HomeMy WebLinkAbout07-18-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
.~-~ nn ,~
Estate of ,~ (q/If ~~ ..~,2/h~/ C~'(GtOL-~ CCIr ,Deceased ESTATE NO: 21-~ (- `I~ j
a/k/a:
a/k/a:
a/k/a: SS NO: 02 7~ ~ ~ ~ -7 j~
.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 Calso)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters / under
the last Will of the above-named Decedent, dated ~~ ~' i~Lb3 and codicil(s) dat d ____
(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(g): _
^ B. Grant of Letters of Administration
(If applicable, enter d.b.n., pendent life, 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 ~,~~rt' to a pending d~;u
proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3~i, excepttas follow:
Name
4ddress
ie Decedeat ~ ='
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_~ C -^s
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N
D : r.a
USE ADDITIONAL SHEETS [F NECESSARY
THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at de th in Cumbe I~
At i U(o Gv~~a- ~nr 1'I~IOI c„ I ~e
ia, with his/her last
(Street address with Post OftiEe and Zip Code, Municipality: Township, Borough, Cyit )
Decedent, then ~ years of age, died 7 ! 20! ( at ~ ;~ ~l N
or Dri
(r .~ttc 5'
.i~
__ ,-r1
/7 s^']
~rl
sidence
(Mon , Da , Year ofdeath) (City and Statdwhere~leath occurfed)~
Estimated value of decedent's property at death:
If domiciled in PA All personal property $ ~, 00 C>
If not domiciled in PA Personal property in Pennsylvania $
_If not domiciled in PA Personal property in County $
_Value of Real Estate in Pennsylvania $
n A Total Estimated Value $ _ ~ (gC;!G
~~ Gt-'~ S -'t,~uy~~ille ~~t ~Q
Location of Real Estate in Pennsylvania: QI'rovide full address if possible.) ~C ~ ~ 1 ~q Sifl~ t'~_J /~T ~~C ~ -U f ~`/G~~'[~ ~'r~
~-
Signature(s) Name(s) & Mailing Address(es)
L}r,l ~v~seiT cJe., r'
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Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page l 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 affirmed and subscribed
this ----~=~~
///-,
9. - / W
the Register
Estate of
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DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW, this ZS ' ~ay of
the reverse side hereon, satisfactory proof
/Testamentary _ of Administration _
L
Deceased File Number: 21-~--~~~
~~ U l 1 , in consideration of the Petition on
presented before me, IT IS DECREED that Letters
are hereby granted to:
.fa.. d.b.a., dbsctn., e1r.)
the above estate and that instruments( dated _~_)
admitted to probate and filed of record as the last Will and
' [~ ~ _ described in the petition be
;odicil(s) of Decedent.
in
~ ~~~
Glenda Farner Strasbaug ,~ ,~ ~],~
Register of Wills L' l1~' ~
FEES:
Letters ....................$ ~
Will ........................ ~ ~
Codicil(s) .................
( ~) Short Certificates ~~
( )Renunciations.......
Bond ............................
Other .............................
.................................
Automation FEE......... 5.00
JCS FEE ................... 23 50
~, r
TOTAL..... .$ ~--~'~'
Atty's Signature
PRINTED Name:
Supreme Court ID No.:
Address:
Phone:
Fax:
Signature of Counsel Required to Enter Appearance
Interim Furm RW-02 revised 1226.10 by Cumberland County pending action by the Court Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, x;6.00
P 17452063
Certii~icar3on Number
This is to certify that the information here gi~'en is
correctly copied frl)m tin original Certificate of Death
duly filed with me as Local Registrar. The original
certificate wrill F~c forwarded to the State Vital
Records Office fc~s permanent filing.
L S~•n.~~-~ -- ~ JUG. 1 8 2011
Local Registrar Date Issued
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H166.1dd REV 11f2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
PERMANENTN CORONER'S CERTIFICATE OF DEATH
BLACK INK
~t,,, „~, (See instructions and examples on reverse STATE FILE NUMBER
t. Name d Decedent (Flst middle, ksi, suRa) 2. Sex 3. Social Seery Number 4. Dale of beam (Ma1th, daY• Year)
Donna J Cha Blear Female 271 - 42 -0712 Jul 14, 2011
s. Age (Last Binnday) under, ar tilde /say B. Dare or eilm (Ma,m, ar ?. WrItplBCe (ci aril mere a axxmy) ee. Place d Deem (gredc arty one(
awna~a Dem Ha., Nlam. Hospital: Omer:
64 vre. Au ust 30 1946 Flint, MI ^mpadem ^ER /Oulpatienl ^OOA ^Nurskg Hans Residence ^Omer~Spedy:
eb. County of Deam &. Ciy, Bo wp. Deem Bd. Fedpdy Name (tt not inatitutian, give street ant number) 9. Was Decedent of Hispanic Orypn? ~ No ^ Yes 10. Race: Amercan Irlden, Black, While, ek.
(If yes, seedy Cuban. (Spedty)
Cumberland South Middleton 106 W. S tin ills Road Mezicen,PUertoRican,em.)
11. DepedeM's Usual lion Kind d wale done d most of life. Do not male retke0 12. Wee Decedent ever in me 13. Decedent's Eduwtbn (Specify only hgheat grade completed) 14. Martel Se1ue: Married, Never Marred, 15. Surviving Spouse (If w6e, qva maiden dame)
Knd d Work Kind d Bueireas / Im
t U.S. Amletl Forces? Elemenkry / SecoMary (0-t2) College (1> a 5a) Wxlowed, DNOnxxl (Specify)
Married Everett Cha
el
ar
.
Guidance Instructor Governmen pp
e
^vea ~]NO 12
18. Decedent's Mdfirg Adtlress (Street, ary / rown, skk, zip ~)
106 w. Springville Road Dacedam's Did Decedent
,yp.^va, tu.edro s,-N~ld, ~~-.... Tvq.
adaal Residence ,ya. State PA
Boiling Springs, PA 17007 p
tro.cwny Cumberland tTd.^NO, Decedent Livetl within
Actual Lilnils d city / Baro
18. Famer's Name (First midda, km, su6N)
James Curp t9. Homer's Name (Flst midde, maiden surname)
EllaJean Hart
2oa. Inrorlmm'a Name (type / Prm) lob. mfamalrs Maifinp address (street, dry /town, mere, aP axle)
Everett Chappelear 106 W. Springville Road, Boiling Springs, PA 17007
21 e. Mematl d Duposilion ! ^ Cremetian ^ Donation 216. Dare d Dispoaitian (Math, day, Year) 21c. Plea d Dispmifion (Nmne d cemetery, aematorY a Dena place) 21d. location (City /roan. male, xip code)
® Burial g] Removal Irom State ~ Wa damstlon or DarUon AumlorlxM
^ Opbr.Sp,p . IEnrmneNCaonert ^vea^Np July 19, 2011 Duncan Falls Cemetery Duncan Falls, OH
229. sknanxe I service Ucensee ( sing as each) z2b. Utwnse Number 22p. Name aril adare~ m Fadtiy Ho man-Roth Funeral Home & Crematory
_ - 138504 219 North Hanover Street Carlisle PA 1701
C venal carolyirg 23a. Tome Beal of my knowledge, seam alxurred at 6a time, dale ant pkce skied. ISgnarore and atle) 23b. License Number 23c. Date signed (Homo, der, year)
physician k nil eveikNe al ame d deem to
tamly cause a deem.
~ Items 2426 mum ce mngmetl by person 24. Time d Death 26. Dale Prmaulxxfd Deed (Mash, day, year) 26. Was Casa Referred ro Medal Examiner /Coroner for a Reason qua man Cremation or Donation?
wholxonounceadeam. A rx 11:00 A:" Jul 14 2011 tea ^No
CAUSE OF DEATH (See InatnsoUona and examples) r Appmximete'eiervd: Pan II: Enter Omer ' 28. Dd Tobacco Use CamaWe to Daam?
Item 27. Pan I: Enter mechain d evema - daeasas, injures, a canplicetions - met decfiy paused th deem. DO NOT enkr tertninel everts axis as celdac anew, r poser ro Deem bd trot ImuNrg h me wtlenying cause given ro Ped l ^ Yea ^ Prabebty
respirarory artem, a ventriadar 60mktion whMW mlonkg the etiology. Lint aiy ale cause m each Ilne. ^ No ^ Unloavm
aAMEgaTE CAUSE IFirel dseasa a - I
anddim resdangn m) _). a. Occlusive Coronary Artery Disease ~
Hyperlipidemia 29. If Female:
i
^
Due to (a ac a consequence oQ: Nil plegnent wah
n Irani year
^ Pregnant al time d death
$eWentkRy Ibi Nnldtiom, A any, b.
lead~g ro me ceuse Fated on tlce a.
UNDERLYING CAUSE I)ve to (or as a consequence oQ:
E ^ Na pregront bd pregnam wimin 42 Gays
raer me
(dsease a roW mat idtimetl Ifle p
~ al deem
n deem) LAST.
events resultin9
O
ro
Q ^ pregnant hd pregmnt /3 days ro 1 year
(or as a consequelroe o
:
ue
d. ^ Uranown 6 pregnant wIIMn dro past year
30e. Wes an Adopay 30b. Ware Aulapsy FlMir~ 31. Heenan d beam 32e. Dek d Injury (MOmh, day, Year) 32b. Describe How Injury Occurted 32c. Place d Injury Fknne, Farm, Street Feclay,
Performed? Avaikda Prot to Compldipn
d Ceum d Deem?
~ Netixal ^ Homicide ~ BdMm9~ ~~ (FYI
~ ^ Aaident ^ Pendag Invastigetron 32d. T d Injury 32a. Injay al Wolk7 32f. H Treraportatron Injury (Specfy) 32g. Location d Injury (Slrem, city /town. mete)
No
^ Yes l
"'C ^ Yes ^ Na
^ Suidde ^ CaAd Na he Detemuned ^ ~
^ Yes ^ Dryer /Operator ^ Passenger ^Pedestmn
M ^gAer' Spea'y:
33a. Certifier (aleck mly are) 33b. Signenxa and
• CarllfYln9 phyekixn (Phyaxan camfmg ~aee d seam wren andha pnyalaan lwe "a"'"'ped deem and ampleled rani z3)
Ham opelrrred dw to mr eweye)eM mearru stale~-------------------------------- ^
To lM txxtdmy krwwkdge - Chief D e tit Co r one r
,
• Promuneing ant canXldnp phyekkn (PAYmden tom pnmwxilg deem end cenlNirg b cause d death)
^
' 33c. license Number 33d. Date Sp M (Monet, day, Yom)
_ _ _ _ _. _
aues(s) end memtx ere staled, _ _ _. _ _ _ _ _ _
To the beet d my knovAWge, de.m Ixzurted el the time, dsle, xld plea, end due to tM
•
C 1 2 1 1
ilirisso' n eM / a inveslKplbn, in my apinkn~ tlaetll aeursed m the Uma, dsta• aril place, and due to tM pauee(a) and manner as etaML
bn ok t a w y~. d Who red Cause d Dapm ~em pl Tme / PnM
""~a~tfiew ~P Doer, l.Cl eL Lepputy Coroner
nt D'
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, day
year)
36: ale Rletl (MOnm Suite ~~1
6375 Basehore Road
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Mechanicsbur
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17050
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Dispositron Perms No. t ) VL l `P 1 ~tJ
LAST WILL AND TESTAMENT
I, DONNA J. CHAPPELEAR, of South Middleton Township, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
;,_-,
1. I direct my Executor to pay all of my debts, funeral and administrati~n~penses 'as -~
~:, ~--~=
soon as maybe done conveniently after my decease. ~~rn ~-
cv <~~.- `,1~_~,
cn ~
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2. I authorize and empower my Executor to sell any realty owned by me at ~y~eath
and ' ~ - ; '-'
`" o
,
~~,
not specifically devised herein, at either public or private sale, and to give good and sufficient
deeds therefor, in fee simple, as I could do if living.
3. I devise and bequeath all of my estate of every nature and wherever situate to my
husband, EVERETT E. CHAPPELEAR, providing he shall survive me by sixty (60) days.
4. Should the gift in Paragraph No. 3 not take effect, I devise and bequeath all of my
estate of every nature and wherever situate to my son, ANTHONY J. EVANS, absolutely.
5. I nominate and appoint EVERETT E. CHAPPELEAR to be the Executor of this my
Last Will and Testament; he is to serve as such without bond. Should he die before my death,
1
renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I
nominate and appoint ANTHONY J. EVANS as substitute Executor, also to serve as such
without bond, with the same powers as are given herein to my Executor.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 1st day of May,
2003.
(SEAL)
DONNA J HAPPE R
Signed, sealed, published and declared by DONNA J. CHAPPELEAR, the above-
named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her
request, in her presence and in the presence of each other have subscribed our names as
witnesses hereto.
2
ACgNOWLEDGEMENT AND AFFIDAVIT
WE, DONNA J. CHAPPELEAR, SHARON L. SCHWALM and MARTHA L.
NOEL, the testatrix and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testatrix signed and executed the instrument as her last will and that she had signed willingly, and
that she executed it as her free and voluntary act for the purpose herein expressed, and that each
of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that
to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of
sound mind and under no constraint or undue influence.
DONNA CHAPPE AR
SHARON L. SCHWALM
M THA L. NOEL
COMMONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by DONNA J. CHAPPELEAR, the
testatrix, and subscribed and sworn to before me by SHARON L. SCHWALM and MARTHA
L. NOEL, witnesses, this 1st day of May, 2003.
,. ~
C~-~;C~_-.__
~-
Public
', Not al 3ea1
Roger `i3: 'in, Notary Ptibl€c
Carlisle Boro, Cumberland Couniy
My Commission Expires Oct. 3, 2004
Member, Penns~lvania,4sseciaTion oiNotaries