HomeMy WebLinkAbout09-14-11. IN THE COURT OF COMMON PLEAS OF CUMBERI,~JD CO
UNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of Charlotte R McCoy
a/k/a: ,Deceased ESTATE NO: 21- ~ ~ ~ ~_
a/k/a:
a/k/a:
SS NO: 175-34-4890
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SE
applicable: CTION `A' or `B' AND `~C» ~
~ A. Probate and Grant of Letters Testamentary or pAdministration c.t.a.
and aver that Petitioner(s) is/are entitled to the aforementioned Letters Testamen a.b'n.c.t.a. (complete Part C also)
the last Will of the above-named Decedent, dated _ 11/23/2010 ry "rn-~ under
____ and codicil(s) dated ~ `~::: ~?
-A.~
~ ~ . ~ ~_.~
rn
(State relevant circumstances, e.g. renunciation, death of executor, etc.) «.L. ~ .
Except as follows, Decedent did not m was n _ '
~`y, of divorced, and did not have a child born or ado ted a ' ' ~ rs ~ ~-
instruments offered for probate; was not the victim of a killing, was never adjudicated p fter~~on of the
party to a pending divorce proceeding at the time of death wherein rounds f an incapacitated pers~--,hand was not a
23 Pa. C.S.A. § 3323(8): g or divorce had been established as defined ' ~ `~'
.:.. ~~ ~.
^ B. Grant of Letters of Administration ~..r.
(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
following spouse (if any) and heirs (If Administration c.t.a. or d.b.n.c.t.a., enter date of W was survived by the
heirs); was not the victim of a killing; was never adjudicated an incapacitated erson• an ill m Section A and complete list of
proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.Ano 3 party to a pending divorce
§ 323(8), except as follows:
Nsma
ent
1 nl~ a~;c:'1'lON MUST BE COMPLETED:
Decedent was domiciled at death in Cumberland County, Pennsylvani with h'
At 1010 Allen Street New Cumberland 17070 ~ Is/her last family or principal residence
(Street address with Post Office and Zip Code, Municipality: Township, Borougl~~ City)
Decedent, then 67 years of age, died 8/28/2011
at New Cumberland, Pennsylvania
Estimated value of decedent's roe (Month, Day, Yeaz of death) (City and State where death occurred)
_If domiciled in PA p p rty at death:
_If not domiciled in PA All personal property $ 150 000.00
_If not domiciled in PA Personal property in Pennsylvania $
_Value of Real Estate in Pennsylvania Personal property in Couniy $
Total Estimated Value $
Location of Real Estate in Pennsylvania: (Provide full address if possible.) 1010 Allen Stre $ 150 000.00
et New Cumberland PA 17070
Signature(s)
Name(s) & Mailing Address(es)
Karen L Bretz 2034 Stanton Street York PA 17404
~. .~ 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
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e a thi ~ `I ~ da of
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Register
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DECREE OF PROBATE AND GRANT OF LETTERS -- ~- `~~' ~'
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Estate of Charlotte R McCoy ,Deceased File Number: 21- / ~ ~ ~ _ ~~
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AND NOW, this l day of r~,Q~ o~G ~~ in considerati
the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREEDhe Petition on
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.)
Karen L Bretz
the above estate and that instruments(s) dated 11/23/2010 described in the petition be
admitted to probate and filed of record as the last Will aid Codicil(s) o~ Decedent.
Register of Wills
FEES:
Letters ....................$ G~-+
Will.. .................._~ , G
Codicil(s) .............. .
((~) Short Certificates
( )Renunciations.......
Bond ............................
Other .............................
Automation FEE......... 5.00
JCS FEE ................... 23.50
TOTAL ............ ~~~: 56-
....$
Signature of Counsel Required to Enter Appearance
in
Atty's Signature
PRINTED Name: ~ ' ,
regory J Katshir Esquire
Supreme Court ID No.: 61967
Address: 90o Market Street
Lemoyne PA 17043
Phone: (717) 763-8133
Fax: (717) 763-9425
o.,..,. ~ o~ ~
~ ~~ ~~
LOCAL REGISTRARS E
C RTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.010
This is to certify that the information here given
correctly copied from an original Certificate of Deg
duly filed with me as Local Registrar. The origin
certificate will be forwarded to the State Vi
Records Offir_e l~or permanent filing.
o,..~ AUG 3 0 2011
L~r~ /a~~
Local Registrar Date Issued
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43 REV tt20o8 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
E /PRINT tN
~NiaKT CERTIFICATE OF DEATH
(See Instructions and examples on reverse) STATE FILE NUMBER
t. Name of Decedent (FhM, middle, last, suMa 2. Sez 3. Saaal Serxrrity Number 4. Date of Death (Month, y, Year)
5. Age (Last Birdndey) User 1 r Under t da 8. Date of Berth Month da 7.81 and Mate a reel oou 8a. Place of Deatlt Check on one
6 7 "'r""'" Days r~,B '""""~ June 2 , 1 9 4 4 York, pA Hospital: Other:
• Yrs. ^ Inpatient ^ ER I Outpatient ^ DOA ^ Nurshg Home Residence ^ Other • Spedry:
8b. Coumy oT Death 8c. City, Boo, Twp. of Death 8d. Fealtty Name (tt nW instihdion, give efreM and number) 9. Was Decedent of Hispanic Origh? ®No ^ Yes 10. Race: American Indian, 81adc, White, etc.
Cumberland New Cumberland 1010 Allen Street ("''~~aD°`~'0i~"~ (Sa~M
Mexican, Puerto RICan, etc.) Whit e
• 11. Decedents Usual eon Kind of work done mast of life. Do not slate reti 12. Was Decedent ever h the 13. Decadence EduceBon (Specey only Nghest grede completed) 14. Marital Status: Herded, Never Marrbd, 15. Survivhg Spouse (If wife, give maiden name)
01 of I U.S. Amted Forces? yy~a, phq~
.SOCla WOrk gO Elementary I Secondary (at2) College (1 a 5+) (~ef~')
Hos 1~ ^ Yea Cg No ~+ Divorced
8. s Mai ~s~aTess (stree city /town, state, zJp code) Decedents P A Did Decedent
A ~ 1 e n S ~ r e e t Actual Residence 17a. State Tai gh ? 17c. ^ Yes, Derx~dent Lived in T~
• New Cumberland, PA 1 7070 „~.~„~, Cumberland '~ nd.®No,DecedenlLivedwitltin New Cumberlan
Actual Umtts of CitylBoro
18. Father's Name (Flrst, midde, last, sulfa) 19. Mothers Name (Fkst, middle, maiden sumerrre)
Albert Kuentzler Pauline G. Copenheaver
20a Irdomtants Name (type /Prim) 20b. Informanre Meilhg Address (Street, dry /town, slate, zip code)
Karen L. Bretz 2034 Stanton Street, York, PA 17404
21 a. Medad of DispOSitlon r ~ Crematlon ^ Donation 21 b. Date of Dispoeftlon (Month, day, Year) 21c. Place of Disposition (Name d cemetery, cremMOry a other place) 21 d. Locatbn (city /town, state, zip code)
^ ^ a,dM ^ RenavaliranStete ~ ~„, o~DautWnAutltodzsd Yee^~ Sept. 1 , 2011 BFH Crematory Grantville, PA 1 7028
22e. d Funerd ~}° ~(a such) 22b. Lloerroe Number 22c. Name and Address of Fedtity
- - G~~~.... FO 012342-L Stone&MurrayF.H. 408 3rd.St.,New Cumberland, PA 17070
xertre 23ac only when certltying 23a. 7o tlts bent of my death aocurred M the tlme, Aare era place stated. (signature end tltle 23c. Date S
b rat avaNeble M tlrtre d death ro (~~ ) 23b. License Number Igned (Momh, day, teed
rarely cwroe of death. '~ ~ o 'C~ ~~ ~ 3 ~, Sa ~ .
~a ~
Items 24-28 must be corrtgeted by penan 24. TFne of Death 5. Dare Pratormced (Month, daY~ teed 28. Was Case Referred ro Medical F_xamhsr /Coroner fa a R r than Crematbn a DonMbn?
- who pronounces death. M. ^ Q ^ Yes ~No
CAUSE OF DEATH (Sae InstrucUona end eza ) e~ r Approximate hterval: Pert II: Enter dher \ 28. Dkl Tob~co Use Contribute to Death?
Item 27. Pert I: Eller the cdtain of evems -reassess, injurbs, or complications • that directly caused dre death, DO NOT sorer tenninM events such es cardiac arrest, r Onset ro Death but not resulting h the underlying cause m Pan I.
respkatory artast, or vemriatar flbnllation witlaut showing the etiology. List only one cause on each line. r !lam ~ ^ Yes ^ Probably
A , r ^ No ^ Unknown
IMY~DIATE CASE (Fall) disease or {!~ n ~ ^ ^ _~I- ~ ' r
r
condition reau ' in death J ' Ti W.~ (~ --
-~ a. ~~ ~ ~ ~ ~ ~p ~l C ~ ~ r 29. a Female:
Due to (a as a consequence oq: , ^ Not pregnant within past year
ro ~~ ~ a b. ~ ^ Pregnant at time of death
Eraer UNDERLYgId CAUSE Due to (or es a consequence of): i ^ Not pregnant, but pregnant within 42 days
(dbeeee a injury stet initleted the c. r of death
- evenre resWtlng m deMh) LAST. r ^ Not
Due to (a as a consequence of): r
pregnant, but pregnant 43 days to t year
• d. , before death
30a. Was an r ^ Unknown ti
Autopsy 30b. Were Autopsy Flndngs 31. Manner of Death 32a. Date of In u Month, de , Pregnant wtthh the pest year
Perlomted? AvaNable Prbr ro Completron j ry ( Y Yom) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Ferm, Street, Facrory,
of Cause of Death? ^ Natural ^ Flonticae Olflce BWkling, etc. (Sped/yj
rr~~ ^ Acddem ^ -endl In 32d. Time of Injury 32e. Injury et Work? 32f. tl Traunporbtlon I u (n)ary (Street sly I town, state)
^ Yes 1Z7"No ^ Yes ^ No ~ ~ M ry (SPAY) 32g. Locatron o1
j ^ Suicide ^ Could Not be DetermhaKl M ^ Yes ^ No ^ Der/~re~ ^ ~~ger ^ Pedestrian
Otlter • SpecNy.
33a. Certifier (dreck ally one) 33b. S Title of ~ereRar C ~ _ /~
• ~Y-n9 t*y~n (~Y~+ Keying cause a death wf»n anoe,er pnyalaen hea praaunced dim and completed ftem 2s) //~, J, ~/~/~/
To thetrwtofmyknowbdge,dwthoecumddwtotMawe(a)andmaruN-aerated--------------------------------- -
• Pronounchrg and ~YMg PhY~bn ( both prarourxarq death and ceneykp to cause of death) ^ 33c. LicensehhNumber /'' / 33d. Dare Signed (Monts, day, Year)
To the beat d my ImowNdps, death oceurred at the ems, dab, and place, and due to the cauaa(s) and manna es etated_ _ - _ _ - _ ~ 11J 0 3,3 ~ g'b ~ ` g' 2 9 / 1
• Ibdkal EnrMrwrlCoroner - -' - - - - - -' -
thrthe bob of aeminatbn and / a InwatlgMbn, in my opinion, daNh occurrod et the dms, dab, and
place, and dw to tM duaa(s) end manner ae ebbd_ ^ 34. Name and Address of
Corttpleted Cause of Death (hem 27) T / Pn~j ~-r-~
35. Registrar's Sfgneexe era District Number 38. Da ( , deY~ year) ~~ ~ l l~ tJN7r ~ / re J L' L
" Dispoattion Permit No.