Ave., Marysville, PA 17053
Compep items 23a< orJy when 2pa. To ~~,d/[~my death occurrW al do time, da4 and
physican is na avaJable al linty am b ~~~~" _ 1 Wan sliled. (Sgrwture and tide) 23b. License NurMer
rertiry cause d death. r,[V~ ~ A I ~-f 27c Date SKyted (Montn. day, year)
_~ hems 2t-26 must De conpleted by parson 2!. Time d Deem Z5. Oa P ~' `r ~ ~~ I ~ / ~ ~,A ,~ ~ ,~ Q//
»tb prorwrrtces deem tonotxxyd Daw (MOnm, day. year) 26. Was Casa RaierrW b Mrsdcr
a , ~ Q M. ~„ „~ ~ ~ ~ ~1 O I Examirw / C«oner br a Reason Omer than Cremation or Darracon?
.[ ^ Ye: ^ No
hem 27 Part I. Enter the CAUSE OF DEATH (See inslructlons and examples)
fban of event -diseases, kyunss, a tprrpkCatitlrtf • mat directly cwsW Cn deem. 00 NOT enter termrW events such as rer6ac arrest, ~ Appoxmak intervr: Part II: En4r odser ~ 26. Dd Tobacco Usa
respiratory arrest. or vantrwtilar fbrilladpn wimout d,e QriSet b Oaam but red recd' in me Contribute b Deam?
showing etiob9Y. List orJy orr Huse on each Ina. r b"9 urxferlyirg cause given n Part I. ^ Yes ^ Probabry
IMMEDIATE CAUSE (FrW disease or ~
condition rewltvg n deem) A - r ^ No ^ Unkrawn
~ a. ~QI/~~ ' 29.11E
r curate:
Due b (a as a consequence pf). t
~- ~ SequenWlty Gst mrs6tions. Y any, C ,~r- ^ r ^ Na pregnant wimin past year
to the cause fisted on Inc a. b ` 1 ~
-_~ t Enter UNDERLYING CAUSE Due b (or as a consequence of). t ^ PreynarN at time d deem
r
Idssease a iryury mat initiated the t ^ Na pregnant Dot pregnant witran a2 days
evenly restating n dean) LAST. c t
~ Osse b (or as a consequence d): t d deem
' ~ Nd pregrwx, dot
d. r pregnant i3 days to t rear
r bel«e dean
10a. Was an Autopsy 30b. Were Autopsy FrWngs 31 Maurer d Dean ' ^ Unkrown d Est Y~
Pedormed~ Avrlabk Prig b Cortpletxm 32a. Dak d Iryury (MOnm, day. Year) 32b. Describe Flow Iryury Occurred pre9^arv vnthn Inc
a Cause d Deem? ~laNral ^ H«niade J2c Place d Irytuy: Harr, Farm. Sven. Factory,
rrYYII Ofrw;e Bwb'vg, etc. (SPedhl
^ Yes LS.Y No ^ Yes ^ No 1 ~ Accident ^ Penang Invesbgalipn 32d Time of Injury 72e. Injury al Won? 321. II Transportation I
Cl ~~ njurY (~,'/ J2g. Loretion d xyury (Street ary! lows, state)
^ Could Not tie Dafermned M ^ Yes ^ No ~ ~^'er/Operate ^ Passenger ^ Pedestrian
33a. CeNfier (check orvy one) Omer ~ Spealy:
• Certifying physician (Pnysxaan nrtiryng cause d deem when arothar 93b. Sgnalure and Tqk of Cerd6er
7o the Dtst of m phYsiaan has Wonounced deem and campleled deco 29)
Y knowledge, deem occurTW tlw to the reuse(s) antl manner as staled _ _ _
~ Prorquncinq and urtifying PhYrclen - - - - ' ' ' ' ' ' ' - - - - - - -' - '
(PhYSaan both pr dean and cero _ _ _ _ _ _ _ _ _ _ .
z To the best of m Yntlw onotxxrg fY'n9 b rouse d dean) ~3c. Lx:ense NtxrWer
w Y Fedge, death occurred at the time, dab, orb plus, and dw to the reuse(s) and manner as stated_ _ _ _ _ _ _ _ ~ 33d. Date (Mmm, da , years
° Medical Examiner/C«oner //``
0
w On the basis of examination and / « investigation, b my opinion, death occurred N Me time, date, and place, and due to the reuse(s) and manner as stata~ ^ ~~ V ~ ~ } L t)
° 35.t Re4. s tore icy ~ Nanw and Address d Person Wtb Conpleled Cause d Death (hem 27) iy I
Z ~ ~~ ~ ~ i~ J6. Data F (Mmm. y. year)
\.J to~.s ,~'1 Vl~ ~ v~T~ 503N. ~.15~ St, Camel-f,~(, r~/~ 170~~
DiSpOSdidn Permit No O ~ ~, y ~ 7
LAST WILL
R. SCOTT CRAMER
Attorney at Law
5 5. Market St.
P. O. Drawer 159
Duncannon, PA 17020
I, DOROTHY J. MaCIILLY, of 315 Hickory Road, Carlisle,
Cumberland County, Pennsylvania, declare this to be my Last
Will, hereby revoking all prior Wills and Codicils.
FIRST; I direct that the expenses of my last illness and
funeral be paid out of my estate as soon after my death as is
convenient and expeditious in the judgment of my Executor,
hereinafter named.
SECOND: It is my intent that my funeral expenses be paid
from the proceeds of any life insurance policies which I may
own at the time of my death.
THIRD: I give and bequeath all my certificates of
deposit to my two sons, John D. McCully and Donald L. McCully,
in equal shares, share and share alike.
FOURTH: I give, devise and bequeath the rest, residue
and remainder of my estate to my three children, Thomas R.
McCully, Jr., John D. McCully and Donald L. McCully, or their
then-living issue, in equal shares, share and share alike.
FIFTH: All estate, inheritance and other death taxes,
together with any interest and penalties payable with respect
to property or interests therein subject to taxation by reason
of my death and whether passing under my will or any codicil
thereto, or otherwise including jointly held and other non-
testamentary property shal? be paid cut of file principal of my
residuary estate without apportionment.
SIXTH: I hereby nominate, constitute and appoint my son,
Thomas R. McCully, Jr., Executor of this my Last Will. I
further direct that he shall not be required to post any bond
to secure the faithful performance of his duties in the
Commonwealth of Pennsylvania or in any other jurisdiction.
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IN WITNESS WHEREOF, I have hereunto set my hand and seal
to this my Last Will, which consists of two (2) sheets of
paper, dated this ~r~-+h day of May, 2000.
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The writing contained on this and the one preceding page
was signed and sealed by Dorothy J. McCully, and by her
published and declared as her Last Will, in the presence of
us, who have hereunto subscribed our names as witnesses at her
request, in her presence, and in the presence of each other.
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R. SCOTT CRAMER
Attorney at l.aw
5 S. Market 5t.
P. O. Drawer 159
Dunconnon, PA 17020
COMMONWEALTH OF PENNSYLVANIA)
)SS
COUNTY OF PERRY )
I, Dorothy J. lYtcCully, testatrix, whose name is signed
to the attached or foregoing instrument, having been duly
qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will; that I
signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
~~ ,> "
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R. SCOTT CRAMER
Attorney at Law
5 S. Market St.
P. O. Drawer 159
Duncannon, PA 17020
SWORN or affirmed to and
acknowledged before me by,
Dorothy J. McCully, testatrix,
this ~~-~~"day of May, 2000.
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My ~sm:~i
COMMONWEALTH OF PENNSYLVANIA)
)SS
COUNTY OF PERRY )
We, '~~ lCt~~:~.~. ~'~~+~ E t and ~. ~'~!lr~n ~ ~ ~~ - (:~ ~~ ~ , the
witnesses whose names are signed to the attached or
foregoing instrument, being duly qualified according to law,
do depose and say that we were present and saw testatrix
sign and execu a the instrument 3s her Last. Will; that
Dorothy J. McCully, signed willingly and that she executed
it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the
testatrix signed the mill as witnesses; and that to the best
of our knowledge the testatrix was at the time 18 or more
years of age, of sound mind and under no constraint or undue
influence.
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R. SCOTT CRAMER
Attorney at Law
5 S. Market St.
P. O. Drawer 159
Duncannon, PA 17020
SWORN or affirme to and subscribed
to before me by -~ ct~ (~'~~ ~~ ~ ,
and ~~~.~,~,,~,~ ~. (ia.~a~~ witnesses,
t,uis ~a ~E-th aay of 'clay, ~ uu~ .
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