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Home My WebLink About08-16-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNT.', PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTE'~RS Estate of Randall G. Dellinger a/k/a: R. G. Dellinger a/k/a: a/k/a: SS NO: 201-46-9806 Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as applicable: ' D A. Probate and Grant of Letters Testamentary or ~ Administration c.t.a., or d.b.n.c.t.a. (come Part C a~"so) .~ and aver that Petitioner(s) is/are entitled to the aforementioned Letters --°~ -"7 - _ _ _ 5/23/1989 arld colicil s dated 1/ ~~ '--~ the last Will of the above-named Decedent, dated O -~ ~~-~--~ ~ ?~~ (State relevant circumstances, e.g. renunciation, death of executor, etc.) - % C7 " ~ '~- Exce t as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after .;~e~tion of t ~ p instruments offered for probate; was not the victim of a ktlling, was never adjudicated an incapacitated per , aid was nat~ a r~ ~ in divorce roceedin at the time of death wherein grounds for divorce had been esta .fished as del~ed in`'~ party to a pend g p g 23 Pa. C.S.A. § 3323(8): ^ 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 (1f 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 grou~ids for divorce had been established as provided in 23 Pa. C.S.A. § 3323(8), except as follows: :nt THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At 301 Chickory Circle, Mechanicsburg, Pa 17050, Silver Spring Township (Street address with Post Office and Zip Code, Mumcipaltty: Township, Borough, City) Decedent, then 55 years of age, died 7/26/2011 at Mechanicsburg, PA (Month, Day, Year of death) (City and State wheve death occurred) Estimated value of decedent's property at death: If domiciled in PA If not domiciled in PA If not domiciled in PA Value of Real Estate in Pennsylvania Location of Real Estate in Pennsylvania: (Provide full address if possible.) Interim Form RV4'-02 revised 12.26.10 by Cumberland County pending action by the Court Deceased ESTATE NO._21~1=., All personal property Personal property in Pennsylvania Personal property in County Total Estimated Value $ 5,000.00 $ 5,000.00 Page I of 2 USE ADDITIONAL SH~;~t~, 1r Nr,c:~~~~rcr Signature(s) Name(s) & Mailing Address(es) 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 ar~ltrus ofthe correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representa ( ) Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed 2 ~ ~h ,U be e me this a ~ of ~ :~_ _ ~ ~.~ <~~ ~ ~; :~ t .-~ Z ~...~ ~:.~ -,. e R g ster ~ ~. ~" ~'` -, OF PROBATE AND GRANT OF LETTERS -; ~ ~`~ DECREE ~ Estate of Randal G. Dellin er a k a R. G. ellin t da of AND NOW, this ~ y the reverse side hereon, satisfactory proof having of Administration ~~ ~ 1 -~0~ ~ g . Deceased File Number: 21- ~:~:~ (' , in consideration of the Petition on 1 presented before me, IT IS DECREED that Letters are heY•eby granted to: :ate ~-,- r+_ ,, , ~ E....~. ~ ::~ r-; ,._-, .. , ...., _ ---, ~~ ~~ ~a ~.~ x Testamentary (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) Gail B. Dellinger in the above estate and that instruments(s) dated 5 / 2 3/ 19 89 & 1/ 3 0 / 19 9 8 described in the petition be admitted to probate and filed of record as the last Will and Codicil(s) f Decedent. da Farner Strasbaugh ~~ ~ - e ister of Wills ,~~ W~ t g c~~~ FEES: Letters ....................$ 30.00 Will ....................... 15.00 Codicil(s) ............... 15.00 (6) Short Certificates 24.00 ( )Renunciations....... Bond ............................ Other ............................ Automation FEE........ 5.00 JCS FEE .................. 23.50 TOTAL ................$ 112.50 Signature of Counsel Required~e Appearance Atty's Signature PRINTED Name: Robert C. Sardis Supreme Court ID No.:_21458 Address: Phone: Fax: 26 West High Street Carlisle, PA 17013 717-243-6222 717-243-6486 Page 2 of 2 Interim Form RVJ-02 revised 12.26.10 by Cumberland County pending action by the Court _ r-- H105.K05 REV (I~l ~lrt -" 1 ~~~++ LOCAL REGISTRAR'S CERTIFICATION a-F DEATH WVARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 17644555 Certification Number This is to certify that the information 1-ere given is correctl~/ copied from an original Certifil:ate of Death duly filed with me as Local Registrar. The original certifiaite will lie forwarded to the State Vital Records Office for permanent filing. i ' /~ '~ ~ ~ ~' I ~ I,t/ ~ ~ Local Registrar Da'_e Issued C"') ~:~: __ _ ^.. ._..._ .~.. -~ ~. ---" _.. _ _;,, _. r) ~ .r r ,_._.: '' i ~"t _. r r ,,... .,,,-, _ 11 _ +.~'`... t~ ~ C~1 ` ` ~-7 CJ ~ ~ ~`: ~: ~ :t • r- --- i" I" t ~, COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS H,os.,a4REVnnoo6 CORONER'S CERT1FiCATE OF DEATH TYPE I PRMIT 1N PERMANENT (See instructions and examples on reverse STATE FILE NUMBER gtACK W K 4. Date d Deem (Monet, deY• Year) ~ 3 3-0 7 3 z. sex 3. Sa9a1 Security Number ,.NameaDecedernl~.m~e•~~~'x) Male 201 _ 46 _ 9806 Jul 26, 2011 Randall G De l lie er sa. Place a Deem (check only omr) Under , year Under 1 day 6. Date a Birth (Month, da ,year) 7. Birmplece lGry anti state or caupY) Omer. 5. Age (Last BirHdeY) Hospihl: Moms Days rows MnuMs March 2 2 19 5 6 L~banDn I PA ^ inpatient ^ ER I Outpatient ^ DOA ' ^ Nsing Home ^ Resdenp t 0. Race: American Indian, Bhck Wftite, etc. 5 S Yrs. 9. Was Decedent a Hispanic Origin. ~ ^ ISM 8c. City. Bo wp. f Death 8d. FadAly Name (H not inslitNion. 9h'e ~8et anti number) (If yes, seedy Cubsn, • 80. County of Deem Mexican. Puerto RM;an, etc.) white Cumberland Silver S rin 423 Carmella Drive nadecampeled) ,a.Madhishrus:Marned,NeverMamed, ,6.~„~,;ngsPousaofw~rire.i~e~en^~ne) nqa, d Ale. DO rat state retired 12. Was Decedent ever in the 13. pecedent's Education (Seedy ony l 9 Widowed, Divorced (Speciryl 11. pepdem's Uural lion Kind a work done Kkd a Brsirtese I Irtdustiy U.S. Armed Forces? Elementary I Secondary (0-, 2) College (1-4 or 5+) 11 B . S el SS Knd d Work ~wrny lter CllStr ^ YeS ~ ~ 5+ Did Decedem~n-1Cu IZI~I3agp-r ~^^.•C'^ ry~ .~llyer Spring Twp. 7" p~pent's PA Live in a , 7c. L"~ Yes. Decedera Lived in , ti. Decedent's Mailing Address (Street. city /tam. state. zip code) Actual Residence 17a. State Township? 17d ^ No, DecederA Lived wdhn 301 Chickory Circle ,7b. coDnty CtIInberland AdDaI Limits a ~ I eoro Nyechanicsb PA 17050 ,s 1AoHrra Name (Pest, middle, maiden sumarne) t6. FaHw's Name IFuu. middle, last. sulfa) J~ .Sp3Illlllth Richard N . De111T1CJer Sr . zoo. Infomrenrs Maiing Adaress (Street. cin !town, slate, zp code) 20a. Irdormenre Name (TYce / Penn 301 Chickory Circle, Mechanics , PA 17050 Gail B. Dellinger z,d. t.opuon (cHy! town, afore, vP cede) 27 a. Memod of Disposition ^ cremation ^ Donation 21D. Date d Disposition (Monet, deY. yearl 21c. Place a Disppitiar (Name a cemetery, crematory ar odNr Place) NfeChaniCSbUrg, PA °w • C~ Burial ^ Removal from State ~ McCmearl Eltanm~ ^ Yes ^ No JAY 30, 2011 Gate of Heaven Ceimetery ~' ^ O~ - ~'h z2b. license Ntanber z2c. Name and Amraca a Faddy $ Market Plaza Way zza Signature d Funeral Lbensea la `~'~" ~ FD 011 667 L N1a1peZZ1 Ftiineral Home, a . - 23b. license Number 23a Date Stgned (Monts, day. year) 23a. To the best of my Wwwleclge, deem occurred at the time, date and Die stated. (Signelure and titiel Corrplele Hams 23at Oe+ufYng OhY~n ~ rat time a deem a prey cause d deem. 26. Was Case Referred a Medical Examiner! Coroner for a Reason Omer men Cremation or Donation. 24. Tma of Deem 25. Dale Pnonounpd Deed (Monet, day, Year) es ^ No ~ Hems 2426 must be corrgkted by Pers°n • wta pronoutcea deem. A rX . 5 : 4 5 A . M. Jul 2 6 2011 a rMerr~: pan II: Eller other , ~ 28. °'° Tobacco Use CorMdae ro Deatlt7 CAUSE OF DEATH (Sae Instructions serf examples) n ~°%~t yd ~ ~ipny in da uneBAyky pose given in Part I. ^ Yes ^ Pmbaby mat directly posed the deem. DO NOT amen terminal events such as prdiac anesl ~ Onset to peam ^ ~ ^ Unknown Hem 27. Part 1 Enter the drain a eveNS - dcseasas, injuries, or cangfipHons' respkatory arrest. or ventriadar fibrillation wHtaul showk+g the e0do9Y. Lrst at1Y one ~e on each Ana. r e r l i 1 d emia ~. n Female: Tf CAUSE Fxrel disease or ~ P V C' S , HYP p ^ Na pregnart witlwt Pest rear ' ^ Pregnant at time d cream l'"~D1A,es„~,gin~eam) ,; a, Nonischemic Cardiomyopat y Duero (or as a consequence ofl n ^ Not pregnant, bul pregnerx wAhn 42 days n SequenNaAy list pnditi0rts, if any. b. r of deem l~aq a the pose bsted an tine a. Duero (or as a consequence al~ r Fsyr $re UNDERLYING CAUSE r ^ Nd pregnarM, bul pregnara 43 days a ,year (disease or k!IwY mat initiated dte c. n before deem m deem) LAST. r evsMS rasrAtirg Due to (or as a consequence of): r ^ lhicnovm Y pregnerH wimkt me past year r ~ d 3'1c. Place d Injtxy Home. Farm. Street, Fedory, 31. Manner of Deem 32a. Date a Injury IMO^m• day Year) 32b. Describe Fbw Injury Occurred Olfice Building, etc. (SpecfHl 30s Was an Auropsy Sob. Were Autopsy Fxt6rgs Performed? Available Prbr to Completion Natural ^ Florrticide of Cause a Deem? 32g. Caption of Irpury (Sheel dY I town, state) ^ Accident ^ Pendsy Investigation 32d. Tme d kqury 32e. Irqury at Work? 321. H Trernportalion Injury (SpedNl ^ y~ IVI ~ ^ Yes ^ No ^ Driven Operator ^ Passenger ^l'ede&nan ~l ^ Yes ^ No ^ Suidde ^ Could Not p Delemtxred M, Omer - Speciy. 33b. Signature anti r 33acertir~er(aadt«ryone) d~,hydcanpletedHem23) Chief Deputy Corona • CartHying PMe~ (PhY~en ~Yi^9 ~e a death when artoHter PhYs~ nos Prone ^ ~ 33d. Date Signed (Mmm. day. Yeal ------------------------ To tllebat a my bav+ledge, dMh xeurrod due to Hr pose(s) and manna n stated - _ - - - - - - 33c. License Number Pmraurieing and prtnYing 1>M~len (PMe~en ~" ~101f d"g dam ~id a `198 a ) J u 1 2 6 , 201 1 ~ To the beet a my kmwkd9e. deem oaurred a< the Hme. date, and Place, a~ due ro tIw ewe(s) end manner as shred.. - - - - - - - - - - - - - - - -' ~+ Msdcal Fxaminer !coroner in my opinion, dam atoned et Hrs tNrre, doh, and place, and due to H+s cawa(e) end manner u shtea_ ~ 3a. Nam.$yd Addr~sf ew°~1":0 one r; ° l+tlHle L T' L e u ty C o r on e r ~ On the besie a examkutfon and 1 or inveatgatlOn, 1Rd L L [7 ° ~ e ( ~ ~~ Mechanice;burg,RPaa~17050e ~~ 0 35. rer' ore ayQ Dst r i ~l i 1 i ~ i .i i -~ i .~u~ • ~ o ~ i - iii/ l) ~`'~~(~ Z Dispositiat PennH No. ~ ~ / / ~~= 5