HomeMy WebLinkAbout08-22-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LET'CERS
Estate of Janet A. Moyer
alk/a:
alk/a:
a/k/a:
SS NO:
166-54-3891
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 C nlso}
and aver that Petitioner(s) is/are entitled to the aforementioned Letters under
5/25/1989 and codicil(s) dated none .
the last Will of the above-named Decedent, 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
(If applicable, enter d.b.n., pendent lite, durante absentia, dmante 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(g~except as follows:
Deceased ESTATE NO: 21-
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Name Address ~ -~._, r-~
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LTSE ADDITIONAL SHEETS IF NECESSARY :A ~~_ ~ ~.~'3 G
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THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence
At 940 Walnut Bottom Road, Carlisle, South Middleton Township, Cumberland County, Pennsylvania
(Street address with Post Oftice and Zip Code, Mumcrpahty: Township, Borough, City)
83 ears of a e died 7/20/2001 at Carlisle, Pennsylvania
Decedent, then y g
(Month, Day, Year of death) (City and State where death occurred)
Estimated value of decedent's property at death: $ ~` / D0.OJ
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 $ ~S 1 ~ 0.00
Location of Real Estate in Pennsylvania: (Provide full address if possible.)
Signature(s)
Name(s) & Mailing ~~ddress(es)
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court
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 andthe
correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) o
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed. and subscribed j , ' ~.-
Gt/
~~da of
be me this _ y
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DECREE OF PROBATE AND GRANT OF LF;TTER~= ~ ~:..
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Estate of Janet A. Moyer ,Deceased File Number: 21-_ '~~'~~ ~ ~. t^ ~~
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da of ~' ( , in consideration of the Pet~rtion on
AND NOW, this y
the reverse side hereon, satisfactory proof havi g been presented before me, IT' IS DECREED that Letters
X Testamentary of Administration are hereby granted to:
(If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) .
William E. Moyer _ , m
the above estate and that instruments(s) dated 5/25/1989 described in the pefiition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.
Glenda Farner Strasbaugh, ~ .. .:~~~~
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Register of Wills
FEES: _
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Letters .................. .
Will .......................
Co icil(s) ............... -~-
( Short Certificates '
( )Renunciations.......
Bond ............................
Automation FEE......... 5.00
JCS FEE .................. 23.50
~ ~~--~s ~
TOTAL ................ $
Signature of Counsel Required to Enter Appearance
- a
Atty's Signature
PRINTED Name: Michael A. Scherer, Esquire
Supreme Court ID No.: 61974
Address: 15- West South Street
Carlisle, Pennsylvania 17013
Phone: (i' 17) 249-6873
Fax: (i' 17) 249-5755
Page 2 of 2
Interim Form RW-02 revised 12.2G.10 by Cumberland County pending action by the Court
RENUNCIATION
REGISTER OF WILLS
Cumberland
COUNTY, PENNSYLVANIA
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Estate of Janet A. Moyer ,Deceased
I, James A. Moyer _, in my capacity/relationship as
(Print Nanre)
son of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
William E. Moyer
~~
(Date)
Executed in Register's Off ce
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form RW-06 rein. 10.13.06
(Si atan-e)
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(Street Address)
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(C'ity, State, Zap)
Executed out of Register's Office
Before the undersigned personally appeared the
parry executing this renunciation and certified
that he or she executed. the renunciation or the
pu oses ated within on this day
of ____-_~ J~ --
tart' Public Zo/ ~
My Commission Expires: ~~ ~9'
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Conunission.)
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~~>'uli~Cra~w • N~YLit/kPgt-
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Ci•isr~` l~ilee Jr„ Notary Public
;3 , ,s 9ny~der County
My ~Ma` ' . _ Feb. 19.2012
Memf~er, F~ennsylvar~la Notaries
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;1115.805 RED U11%0'~ ~_) /'rIR /~~ ~ ~`1
LOCAL REGISTRAR'S CERTIFICATION OF DEA~'~~
WARNING: It is illegal to duplicate this copy by photostat or ~~hotograph.
Fee for this certificate, $6.00
P 1772725
Certification Number
This is to certify that the inf~rrr~(ation ]lure given Is
correctl}' copied from ~ln on final Certifi~~ate of Death
duly filed with me as Local Registrar. The original
certificate will be for~~var~(;d to the State Vital
Records Office for perrr~anE~nt filing.
~''~'' J 2 2'Oti
Local Registrar Date Issued
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H105.143 REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE / PRINt' IN CERTIFICATE OF DEATH
PERIAMIENT
~,~ INK (See Instructions and examples on reverse) STATE FILE NUMBER
2. Sax 3. Sodel Securely Number 4. Date d Desch (Month, deY, Yom)
,. Name d Decedent (Bret, midde, teat auttlx) Female 166 54 _3891 July 20 , 2011
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Janet A. Moyer -
~ Age (~ ghd~y) Under 1 under 1 da s. DaM d Bkm 7. CI end ataro « cou 6a. Plaoe d t7ulh Check une
Dec. 31, 1927 Mechanicsburg, PA HOep'~I' Omar
83 'b"ma Days Noun Meares
Yrs. ^ Inpetlenl ^ ER I OutpedeM ^ DOA ~+Nurakrg Nome ^ ReaWerae ^ Odter • SpaL71Y
9. Wss Decedent M' Hlaperdc Odge? No ^ Yea 10. Race: Artredcan Indian, Blade, Wdro, etc.
~. ~~, d pum 6c. Cely, Bono, Twp, d Death 6d. Faa'elry Name (If not Iradeludon, gNs street and remiber) (If yes, spedly Groan,
Cumberland S. Middleton Zap. ManorCare Health Services ~,~n R,~,,,,,~.) ( White
11. Deaderrys llerxtl Klnd d work done du moat d Ida. Do not state red 12. Wes Decedent ever kt dte 13. Decedem's Edtx;adon (Spectty any niglreat grads twnrpleted) 14. Markel Srotw: Heeled, Never Marded, 15. Surviving spouse (tt wile, give maiden name)
U.S. Amred Forces? Elementary I SeaorMery (0-12) Cortege (1.4 rx 5+) W~'"'~, Dlv«ad (Speclly)
Kell d work Kind d t3uelnees /Industry ldowed
Homemaker Own Home ^ vas ®Fro 10
Decedenra °~ °~'d ,~y~ S . Middleton
16. Decedent's Malelrg Address (Street, sty I town, slate, zip code) Adwl Residence 17a. State PA LNe e e 17c. L_TYes, Decedent lived in Tom'
940 Walnut Bottom Road Cumberland T°wnstnp? 17d.^No,DecedentLivedwithin CitylBoro
Carlisle, PA 17015 "~ ~°""ty Actuallimdsd
16. Famer's Name (Flrsl, middle, last, suffix) lg. Homer's Name (Flret, middle, maiden sumeme) ~~ Hoover
Paul Cline
~''~°"~"t'a "~ ~`'~ / Prm,) Bi 11 Moyer ~~nrA~ters ~~ ~at:'~"is`~e , PA 17015
21b, l>aro d Dlsposltlon (Month, day, year) 21c. Place d Dlopaltbn (Name d rxmerory, crematory « Deter place) 21 d. Location (City I town, slate, zip code)
z,a. Method d asposelbn r ^ Cremation ^ °~'~°° Jul 22 , 2011 Mt . Zion Evangelical Lutheran
C~ audal ^ Removal aom sroro ~ was cr«netbn a Donadort Authorized Y Lewi sherry r PA
^ tx~- br M.dleal ExemhnrfCoroner•! ^ Yes^ No Church Ceme e
22e • d Fug ~~ ~ ~) ~, Liarree Number 22c. Name end Address d Faddty Hof fman-Roth Funeral Home & Crematory
~ 8504
23b. ~~ Number 23c. Daro signed (Honor, day, Y•ar)
• when artifyirg 23a. To dre best d my ,death occurred t dme, derv and stated. (Signature aril tide) ~~ / ~ ~ ~ //
plyeicien ro Made at time d death ro J ` OC/fin
oerdly cease d deem.
24. Time d Death . D Pronounced Dead (Manor, day, Year) 26. Wes Case Relen~eld to Medical Examiner / Coronar for a Reason ` remotion « Donation?
elanre 24-28 mmt be oamplated by Parson ;.y/,~ ~ ~ ( ^ Ye s IGy No
who Praaurw:ea deem. p 3 I V ~- . .
i Approxlmero Interval: Part II: nror other 26. Did Tobacco Use ContrbrAe to Death?
CAUSE OF DEATH (See tractions end exa Ise) r Onset ro Deem but rat reardtlng a me urdedying cause ghren a Pad I. ^ Yes ^ Probsby
drat cawed the deem. DO error el events such as cardiac angst,
Irom 27. Part I: Enter tla chain d eveMS -diseases, eludes, or cwrttptitxlions' dkecdy r ^ No ^ Unknown
respiratory arrest, a veMrirwlar ltbdkation wkttat showing dre elbktgy. LJsI only one caws on each lee.
29. tt Female:
candib«~i resUNhtg m ~~ ~ e. '~Q'~ S ~ ~ ' ^ Not pregnant wime peat year
r
r ^ Pregnant at drtre d deem
Duero (a es a cons wrae d1:.[ ~ r
bt condidorrs, el ern, b, C'y~,c~ S' 1 _ ~ -~ A 1 ~ ~.•~,~ ~ ^ Not pregnant but pregnant within 42 days
Eresb~UNDERLYpNi CAUSE a Duero (a es a eanseq nee ot): ~ ~ of deem
( « ~ ~~ m, , ^ Nol pregnant but pregnant 43 days to 1 year
events reaAdrg~m deem) LAST. °~ Dw to (« as a consequence of): ' berore seam
r
r ^ Unknown it pregned wkttirr me pest year
d. r
32a. Date d Injury (Monet, day, year) 32b. Ducrlbe Flow Injury Occurred 32c. Place d injury: Nome, Fenn, Street Factory,
30e. Wes an AuMpay 30b. Were Autopsy Fexlkgs 31. Manner of Deem OttICe Build'ng, ale. (Speeiyl
Pedomred? Avairobro Prbr b Corrrpletbn ~ Nelurel ^ Homicide
of Cawe d l)aam? Lacatbn of Injury (Street city / own, sroro)
^ Accident ^ Pendng Investigation ~ Tfrtre of Injury 32e. Ir~ury at Work? 321. It Trertsporrotbn Injury (SperJly) ~g~
^ Yes ~ No ^ Yes ^ No ^ Yee ^ No ^ DdverlOperetor ^ Pesae ^ Pedestrian
^ Suicide ^ Coukf Not be Derormeed M. Omer - Specify:
!~ ~/
33e. Certlfier (check ony ana) 33b. SI lure and ~ n
Cartelying Pbyaklm (Physiraan artttykg cave of deem when aramer physician has pronouraed deem end completed Item 23) ~q ~ ~ ~ r
To the but d my Imowladge, deem oaurred dw to the cause(s) end manner n steed _ _ _ _ _ _ _ -' _ -' - - - - -' - -' - -' - - - - - - -' - 1~ 33c. License Nwn 33d. Date Sigrad (Monet, deY, Yaar)
• Prarauncing end uAlMng phyablan (Physician tx>tfl praatsrdng seam end aNrykrg ro caws of sum)
To are but a my lmowMdgs, dudr occurred et the Hme, ~, and ptaa, and aw to db eas(e) and manner as staled- - - - - - - - - - - - - - - - - - ^ (5O (O :~ ~ S L / ~ O / ( 1
• Medlesl Exudrw/Coroner '
On dre hub d axnnlnatbn and / «Inwsdgetbn, In my opinion, rketh occurred N the tlm., dsro, and Plea, and dw to dre ease(s) and manner N etdsd_ 34. Name and Adereee of Person Artro Completed Cauca of Deem (dam 27) Type d
Darryl Guistwite
~ R~"t'~ ~Di~`p"~"~ ~ ~~ I 1 I a I 1 I (~ I ~• ~~(~'~~y~'~ar) 56 Ashton Street, Carlisle, PA 17015
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Disposilbn Pennk No. _