HomeMy WebLinkAbout08-31-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of Arlene A. Eppley
alk/a:
alk/a:
a/k/a:
Deceased ESTATE NO:_21- a~
SS NO: 200-24-1011
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 under
the last Will of the above-named Decedent, dated __ 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(8):
~ 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 anal complete list oi'
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(8), except as follows:
n/a
e~rlrPCC Relationsbiu to Decedent
Linda ~4. Lysle 185 N. Middlesex Road, Carlisle, PA 17013 Daughter
Michael M. Eppley 153 N. Middlesex Road, Carlisle, PA 17013 Son
.--- ~
~.
USA; Alllll l lUl~iAL ~tiL' r. i 7 lr iv L' ~.r.~7Jt~il i
THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family ~
At 153 N Middlesex Road, Carlisle, Middlesex Township, Cumberland County, Pennsylvania 1
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
D d t then $~ ears of age died 7/29/2011 at Hershey, Penn
-~,
~-~~ , - -,
G.. _ -~
residence^-.~- -^-~~.
_µ_ ~ -r"1
ece en , y rr ~
(Month, Day, Year of death) (City and State where death occu ed) - -- `'`~ -i-i
Estimated value of decedent's property at death: ~`~
If domiciled in PA All personal property $ 7,000.00
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 $ 7,000.00
Location of Real Estate in Pennsylvania: (Provide full address if possible.) None
C:nnutnrn(cl
Namc(s) & itiiailin~ Addresses}
~:~ /1 185 N. Middlesex Road, Carlisle PA 17013
r_.,.~.... ~,...., n~x~_m ~o.,~~P,~ t ~ ~~ i n h., C`„mhPrlant~ ('nunfv nendine action by the Court Page 1 of 2
_~~
-~ 'T-
_ ..:. ,./
":..~
is
~~
~ti
OATH OF PERSONAL REPRESENTATIVE > ~ ~w ;----~ ,,..~
~~m ~ ,
Commonwealth of Pennsylvania ~ SS =~- ~'~' `~ __..
County of Cumberland c. ~ ~~ ~ -
.- _~„ i
~.±'~
The Petitioner(s) herein named swear or affirm that the statements in the foregoing Petitio~`are true a ~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
l_~~~-
,~ -~c n
keg~ister
DECREE OF PROBATE AND GRANT OF LETTERS
Estate of Arlene A. E le ,Deceased File Number: 21- ~~-__~I~, L ~
W this ~ da of D~ ~~~ , in consideration of the Petition on
AND NO ~ y
the reverse side hereon, satisfactory proof ha ' been presented before me, IT IS DECREED that Letters
Testamentary x of Administration are hereby granted to:
(If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.)
Linda A. Lysle i _ - _ in
the above estate and that instruments(s) dated describd~ in tbie petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. ~ - ~
,. ~ _
Glenda Farner S rasbaugh; .
Register of Wills ~
FEES:
$ d6
Letters .................. .
Will .......................
Codicil(s) .............. .
(Short Certificates ~
( )Renunciations.......
Bond ............................
Other ............................
Automation FEE........ 5.00
JCS FEE ................... 23.50
TOTAL ................$ 28.50
44 West Main Street
Mechanicsburg PA 17055
717-697-8528
717-697-7681
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 of 2
Signature of Counsel Required to Enter Appearance
i~^
Atty's Signature
PRINTED Name: Keith O. Brenneman
Supreme Court ID No.: 47077
Address:
Phone:
Fax:
_
a ~""
n/,,~/,, k>_~~ ~nlnr, ~ ~ ~~ /~
(, 1
LOCAL REGISTRAR'S CERTIFICATION OF DEA1'F~
WARNING: It is illegal to duplicate this copy by photostat or photograpfl.
=ee for this certificate, $6.00
P 177274~..~
Certification Number
'This is to certify th~lt tht~ inf•o~-mation hr;re ~.iven is
correctly copied from stn Original Ctrtif•icate of'Death
duly filed with me as Local Registrar. The t)riginal
certificate will he forv~arded to thr' Statr~ Vital
Records Office for perrn~tnent filing.
_.
~`~t+a~c~~,~,~t~l~~~ A 2011
Local Registrar Date Isst)ed
~~
~~
~ ~ rte--'-,)
.;i ~ '1 1
a
'.
N
,~
H105.144 REV 11n006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
~T" CORONER'S CERTIFICATE OF DEATH
BLACK INK ISAP in4fn/MMnA Aaff4 AYAMeetAA AA 1'AVAt'.A71 STATE FILE NUMBER
W
0
~~
~~
:..~..
~~
•w..
..,,~„~
. w'n.
A'.:
~~~
.7 t~~
,
'7";
r --•
~..!~
T
1. Name d Decades (Prat. mldde, bsl, srAkz) 2. Sex 3. Sodd SecyxKy Number 4. Date d DrM (I AoMh, day, yrr)
Arlene A, le F1~c)ale 200 - 24 - 1011 July 29, 2011
5. Age (Last BkdMey) Under 1 llrWer 1 do 8. Daro d &M (Marts, 7. Birthplace C and skis a earl Ba. Plea d Orth Check on one
Monee o.ta Hass aarxrbe Hoepitel: Other:
g 0 Yrs. 5/ 1 / 19 31 Bowmansdale , PA ®Inpa,bM ^ ER ! outpetienl ^ DOA ^ Wring Home ^ R esiderx:e ^olher - speaty:
Bb. County d DeaM Be. Ciy, Born, Tw,~. d Death lid. Facilely Name (K nor institution, glue street and asrber) 9. Wr Decederd d Hispanic Origin? ®No ^ Yr 10. Race: Amerkxn irdwt, Bledt, White, ek.
.
Dauphin
Derry
Hershey Medical Center (K Yes, epecfly Cuban,
Mexican, Puerto Rkkn, ~e.) (SpecMY)
White
11. Dacsdenrs Usual Kind d wok d ab moat d iro. Do nd pole 12. Was Decedent ever In dk 13. Dacedsnrs Educatbn (Spedry only highrl grade comp leted) 14. Medkl Status: Mewled, Never Monied, 15. Sunr vmg Spo use (K wNe, give maiden name)
Kind d WoAc Kind d Bueirtra /Industry U.S. Armed Faces? Ebrtknkry I Serwndary (0-12) College (1 J a 5+) W~01M0d, DNaced (SpecHy)
Aid Hone ealth Care ^Yr (~No 12 Widowed -
• 18. Decadenl's MaiNp Addrocc (Street, ph /town, state, zip coda) DeoedeM's pp, Did Decadent
Lhre Ina 17
d~lesex T
d n M7
id
®Y
d
d Li
Ad
l R
17
S
t
D
153 N . Middlesex Rd. om.
.
ence
c.
ece
er
ve
ue
es
a.
a
e
ee,
rowrknlp?
PA 17013
Carlisle 17d. ^ No, lkcedent Lkred withn
,7b. Coerrry Ctut)berland
, AcWel LImNs d Chy / Boo
1& FaMMs Name (First, nridde, bst, arAAx) 1g. Mother's Nome (Brat, midrib, rtteMen eumame)
B
M
G
i
Clifton - Mc Clare .
ng
or
ary
20s nfameM'e Name (Type / PrIM) 20b. Inbrmanrs Mating Address (Street, oky I taus, state, rip cods)
Michael M. le 153 N. Middlesex Rd., Carlisle, PA 17013
21 a. Method d Obpattbn ^ Cremation ^ Donatbn 21 b. Date d Obposttion (Marts, day, yrr) 21c. Place d Dbposaion (Name d cemetery, crtvnetory a oMer plats) 21d. Locetien (pry /town, skis, zip code)
~ Banal ^ Removal from sale , "'" C.ematbn a Dorados Auitarizsd
^ Otlkr - SpecrTy: ' by kladlcN Exsmkter ! Coraterl ^ Yr ^ No 8/3/2011 Westminster Memorial Gardens Carlisle, PA
_
?2a. Signeesa d l.ieensee (a ) e 22b. License Number 22c. Nerve end Address d Feciiry
FD 012633 L Ekaing Brothers Funeral Ht~te, Inc., Carlisle, PA 17013
23ec ony when awtilyirg 23a. To tlw best d my , drM axared at the tlme, dale and pba stated. (SlgrreNre and ffib) 23b. Lbenr Number 23.. Daro Signed (Monts, day, year)
physition b not svaibbM a< time d drM ro
oertiy auee d aeenu
~ Aerre 2128 mutt be oongleled by person
24. Tkrrs d Deadr Pronounced:
25. Dsk Prorrwrxxd Daed (k4crslr, d+X Y•w)
28. Wes Casa Referred to Marital Exmrlrwr / Coroner fo ~ s Rerun OBrer Ilan Crsmetlon a Denetbn7
.' wM pmrrasroes arar. 02:54 P M. July 29, 2011 ®vr [] No
CAUSE Of DEATH (See Instructlone end e:•mples) r Approxlnwk haervd: Part II: rwder odwr ~3. Did Totxeao lks Contrdte ro DrM?
Merv 27. Psrl I: Enter 8re ~m~Dty - deeres, krjuriea, a mmpicatlons - thtl drcectly cared the deeM. DO NOT enter temrkrel everts such r Cardac sweat, r Onset b DrM but not resuKkrg n the undeaykg ease given n PaR L ^ Yr ^ Pmbsbly
rrpiratory meat. a wxdrkxlar tbrilelion wtttrat showing the eddugy. Uet only one cause on each line.
r
r
^ No ^ Unknown
OIMEOIATECAUSE tFineldersea
condAd, rruMirg n rleeM) -~ a. Skull Fracture ~ Dementia 21. If Female:
^ N
s
Duero (a r a mnsepuena dl: r
let axrdtiorrs, d any, b, Fa I I r
r n past Year
d pad wn
^ Pregnarn at time d arts
suss 6sled on Ins a.
CAUSE Due to (a es a consequence ofJ: ~
Enter II
RI.yING
N
D
E ^ Nor pregrwa, but pro~arn wiMn 42 days
~y
w
~
s
y
bvsnro ns ang n d~e.M• L) 10~$~'a c t d deaM
Due to (a as a cwnxquence on: i
r
^ Not pregnant, but pregnem 43 days b , yrr
before oath
• d. r
Unknorm A prepreM wrMin the pal year
30s. Wr r Autopsy 30b. Were Aukpby Findrrgs 31. Maurer d DrM 32a. Dsro d Inhsy (klornh, day, year) 32b. Deeedbe Flow krJury Oxuwed 3?c. Place d IrQay: Flortre, Fenn, Street, Factory,
Pwt«rrred7 Avaable Prior to ComplMion
d Csrae d DrM? Natu~ ^ Fbnridde
^ July 13, 2011 Fell from standing position and struck head on sink fio~ Busting, see. (Spectry)
^ Yes ®No ^ Yes ^ No ~ Acdderd ^ Pendkq Imestigedon 32d. Time d Iry'rry 32e. nWry at Wok? 32f. M Tmaparrotian Irrjrxy (SpsciNl 32g. Lastian d kN+Y (Sired, aY I town, skro)
^ spade ^ coos No11~ °e18nnk1ed Apx 04:28 P ^ Yes ®No ^ lMver/ °p°ra'a ^ Paeaerrger ^Pedsatrlan 1 3 N. Middlesex Rci, Carlisle, PA 17013
M. on,e<- specNy
33s Cwsrw (check ony one) 33b. signature errd rdb a
• Csrtlryirq pryakbrr IPhyskdan oertifyirrg cause d deaM when errottrer physidan has pronounced arts end completed ttem 23) - G
t
k
S
i
C
To Ilre best d my knowedge, tints occurred due to the auN(s) end rrwrner r eklad_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ,
oroner
raham
. He
r
c
• Pronorndng and artMyeng physkim (phYsiden bdh pronoarcnq death end artilying ro tear d tints)
k
l
h
t
d
t
d
^
d 33c. L Icerae Number 33d. Dale Signed (MorrM, day, year)
- - - - - - - - - - - - - - - - - -
To tM beet
now
er, dale, en
pea, and dr to the our(s) and mamer as ek
e
my
edge, loth omrred N t
e
• Yadlal Examiner /Coroner August 1, 2011
Dn the brb d exarNnstlon and / a krwstigNion, h my opinion, tints oaurred at the 8ma, date, and pba, and due to tM aur(a) end rrranner r akrod-
34, Noma end Addrrc d Person Who Compbted Cauca d DeaM Otem 2~ Type !Print
Graham S
Hetrick
3s. Begotten ono gsb;crl t~e^ {~- l~ ~_
~ ~~ C ~ ~ ~ ~ ~ ~ ~
` 36. Dale Feed (kte"M, day', yrr) .
1271 South 28th Street
~
~HJ~C-~lk>~1DPY ~ Harrisbu PA 17111
Dispatitlar Permk No. ~ (~} tpY(n ~-~n~
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
~ ..
./
r ~
c~ d.w~} r ~ _
~
.
;..
,_.
,~` _ --
__~ ~.
..~ _ ~:
-
1n 4.. W
zi ii-o9~~
Estate of Arlene A. Eppley ,Deceased
I, Michael M Eppley , in my capacity/relationship as
(Print Name)
son of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Linda A. Lysle, daughter of the Decedent.
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
(Signature)
153 N. Middlesex Road
(Street Address)
Carlisle, PA 17013
(City, State, Zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this ~D ~~' day
of /~u CSC>~~f' ,
d~ ,
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
c~+r~oaw~xn~ of viwu
SWifi L. Mitrio~'1, NOruy Pubic
hkd~iniOburi ~+a GrnOrl~nO COUrMy
t',onrnl~kM NOM. M X011
v~ ~