HomeMy WebLinkAbout08-11-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate Of MAY I. BUTLER
a/k/a:
a/k/a:
a/k/a:
Deceased ESTATE NO: 21-
SS NO: 201-18-0410
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 also)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters Testamentary under
the last Will of the above-named Decedent, dated 5/27/2009 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(g): None
^ 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 (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:-
N9me Address Relat~nship to Decedent
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L?SE ADDITIONAL SHEETS IF NECESSARY -~~~ ~ '--'
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THIS SECTION MUST BE COMPLETED: ,~ ---t ~ : r ~-- • '~"
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal r~idenc~~'
At 1513 Shirley Avenue, Carlisle, PA 17013, Borough of Carlisle
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then $~ years of age, died
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
8/2/2011 at
Carlisle, PA
(Month, Day, Year of death) (City and State where death occurred)
All personal property $ 25,000.00
Personal property in Pennsylvania $
Personal property in County $
$ o.oo
Total Estimated Value $ 25,000.00
Location of Real Estate in Pennsylvania: (Provide full address if possible.) N/A
Signature(s) Name(s) & Mailing Address(es)
n! Diane M. Shunk, 808 Huckleberry Rd., New Bloomfield, PA 17068
Interim Form RW-02 revised 1.2.26.10 by Cumberland County pending action by the Court Page 1 of 2
OATH OF PERSONAL REPRESENTATIVE '?~ ~ ~~ c~ ~.~ {
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Commonwealth of Penns lvania ~ m .n ~ ~
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The Petitioner(s) herein named swear or affirm that the statements in the foregoing Petition are true ~d -~~
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
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e me this ~~ ~h d y of
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or the. Register
DECREE OF PROBATE AND GRANT OF LETTERS
Estate of May I. Butler ,Deceased File Number: 21-_ , -
AND NOW, this 11th day of August, 2011 , in consideration of the Petition on
the reverse side hereon, satisfactory proof having 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.)
Diane M. Shunk In
the above estate and that instruments(s) dated 5/27/2009 described in the petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. ~
Glenda r'arner~t
Register of Wills
FEES• / Signature of Counsel
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Letters .................... $
Will ~ ~ Atty's Signature
to
C ~ icil(s) ...............
( )Short Certificates PRINTED Name: Andrew H. Shaw
( )Renunciations....... Supreme Court ID No.: 87371
Bond ............................
Other ............................. Address:
Automation FEE......... 5.00
JCS FEE ................... 23.50 Phone:
TOTAL ................$ //9.~0
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200 S. Spring Garden Street, Suite 11
Carlisle, PA 17013
717-2.43-7135
717-243-7872
Interim Form RW-02 revised 1.2.26.10 by Cumberland County pending action by the Court Page 2 of 2
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HIIh.SO~ hE:A~ Illl!lr'r •
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LOCAL REGISTRAR'S CERTIFICATION ,C)F DEAT~F~
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 1777468
Certification Number
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H10S143 REV 1112006
TYPE /PRINT IN
PERMANENT
BLACK INK
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
/See Instructlons and examples on reverse) STATE FILE NUMBER
1. Name of Decedent (Frst, noddle, last. suffix) 2. Sex
F
male 3. Social Secudy Number
0410
18
201 4. Date of Death (Month, day, Year)
August 2, 2011
May I. Butler e _
.
5. Age (Lest airtfxtay) Under 1 ar Under 1 da 6. Date of Birth Month de r 7. Ci and state «rorei ccun Be. Place of DeaM Check on one
Other
.
~~ ~ Hours twnMee Hospital:
87 Dec. 2, 1923 ~ Carlisle, PA ^ other-specify.
^ Inpatient ^ ER / putpatlent ^ DOA ^ Nursing Home ~ Residerae
Yrs.
~„ty d Death 8c. City, Boro' Twp. of Death Bd. Fedl'Ay Name (If not fnstttulion, ghre street and number) 9. Was Decedent of Hlspenic Origin? [~ NO ^ Yes 10. Race: American Irxien, Bledc, White, etc.
gb
(s0B`~
.
White
• Ctunberland Carlisle 1513 Shirley Ave. , Carlisle ("'~'~ ~''''3aben'
Mexican, Puerk Rican, etc.)
peaderrrs Usud fion Kind of work done
11 roost of Nfe. Do rat state re6 12. Wes Decedent ever in the 13. Decedent's Educaporr (Specify ony highest grede completed) 14. Marital Status: Monied, Never Herded,
Divorced (Specify)
Widowed 15. Survivirg Spouse (If wpe, give maiden name)
.
Kind of Work Kind of 8uslnessltrdustry U.S. Amred Forces? Elementary 1 Secondary (0.12) College (1-4 or 5+) ,
Grinder stet Plant ^ Y•• CKr4e 8 Divorced
• 1s. Decadence pAeiNrg Address (street, city /town, state, zip code)
1513 Shirley Ave . Decedenrs Did Decedent
Actual Reslderae t 7a. state n ~• in a 1 ~a r^~ Yea, Decedent Lived in TN'P
T«mshipv
C
! 7d. yy No, Decedent Lived within
umberland
f Carlisle cdy/e«m
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- Carlisle, PA 17013 .
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18. Fadrefs Name (First, middle, last, suffix) 18. Mothefs Name (Flret, midde, rreiden sumertre)
Orshall
c
Fl
S. Lero Calaman oren
e
20a. hdomreM's Name (Type I Print) 20b. IMomrenrs Mani Address (Street, ' I town, elate, zip code)
New Bloomfield, PA 17068
~2oad
808 Huck~eberr
Diane M. Shunk y
,
21a. Method of Disposition r ^ Cremetkn ^ Donetlon 21 b. Date of Dispositon lMens+, daY, Year)
2011
5
A 21c. Place of Dispositbn (Name of cemetery, crematory or other place)
Ctunberland Valley Memorial 21d. LoafMn (Cltylrown, state, zqt code)
PA 17013
Aisle
~ Buda, ^ Rermwalfr«mstate ~ w.acrematlon«DonadonArxlwrized
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No
1
Yes
^ Otltar _ ~ r by Nedlesl EzeminerlCoroner
• 22a S'grenr vrerel ectlng es such) 22b. Llanse Number 22c. Name and Address of Faclllty Hof fman-Roth Funeral Home & Crematory
138504
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Complete dame fy when arplying 23a. To the best of my em ocamed at the ~me, date a place stated. (Signature and title) 23b. License Number 23c. Date Signed (Month, day, year)
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physiraan Is vapeble at 6me of death to
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y cause o
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Date Praauaed Dead ( ro, day, year) 26. Wes Ceae Refened to Medk:sl Examiner !Coroner f« a Reasor Other than Cremedon « tbnation?
th 25
f D
• 24
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ea
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dams 24-26 must be cartpbled by Person /~ ~ ^ Yes o
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• who prorarrau dutlr. ~)
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CAUSE OF DEATH ( Instructlons end axq Ise) r Approximate interval:
Onset to Deets
vents such es ardec anst
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DO .
Part II: Eller other
but rat resuldrrg in the underlying cause given In Part I.
26. Did Tobaxo Use Cantr~ute to Death?
^ Yes ^ Probably
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na
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.
ttam 27. Part I: EMx the cirekr M events - diaeues, injuries, or complica6onc - that drectly caused the deat
respiratory arrest, or ventricular fiMille6an without ahowiwing fire etldogy. Lint only one cause on each line. r ^ No ^ Unkrawn
IMMEDIATE CAUSE ~~FFiIrral disease « V~ ~ ~.,/) (/~,., r I
corxAtion resulwrg m death)
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J KM C 29. It Female:
^ Not pregnant within peat year
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Duero (« as a conaequerxxr a): ~
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Pregnant at time of death
nant within 42 days
but
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^ N
ary, b, ;
Saquenyegy pat mrMMiau, i
bUImERLYM4G CAUSE a Due to (or as a consequerra oQ: r
7rat kridated the
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(dhease « inlm p
g
~Pregnen
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but pregnant 43 days to 1 year
^ Not pregnant
c
Y
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events res n death LAST. Due to (« as a consequence op: ~ ,
before dull
i ^ Unknown if pregnant within the pest year
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30a. Was en Auropay 30b. Were Autopsy Findkgs 31. Manner of Deady 32a. Date of Injury (Month, day, year) 32b. Ducdbe How Irdury Occrrrted 32c. Place of Injury: Homo, Ferro, Street, Facrory,
Office Buiklvrg, ea. (SpeciryJ
Porformad? Available Pd« ro Completion ~ turel ^ Homicide
of Cause of putlr? Inveatiyetbn
^ Accident ^ Perrdk 32d. Time of Injury 32e. Injury at Work? 321. If Transportation Injury (Specify) 32g. Location of injury (Street, city I town, state)
^ Yes ~No ^ Yes ^ No g ^ Yes ^ No ~ DrlverlOperaror ^ Peesenger CI Padeahian
^ Stdcide ^ Could Not be Delennkred M. ^ Otlrer - Speclly.•
i
~ ~~ ( ~ ~) 33b. Signature and Tlpe of Certlper
• t~Yln9 physleWt (Physician arplyirrg cause of deadr when anodrer physician has pronounced death and completed Item 23) ~
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To 1M best of my kmwbdge, death oaurred dos to 1M ause(s) urd menrrx u stehd _ _ _ _ _ _ _ _
------------------------- ,.
33c. Llanse Number
33d. Data ed ( y, Year)
• Pronowaing sod artKying physlelan (Physician both pnxaunang death and ardMn9 to cause of deaM)
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To the best of my knowledge, death xcuned at the time, date, end place. end due to the cause(s) and manner ustated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ L Z ~ ~, ~
• MedialExamhbrlCoroner
to the ause(a) s«1 manner as steted_ ^
e
On tM buts of snmMetfon arts / or Invutlgetbn, In my opMlon, death occurred at the tlms, date, and pka, and du
34. Name and Address of Person Who Completed Cause of Death (Item 27) Type I Print
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35. Registrar's ors! Died\' I~ ~ ~ I I ~ I V I
~ ~ rt"!' , r~~~ s,~~ .Date Filed ( ro deb 1 Ir)
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This is to certify that she inft>rmation here given ~s
correctly copied from an original Certific;~te of Death
duly filed with me as Local t2egistrar. The original
certificate will he forwarced tc~> the State Vital
Records Oft~ice for perlnanejlt filing.
L~acv~ ~~ 2011
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Local F:egistrar ~ Date Issued
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Disposition Permit No. ~ ~ L ~ ~~~