HomeMy WebLinkAbout09-07-11 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of DOROTHY L. EBERLY ,Deceased ESTATE NO: ~ I G~`t"~
a/k/a:
a/k/a:
a/k/a: SS NO:
Petitioner(s) who is/are 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 and codicil(s) dated
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RENUNCIATIONS FOR MICHAEL E. EBERLY AND KAREN L. KARATHANSIS ARE ATTACHED H ;~~J ~;-r-;
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(State relevant circumstances, e.g. renunciation, death of executor, etc.) ~ ~ t
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after ~'ition the
instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated pez~on~ ~d wa~not a ' -
party to a pending divorce proceeding at the time of death wherein grounds for divorce had been estafi~ld as cH~finecl in
Pa. C.S.A. § ' ~ ~w Q~
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? 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 ascertauied 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 Pa. C.S.A. § except as follows:
Name Address Relationshi to Decedent
[JSE ADDITIONAL SHEF,TS IF NECESSARY'
THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence
At N CORPORATION STREET, NEWVILLE BORO, CUMBERLAND COUNTY, PENNSYLVANIA
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
HARRISBURG, PENNSYLVANIA
Decedent, then 8 5 years of age, died at
(Month, Day, Year of death) (City and State where death occurred)
Estimated value of decedent's property at death:
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 $
Location of Real Estate in Pennsylvania: (Provide full address if possible.)
Signature(s) Name(s) & Mailing Address(es)
Y JOHN H EBERLY N CORPORATION ST NEWVILLE PA
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Interim Form RW-02 revised by Cumberland County pending action by the Court 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 Petit: on are true and
correct to the best of the knowledge and belief of Petitioner(s) and that, as personal reprF sentative(s) of the
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed Y
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re this, ~ d of
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r t i ste
DECREE OF PROBATE AND GRANT OF LETTER~I~ F _~R -
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Estate of Y ,Deceased File Number:
AND NOW, this day of ~,~~~e.m~ o~~~ ~ , in consideratio:l 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.)
JOHN H. EBERLY, JR. in
the above estate and that instruments(s) dated io/13/2004 described in the petition be
admitted to probate and filed of record as the last Will and Codicil(s)~of Decedent.
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lenda Farner Strasba, h~~ ~ f'~
Re ister of Wills ~
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FEES: Signature of Counsel Required to E rater Appearance
Letters ~ .G
Will 15.0o Ariy's Signature ,
Codicil(s) .
)Short Certificates PRINTED Name: ROGER B. IRWIid
Renunciations....... io.o0 Supreme Court ID No.:
Bond
Other Address: WEST POMFF;ET STREET
~ CARLISLE, PA
Automation FEE.........
JCS FEE Phone:
Fax:
TOTAL
Interim Form RW-42 revised by Cumberland County pending action by the Court Page 2 of 2
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RENUNCIATION T= ~
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REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA w;--
Estate of DOROTHY L. EBERLY ,Deceased
I, MICHAEL E. EBERLY , in my capacity/relationship as
(Print Name)
CO-EXECUTOR of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
JOHN H. EBERLY, JR.
AUGUST ~
(Date) (Signature)
PO BOX lOSA RICE LANE
(Street Address)
BENDERSVILLE, PA
(City, State, Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
before me this day party executing this renunciation and certified
of that he or she executed the renunciation for the
pure es stated within on this ~ day
of ~ ~
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Deputy for Register of Wills Nota Public
My Commission Expires: ~ ~ Z(o ~ ~ z,
~~V~ r ~ (Signa of r other official qualified to
4V ¦ ad nis tary's Commission.)
~R tNtCHCOCI(, pQ'T'p~' PI~UC
SEP 0 ~ 2a1~ ~~~~~~c
~RW(CV ~ McKNIGH~~
Form RW-06 rev. ~_A~ ~F~~~~C~
R~Ic~t~~n
Auti, ? z 2oi~
LOCAL REGISTRAR'S CERTIFICATION ,OF DEATH
WARNING: It is illegal to duplicate this copy by photosi:at or photograph.
Fee far this certificate, i,,drr~~""'~~~-. This is to certify that the information here give
~t,o~t~,a~~~ ~FPEij%;~_- correctly copied from an original Certifie~~te of D:
duly filed ~~ith me as Local Registrar. ~['he orig
~ certificate 1,~'ill he forwarded to the State V
~b.~ Records Office for permanent filing.
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P 7 2 7 5 2 8 =°F~9 ~.,.~~~i~a 2a
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Certification Number ---~~f„~~r~~~
Local Registrar Date IsSUed
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Htos143 REV COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE !PRINT gJ
PERMANENT CERTIFICATE OF DEATH
Buac lNK (See instructions and examples on reverse}
STATE FILE NUMBER
I Deoedenl (FusL mills, lest, sutPoc) Soda) Security Number Date of Death ( dt, daY~ Y
r),b2f/ ~~C - 1 ,ZC~
Age (Last Bkdtday) Under 1 Under 1 da e. Date W Birdt Month da Bi Ci and state a coon 6e. Piece of Death Check one
hlonew OeYS Fiorxa MMutee Hospital: Other.
• Yrs. Z, ~ Mt . Rock , P A ®Inpatient ? ER / otdpetiant ? DDA ? Nrasing Home ? Residence ? other - sp~'y:
6b. County d Death Bc. City, Boro, Twp. of Death ad Fariflty Name (M not inedtudon, gHe sleet and number) Wee Decedent of Hiepenk; Odght? (,1~No ? Yes f0. Race: American Inlan, Bieck, White, etc.
Ma
~n cR`~, alp.) (White
. Dauphin Harrisbur Harrisbur Hos ,
t t. OecedenYs l)wd bon Kind of work done most of w0 kfe. Do not slate Was Decedent ever in the Decedent's Educatbn {Spedty ortry highest grade t.'ortpleted) Malal $tetLa: Marled, Never Married, SurvWing Spouse (II wife, give rttaiden trams)
•'i U.S. Amted Forces? Widowed, Divaroed (Specify)
il: KindolWork KMdotBuairteae/Indusby Elementary / Seclat~ry Cdlege or widowed
o Laborer Processin Co. ? Yea C~
U ~ Decedents Mailing Address (Street, dry /town, state, zip code) Decedem's Did Decedent
Actuai Residence 17a. State Pennsylvania Live in a 17c. Yes, Decedent Uved in Twp.
~ N, Corporation St. Cumberland TOYn'~~? i7l.C?]No,DerxsrleniLivedrnthin Boro
• N ewv i e PA 1 7 2 1>b. c01x'ty Adtual UmRs or city/Roro
Father s Name (Frst, nriddfe, last, suffix) Mother's Name {First, middle, maiden sirmame)
Lucinda M. Sheeley
20a, fnaonnanrs Nana (Type r Print) zab. tnrortnanre Maiing Address (sveat, coy ! tarn, state, zip coda)
John H. Ebert Jr. N. Corporation St. Newville, PA
21a. Method of Duaposilan r ~nxnetion Donaion 21b. Oats at Disposition (Month, day, ywr) 21c. Place of Dfsposftton (Name of cemetery, crematory a olherpace) 21d. Location (Ciryltown, State, zip code) 1 7 0 6 5
~ ? Brxiel ? Renroral from State ~ was cremetfon a DorraUOn ArNwrized H o i n e r C r e m a t o r
? r byMedkelExmrlneryCoroner? Yee?No 1 1 g Y Mt. Holly Springs, PA
~ 22e. 5tgroNre d Fteterel Service Licensee (a person acting as such) 22b. Uoarrae Nrarrber 22c. Name and Address at Facility
~ ? ~ 011589E Hollin erFH&Cremator Mt.Holl S tin s PA17065
Compeb hems 23ac only when certifying 23a. To the best of my knowledge, death oc:ctrned at the tinro, dare and place stated. {Signature and title) 23b. license Number 23c. Date Signed (Month, ley, year)
ptrysidan is trot avaUebla at time of death to
cattily cause o+ death.
• Itanc must ba competed by person Time of Death 25.Oate Prorrounced Dead (Month, day, year) Was Case Refer~ed~ Medical Examiner /Coroner fa a Reason Other than Cremelion a Donation?
who prarounces learn. 9 : 5 0 PM M. ~ 1 Z e ~ ~ ? Yes fd No
CAUSE OF DEATH (See Inatructlons and examples) r Approximate Mterval: Part Enter other sianificant conditions rxxttdb to death. Did Tobacco Use Contribute to Death?
Ilan Part I: Enter the chain of events -diseases, injuries, or rxxrtp6cations -that directly CeUSed the death. DO NOT enter terminal events such as cardiac arrest, ~ Onset M Death but na resulting in the underlying cause given in Part I. ? Yes ? Probably
respretory artast, a ventricular fibrillation without showirtg the eNdogy. List Doty one cause on each late. r
~~F~ ^ r No Unknorat
adtl'lia~i estCdfAxrgin dea~tlt) dsease a ~ ~ ~ i g Female:
a. r ? Not pregnant withn past year
i ? Pregnant et time of dealt
~t oondtione, d an , 12~f2RN/ N~7G3f~,~1`7~i~t~ r ,
to cause on line a. b' T- "'-f r ? Na pregnant, but pregnant within days
EMe~~~NDERLYtt/G CAUSE Due to (or as a consequence af): r
(6sease a pyury that rMliatad qte c r of death
• events reaultirtg m death) LAST. ~ ? Na pregnant, but pregnant days to 1 year
Due to (or as a consequence of): r before death
d. ~ ? Urtkrtown l pregnant within the past year
30a. Was an Autopsy 30b. Were ANapsy Firtdngs Manner of Death 32a. Date of Injury (Mtxtttt, day, year) 32b. Describe How Injury tkxuned 32c. Pkce of Injury: Home, Femt, Street, factory,
Pedamed? Avaitel>fe Prior to Competion Office e~•
of Gauss of Death? t/si Natural ? Homicide
? Axident ? Pending Investigation 32tl. Time of Injury 32e. Injury at Work? 32t. it Transportation Injury (SpeciNl 32g. Location of injury (Street, d1Y /town, state)
? Yes ~ No ? Yes ? No ? DdverlOperela
? Suidda ? Could Not be Determined ? Yes ? No ? Passenger ? Prrdestrian
M. Other • Specify:
33a. Certifier {dteck only one) 33b. Signature end Title of CeNfier ~ C.- ~
CenHying phyaktan (Physican certifying cause of death when artadter pttysidan has prorrounced death and completed Item 23)Z~„///`/ ICJ /f
TotMbeetofmykrrowNdge,dsethoceumdduetothecsuaa(a)sndmanrtsrusbted____^-----------^---------..------ ? ,
• Pronorsrcing and cenMying phyNcian (Physician both prwroundng d9alr end cerdtyatg b cause of death) r~o 33c. License Number ~f 33d. Date Signed , ~ ye
w To the beat at my knowkdgs, leant accumd et the time, dab, end place, nd due to 1M cause(s) and manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Elf ` ~ /v^Y Cc~
a IAadkN ExamMsrlCororrer ~ C.^ ~
w On the basb of ettamMatbn and / a Mvaetlgetlon, in my opinbn, leant occurred at the Tithe, dab, and place, and due to the auae(q and manMr is atstetL ? Nsuna and A d Parson Who Competed Cause d Death (Item Type / Prkrt
Martin Karlicek MD S. Front St.
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~ ~ , ~ Data FRad (Manih, dev year) I~i a r r i s bu r g , PA 1
Disposition Penntt No. t d ~4'L~~
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LAST WILL AND TESTAMENT
I, DOROTHY L. EBERLY, of Penn Township, Cumberland County, Pennsylvania,
declare this to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils
heretofore made by me.
I direct my Executors to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
I authorize and empower my Executors to sell any realty owned by me at my death and
not specifically devised herein, at either public or private sale, and to give good and sufficient
deeds therefor, in fee simple, as I could do if living.
I devise and bequeath all of my estate of every nature and wherever situate to my three
children, share and share alike, the child or children of any deceased child taking the share their
parent would have taken if living.
I nominate and appoint JOHN H. EBERLY, JR., MICHAEL E. EBERLY and
KAREN L. KARI~.~ HAi`dASiS to be the Executors of this my Last Will and Testament; they are
to serve as such without bond.
I hereby suggest that my personal representative retain the services of Irwin:;.
McKnight as attorneys in the settlement of my estate. =o f-'-;
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this 13th day of
October,
(SEAL)
DOR Y L. EBERLY
Signed, sealed, published and declared by DOROTHY L. EBERLY, the Testatrix
above-named, as and for her Last Will and Testament, in the presence of us, who, at her request,
in her presence and in the presence of each other have subscribed our names as witnesses hereto.
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ACKNOWLEDGMENT AND AFFIDAVIT
WE, DOROTHY L. EBERLY, MARTHA L. NOEL and SHARON L. SCHWALM,
the Testatrix and witnesses respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed
and executed the instrument as her Last Will and Testament, that she had signed willingly, that
she executed it as her free and voluntary act for the purpose herein expressed, and that each of
the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that
to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of
sound mind and under no r_onstraint or undo::: influence.
r°
DOR HY L. EBERL
..MAR A L. ~ EL
SHA N L. S WALM
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by DOROTHY L. EBERLY, the
Testatrix herein, and subscribed and sworn to before me by MARTHA L. NOEL and
SHARON L. SCHWALM, witnesses, this 13tH day of October,
N ary Public
CO ONW ALTH OF PENNSYLVANIA
Notarial Seal
Roger B. Irwin, Notary Public
Carlisle Boro, Cumberland County
MY Commission Expires Oct.
Member, Pennsylvania Association Of Notaries
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