HomeMy WebLinkAbout08-23-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WII~LS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of Nancy L. Moose
a/k/a:
a/k/a:
a/k/a:
SS NO: 209-28-8541
(Month, Day, Year of death)
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as
applicable:
O 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 6/24/2002 and codicil(s) dated
n/a
(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): n/a
^ 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:
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USE ADDITIONAL SHEETS IF
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THIS SECTION MUST BE COMPLETED: ~-~ ``- - ' :~
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Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or_~rincipal reence`='"'
At 821 Greenspring Road, Newville, North Newton Township 17241 r.:,
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then 73 years of age, died 7/29/2011 at Newville, PA
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
Deceased ESTATE NO: 21- ~ ~ ' ®f~
(City and State where death occurred)
All personal property $ 5,000.00
Personal property in Pennsylvania $
Personal property in County $
Total Estimated Value $ 5,000.00
Location of Real Estate in Pennsylvania: (Provide full address if possible.) n/a
Signature(s)
Name(s) & Mailing Addressfecl
- ~ .--,
Gloria Ann Anderson
810 Greenspring Road
Newville, PA 17241
Interim Form RW_~2 rPVice~i 17 7F. 1(1 tiv ('nmhnrlnnA (~,...s....e«.1:.... ,.,.~:.._ V_. ~t_ n___~
-------------_ ~.,_...., ,..........5 .,.....,...,, u.., ~.,.,u~ ~ Page 1 of 2
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
before me this c~ ~~ day of
For the Register
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DECREE OF PROBATE AND GRANT OF LETTERS
Estate of Nancy L. Moose ,Deceased File Number: 21- ~_- ~ g
AND NOW, this ~ ay of ~~~~ , in consideration of the Petition on
the reverse side hereon, satisfactory proof ha 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.)
Gloria Ann Anderson
in
the above estate and that instruments(s) dated 6/24/2002 described in the petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.
a
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Glenda Farner Strasbaug ~ yL
Register of Wills
FEES:
Letters ....................$ ~~, ~'~
Will ........................ 1~.c~C'
Codicil(s) .............. .
(~) Short Certificates ~. C~~
( )Renunciations.......
Bond ............................
Other ............................
.................................
.................................
Automation FEE......... 5.00
JCS FEE ................... 23.50
~~•~~
Atty's Signature
PRINTED Name: Bradley L. Griffie, Esq.
Supreme Court ID No.: 34349
Address: Griffie & Associates, 200 N. Hanover St
Carlisle, PA 17013
Phone: (717) 243-5551
FaX: (717) 243-5063
Signature of Counsel Required to Enter Appearance
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 oft
105.805 REV (01/071
.~~1 ~~ a~~~ 1
LOCAL REGISTRAR'S CERTIFICATION OF DEA
WARNING: It is illegal to duplicate this copy !~ hotostat TI""I
Y p or photograph.
Fee for this certificate, $6.00
P 1772740Q
Certification Number
This is to certify that Che information here given i~
correctly copied from an original Certificate of Deatl
duly filed with me as Local Registrar. The origins
certificate will be forwarded to the State Vital
Records Office for permanent filing.
~ AU 1 2011
Local Registrar
Date Issued
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TYPE /PRINT IN
H1p5.143 REV 11/1008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
~`ac"'"" CERTIFICATE OF DEATH
(See instructions and examples on reverse)
1. Name of Decedent (First, middle, last, six) STATE FILE NUMBER
Nancy L . Moose 2. sax 3. Social Security Number 4. Date of Death (Month, day, year)
5. Age (Last BiMdey) Under 1 r under 1 da 8. Date of BIM Month, as r 7. lace G and state a torsi f counm a 1 ega p~~ 2~ 9 c~2 8 ~ 8 5 41 J u 1 y 2 9 , 2 011
7 3 '~"~ Days Hours Miwtea
• 2/3/1938 Hospital: Other. Daughters
Yom. Newville PA T~
- ~~ ~tty " Dgro Bc. Ciry, Born, T of Death ^ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Hans ^ Residence i~ I gher - Speciy: H o m e
~ ,~ ib. FaciNty Name (If not InstiNBon, give sheet and number) 9. Wee Decedent of Hispanic Orfginl g] No
Cumber 1 a n d North Newton 810 Green Spring Road (8 Yes, speciy Cuban, ^ Yes 10. Race: Amedgn Indan, Bledc, White, etc.
Mexican, Puerto Rican, etc.) (~~
• 11. Decedents uaud tion Kind of work date du ' mgt of Ble. Do not state retI 12. Wes Decedent ever In the 13. Decedent's Edugtlon (Specify only highest reds whit e
Kind °' W0~ KkW of Buslrtese /Industry U.S. Armed Forces? g ~~1e~ 14• ~re~~ ,Never McMed, 15. Sundvhtg Spouse (II w8e, give maiden name)
Laborer Canning factor E'~n'~" / ry (a12) college (1-4 a 5+) rsP•«/rl -
i6. Dtlgdenrs Meiling Address (street, city/town, state, 'coda) ~~ Yes ®No 1 2 w .
8 21 Green Spring K o a d Actual Reaiaertce , 7a• ste,e P A ~ M
Newville PA 17241 L~eMa L~ North Newton
Cumber 1 a n d Township? ' 7a' Yes, Decedent Lived m
17b. County 17d. ^ No, Decedent Lived within Twp
18. Father's Name (Fast ntidde, last, suffix) Actual Limits of City/Boro
19. MoMer's Name (First, middle, maiden tumeme)
Dean Lehman Vera Fa Swartz
20a. Infomterd's Name (Type /Print)
G 1 o r i a Anderson ~ Inlonnanra Melling aadress (street, ~, ! ~„'' ~1e, np ~)
z,a.MemodorDlspog;tla, 810 Green Spring Rd. Newville, PA 17241
w° • r ^ Cremation ^ Donation 21 b. Date of Disposition (Month, day, Year) 21 Place o
9ralel ^ Removal from State r Wp Crernatlort or Donetlon AufhorleW Nepotitbn (Name of gmeNry, crerrretory or other ace) 21d ogtlon1City /to~~ state,
^ ~- ' byMedlcall:xamlrlar/CororNr? 8/3/2011 ~um~erland Valley Memorial ~arllSle ~~) 17013
^ Yes^ No
• 22a Signature (a ec8ng as such) 22b. License Number
22c. Name end Address Of Fad
• '~~ FD 13895 L ~ Egger Funeral Home Inc
Complete items 23ec ony when certifying best at my knowledge, deem occurred at the Bme, eats and place stated. 1
PhY•~an ie rat evail~le at time of death ro (SlgnaWre and tltle) 23b. License Number ign•d (Month, der, Year)
certMY goes of death. - 23c.^D~ate s Q A 1
~ 24-28 moat be completed by perean 24. Thee of Death 25. Date Pronanced (Month, day, year) • ` - ' V ~ J ci 0 S~ L J 'LC..~ p~ r ~ li i tl
~ Prawunces death. ~ ~ ~ M. 28. Was Case Referred to Medal Examiner / Corener la a Reason r than Crematbn or Donation?
l ~ C,I j 1 ^ Yes ~ No
Item 27. Pert I: Emer the 1~ of evrrrrts - AUSE OF DEATH (See Instruetione and exempt
diseases' ayunes, a contpkcatxxre - that dretdly caused the death. DO NOT r terminal events such as cardiac arrest, ~ Approximate Interval: Part II: Enter other 28. Did Tobaaro Uee Contribufe to Death?
respiretory arrest, a ventricular fibdilation w8hout slgwing the etblogy. List ony one cause on each line, r Onset to Death bW not resultlng in the undedying cause given in Part I. ^ Yes ^ P
IMMEQUITE CAUSE Fkrel disease or ///- ~
oortdilron resultlng in beam) -~ a. ~ "!' ~,~ r ~ ~~ ^ No nkrawn
Due to (or as a consequence of). 4 ~~~ ~ ~^l i 29. rIl~Fema~
bagy hst oonditlorrs, A any, r I{d'Not pregnant wi8wn past year
to the cause Bs1ed on fine a. b' r l~ ' v
Eder UNDERLYM4G CAUSE Due to (or as a consequence o : ~ ^ Pregnant al time of death
(dicaase a injury that klimated the ~ r ^ Not ~
events resu8hg in death) LAST. c ~ Pregnant. but pregnant within 42 de
Due to (or as a consequerxxi of): r ~ ~Q~ on ~ ~ ~ of deem
• d. i ^ Not pregnertt, but pregnant 43 days ro 1 year
before death
30a. was an autopsy ' ^ Unknown e
Autopsy Fxxfegs 31. Men of Death pregnant within the past year
Perfomted? AveAable Prior ro Completion 32a. Date of Injury (Month, day, Year) 32b. Describe Fbw Injury Occurred
of Cause of Death? Natural ^ Homidde 32c. Place of Injury: Home, Fenn. Street, Factory,
OBke Buiktlng, etc. (SpeciyJ
^ Yea No ^ Yes ^ No ^ Accident ^ Pendng Inveatge8on 32d. Time of Injury 32e, injury a! Work? 32f. II Trensportatlon Injury (SpecilyJ
^ Suiade ^ Cook Not be Determined M ^ Yea ^ No ^ Drwer/ Opereta ^ Passenger ^ Pedestrian ~ Logtbn of injury (Street, city /town, state)
33a. Certp(er (rlreck only one) Otller - SpeG/y.•
• ~ fMY•klah (PhYdcian grfilying reuse of death when arather physician has prorxwrxxrd death and 33b. Signatu Tkk
To the bsN of my laroarNdgs, death ocarrad dos to tM gust(s) and manner a stated _ _ _ _ - Meted item 23) ^ - , _- ni
• Pr°"°uneMpuMngPMsiden ---------------------------- ~/
To 1M best of (Phys~en both P10f ~''~ ~M and certliying ro caux of death) . Liten Nu
my krawNdge, dseM occurred H H+a Nme, data, and place, end due ro eM gues(s) and manner es stated- _ _ _ _ _ n 33d. Dale S rtad ( onm, day, year)
u, MedkalExamtnar/caron.r --------- ~ •JG ~ 1 Z.rrl1
w Cm 1M besb Of axamMatlon and / a InvesBgetron, in my oplnbn, death ogurred at the time, date, end - - -
° pkg, and due to the gust(s) and manner as statatl_ ^ 34. Name and Address of P
o ~ Re9Lntrer' re ~ L _~„~ (~~ n~Who CarWleted Cause of Death (Item 27) Type Pdnt
~ - the 1 O,~C~C ',~' ~ I ( ' ,~ I O I Date FNed (MaMh, deY, Yead J ~ rF-~/ S
Dispositlon Permit No.t