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HomeMy WebLinkAbout09-16-11 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ___ CUMBERLAND_ COUNTY, PENNSYLVANIA Estate of Saundra L. Thomas also known as File Number 21-11 '- ~~~~ Kevin R. Thomas ,Deceased Social Security Number 204-28-0447 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE A' or `8' BELOW) ^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the last Will of the Decedent, dated named in the and codicil(s) dated After the execution of the documents offered for probate anDecedentcdidenotrmarryt' was not divorced twas not a party to a pending divorce proceedin wherein grounds for divorce had been established as provided in 23 Pa. C.S.A 3323 p a killing; and was never adjudicated an incapacitated person, except as follows: g § (g); did not have a child born or ado ted: was not the victim of Eric B. Thomas Karen J. Thomas ~o ~umoerland Avenue Shippensburg, PA 17257 (COMPLETE IN ALL CASES.) Attach additional sheets ifnecessa nl en burs. PA 17257 Decedent was domiciled at death in _ CUmberland County, Penensyolvania wahlohn She edUt PraCtPa hes Bence at 19 White House Road Shi ensbur Southam ton Townshi Cumberland C:ountV PA 172 (List street address, town/city, township, county, state, zip code) Decedent, then 74 years of age, died on 03/17/2011 at 359 East King Street Shippensburg, PA ~7Y57 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) $ -------- 4 500.00 Personal property in Pennsylvania g (If not domiciled in PA) Personal property in County ~- Value of real estate in Pennsylvania $ situated as follows: Southampton Township, Cumberland County $ ~- 113 000.00 Wherefore, Petitioner(s) respectfully the undersigned: ~~•~~~ •~ ~~ pwuate or me last Will and Codicil(s) presented with this Petition and the grant o `kt~ters in the form ley:, _~ ~~ X B. Grant of Letters of Administration Petitioner(s), after a proper search, has/have ascertained that Decedent left no,Will and wasasurvived by the following spouse (if any) and heirs i Administration, c. t. a. ord. b. n. c. t.a., enter date of Will on Section A above and comp/ete 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(f provided In 23 Pa. C.S.A. § 3323 (g), except as follows: - -- -~- -~ ~ ~opyngnt (c) 2006 form software only The Lackner Group, Inc Page t o~ . ~~. PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF (Continued) Estate of Saundra L. Thomas __ CUMBERLAND COUNTY, PENNSYLVANIA also known as File Number 21-11 " (1 f C ,Deceased Social Security Number 204-28-0447 Name Kevin R. Thomas Scott Thomas Relate-- o-n~hin Son Son Res- -~en~~ 179 Langstreet Drive Gettysburg, PA 17325 41 Middle Spring Road Shippensburg, PA 17257 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } SS c=? _: .~~ i~t,-~. - The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correCfj~~he bes4-of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent a tioner s will ~n1e11,-aiac#~tuly ~=' administer the estate according to law. , O ~ .. Sworn to or affirmed and subscribed ~_.- ~ -- ~' ,: Signa re of Personal presen ve ~ before-~ne this ~~~ Ada of Kevin R. Thomas"' - Y A `~t i~,~ r ~~ ~ /.~ ~ 1 °`~ f .r ' ,~t,~r_ i ~ ~/ Signature of Personal Representative ~ ~ C..l'~ ~ /, 1 ~-~~~c.~.~~z.? For the R~Gister Signature of Persona! Representative File Number: 21-11 ~ ~ Estate of Saundra L. Thomas Deceased Social ~curity Number: 204-28-0447 Date of Death: 03/17/2011 AND NOW, ~f~~ I'-f72 /~~ ~ /' 'A i having been presented before me, IT IS DECREED that Letters In consideration of the foregoing Petition, satisfactory proof of Administration are hereby granted to Kevin R Thomas and that the instrument(s) dated in the above estate described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters .............................. $ r/ ~O r U~1 Short Certificate(s)........,.. $ ~~, /y1 R_enunciation(s) .............~,_ $ ~ r ~ ~ J ~.~ $ .~~-'~ t') $ $ $ $ TOTAL ................................... $ Form RW Q2 Rev. 10-13-2006 Atti Attc SuF rrG~c,~le do ASSOCIateS, P.C. Address: 126 East_King Street Shi._ ~pPensburg, PA 17257 Telephone: 717/532-7388 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 -- --- ---------- ~..GC:~4L~ REGtSTR~i~'~ ~ERT'I~I>TtG~ ~°~~:- , ~, : - _ y V '~' Vi~11F?~dING: It is iitega! ~o r.'t~pii(;ate thi> ~w~1~,~r ,'~,,~ ahr=ts==,~~<! ,k ~T7 ,, .t'~~ 'hi_ .~~rfli~~__. __ / t.i ,r,~~li `~ fit. ,~~~~.' ,,: ,,': , ~, :, ~~ __ _ P ___17 2 6 3 ~~ 3 7 .k . ,~ k ~.~ - _ ~. . __ H10.5-143 REV 112gg5 TYPE / PRINT IN PERMANENT BLACK INK 1. Name of pecedenl (First,- suXixj Saundra L. Thomas 5. Age (Lass BinhtlaY) Under 1 year rno„ms wys :,; i,_ r ~ f ,~. , ~~ T ~ --T `% m _._. - -=- :o ~ ~r'_~; .1 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL FIECORDS -~ r_- `_,~ C3 CERTIFICATE OF DEATH c. (See instructions and examples on reverse) STATE FILE NUMBER 2. Sex 3. Social Secumy Number i. Dale of Binn (Month, day, year) 7. Birthplace iC' and stale or forerFceumal e 2 (] 4 I. Dale o1 Death (MOmh, tlay, year) - 2B - 0447 March 17 79 ~• ~ ~urBS P ry) Ba. Pyce of Deam (Check only one) -~~- 2 ~ 1 1 vrs. 12-27-36 HoaP„al • BbcoanlyetDeatn Shippensbur9, PA aner~lan~ enroute to hos &. C„y, Born, Twp. of Death &. Feat„y Name (II not insl„align, give street antl number) ^ Inpatient ^ ER / Outpatient ^ DOA M ~t$1 ~~ Cumberland ^NursingHOme ^Resitlence rJOther Specity. Shippensburg s.waal3ettdemolHispeacoe im 11. Decedents USUal Oct 359 East King Street (n yes, opacity Cuban, g ®N0 ^Yes 10. Reca~American radian, Black, Whde, etc eon Kmd a wok done tlurin most of world life. Do rat stale retxetl 12. Was Decedent ever at the 13. Decetlent's Education (~rM Kmd of Wak Mexken, Puerto Rican, etc.) C],.al i ~z (~ltml T.,~.,,,,~,~ KiM of BusMess / Industry U.S. Artnad Forces? (~dY only nighesl grade cortlplatetl) 14. Mar{lal SyaWS: Marred. Never Married, 15. Survrvin White "!'s-`-•~ Am2r1Ca1] ~.'an ~Y Elementary / Secorrtlary (g-12) College (7~4 or 5a) Wicowed, Divorced (Spacf 16. Decedent's Mailing Mtlress (Street c„y l town, slate, ziP code) ^Yes ~] No 1 2 ~ 9 Spouse (II wile, Siva maiden name) Decedem's Years 2 years Widowed 19 White House Road AclualResidence t7a,State PA Did Decedent Shippensburg, pA 17257 uvema 17c~]yes,DecedemLivedm Southampton Twp. 1e. Father's Name (Frret middle, Isar salix) 17h. courtly Cumberland Townsnip? 17tl. ^ No, Decedem Livetl within Tom' Albert Stanton 1s. MaMr's Name (Rrsl. midtlle, maiden samaras) Acwal Lim„s of 20a. IMOrmant's Nema C„y / Boro (TVce/Phm) June A. Robinson Kevin R. Thomas 27a. Melhotl of py 206. IMOmbm's Maikng Adtlress (Street. city /town, Wale, ipcoda-~ Pos„XIn yp{~ Burial ^ RemovanromSyate ^cremafion ^DOnWron 179 Longstreet Drive, • ^ Other - Ski !was cremation a Dorutlon Aumorized 2ID. Date of Dispce„ion (Month, my, year) 21c. Place o1 D Ge t tysbur g, PA 17325 ty apca„ron (Name M cemetery, crematory or alxr place) by Medical Examiner/Coroner? ^Yes^NO 3-22-11 21d. Laalgn (City /town, state. zip code) _ 2za.syr~ ealFUneral Locust Grove Cemetery e (oraing es such) 22b. License Number • ~ T+'f zzc NamearaaddressaFapley Shippensbur9, PA 17257 Carpels rams 23a-c FD-0129B4-L Fo elsan Dory wMn cen„yrng 23a. TO the hest of my knowletlge,death occunetl al the time. data antl place steletl. (SignaWre aM („gj gar-Bricker Funeral Home Inc. , physican n rwl availaae el brae a seam m Shippensbur cemty cause of eeatn 23b License Number -" g' PA 172 S 7 hems 2426 must ba cam eletl 6 24. Time of Death 23c. Date SigneO (Moran, day, year) W y ~ son 26. Dale Pronounced Deetl (Month, tla `~ Pmnolmces tleatA. Y, Year) 8 : 2 3 a eA. Mar eh 17 , 2 D 1 1 26. Was Case Felerretl to Medical Examiner / Goroner for a Reason Other than Cremation or Donalbn? Item 27. Pan I: Enter the cha;n of CAUSE OF DEATH (See instructions antl examples) ^Yes No ~3 4° - tliseases irqures, w cnrtplications - that tlireclly tlausatl the tl9alh. DO NOT enter terminal Events slx~ as camiac arrest, respiratory artesl or entraular lipril'ation without showing the of y° a APProximale interval. Pan Il: Enter ana abgy list onl rte cause on each line. Onset to Death r 5~1dr lCan1 ndn on no m d th IMMEDIATE CAUSE Final disease or ~ ~=-`"~---~ 28. Ditl Tobacco Use Contribute to Death? but not resuk ng ~n the untletlY n9 cease given in Pan I. Yes P contlilan resunirg In am) ~ r ^ ^ robaby -~ a. ~ a No Due to rasa onsequence ol): ~ , ^ Unknown Sequentialy Irst cend„ans.„any, n !l- I, , ` ~~~ ~ 29. II Female: leading to the cause f red on line a. ~ S ~ .p I ~ Enter Ilre UNDERLYING CAUSE Due to (ores a conseq nce o1J: ~ r •~ Not pregnant within past year _ (dsease a injurynt~a hj aiq tlsrle o. 1y/~ ~Q ~- r -Q ^ Pregnant el time of death e o or es a ns ue ce o : a ~ ^ Not pregnant, ba pregnant within 42 days d' ~ of death "~~~--~~ 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death r ^ Nol pregnan4 but pregnant 4 ys to f year Penomretl? Available Prror Id Compieoon 32a. Dale of Injury (Month, tla , r ~-~--•- before tlealh w o! Cause of Death? ~Nalural y Year) 326. Descnbe Now Injury Occurretl --'- ^ U known it pregnant w„bin the pazl year ^ Homalde 32c. Place a Injury: Nara, Farm, Street, Faaory, ^ Yes ~NO ^ y~ ^ Nn ^ Aaitlent ^ pendnp Investigation 32d. Time of Injury Onae Builtlmq, etc (Spacryy) 32e. Injury al Work? 321, Il Transportation Injury (Specilyl ^ Suiatle ^ Could Na be Determinetl 32g. Location of Injury (Street city /lawn, state) 33a Certdier ([Hock an M ^Yes ^ No ^ Driverlppemta ^ Passenger ^Pedesusn y ttr' ^Other ~ Specrl/- • Cerlilying physician (Physician centlying cause of tleam when another grysician has proneurcetl death antl completed Item 23) To the best of my knoMedge, death ottunetl tlue to the taus 33b. Signature end Title of Cen„ier • Prorwuneing antl ttnltying physician Pn e(s) and manner es ststed_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ - n To the best of my hnowletl ( Ys~cen born pronouncing death antl cenilying to cause o1 tlealltl ge. deslh occurred al the time, date, and place, sod due to the cause(s) and manner es slatetl_ _ _ • Metlittl Examiner /Coroner _ ^ 33c. License Numner On the basis of examination end / or investigation, in my opinion, death occurred at the lime, date, end place, sod dire to the cause(s) end manner es statrd_ ^ M ,~ 5 33tl. Datc Siyned (Mon)th, tlay, year) 3L. Reyrstrar's Siynature and vat N er 34. Noma and Addy, a P~wrym Cornolele ~^ ~ - - ` - 1 ~ I / I ~I / • ~! 36 alt Fibtl (Month, da . n I ~! ~ l/ ^~ y;r' (I r 27), Zypc / f•{nt t h.7 I Y YCdr) Yxl Y,.f Disposition permit No. 5 6 4 ~ r4- ~ ~ `- ~---~1 REGISTER OF WILLS OF Estate of Saundra L. Thomas RENUNCIATION CUMBERLAND COUNTY, PENNSYLVANIA Deceased ~~ Eric B. Thomas in me in my capacityirelationship as Son of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Kevin R. Thomas z Zi^l( ~ [Date) ~ ;=1 -_... ~"'' ~'-' - (Signature) ,,, • ~ ~ ~ Eric B. Thomas -~ . -- ~ t_;i; --- L - _ n_ . ,_ ,. ,_.. .._. _ L_) `-: CJ Executed in Register's Office Sworn to or affirmed and subscribed before me thi~_______day of Deputy for Register of Wills Form RW-06 Rev 10-13-2006 38 Cumberland Avenue (Street Address) Shippensburg, Pq 17257 (City, State, Zip) Executed out of Register's Office B the undersigned personally appeared the party ecuting this renunciation and certified that h or she execu a rth' e~i~aion for the purpo es stated wi in o ~~ r y Notary Public My Commission Expires: ~/~y~y7`'~- ~"~"ff }~~' ` t (Signature and seal of Notary or other official qualified to\ ~~~ _- administer oaths. Show date of expiration of Notary's commission. ) O' fVIONW~q~-rp.{ QF pctV9VSYLMA ~ ~T~f~lfi~~ SEAt_ PAiIAElJ4 A;. ,~,'t!~rf";Ai..~~'K6, Notary PubPiG f9orc 01` Stti~pens~:;r~, c;~mtrarland qty ~omm;s~n ~q~jras March 2~!, ~ ~,°)tat. a Copyright (c) 2006 form software onl~ The Lackner Group, Inc. REGISTER OF WILLS OF RENUNCIATION CUMBERLAND COUNTY, PENNSYLVANIA Estate of Saundra L. Thomas ~~ Deceased ~~ James Thomas ran ame in n"~y capacity/relationship as Son of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Kevin R. Thomas ~~/f= .. t~{Date) -~ V ,.., __. __ Q7 __. ~. • _ _.. w< [._. , _ C~._:_ i rte, c7_ - cJ ., C. Executed in Register's Office Sworn to or affirmed and subscribed before me thi~__ day of Deputy for Register of Wills Form RW-06 Rev. 70-73-2o0E' ignature James homas 322 Roxbury Road (Street Address) Newville, PA 17241 (City, State, ZipJ 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 ttusl~da of i ~- y t- . tary i ~-~--~--~-//----_ My Commission Expires:y~~~Z~t °~a, ao~ y' (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) Ca~MMONW~ALTH OF BEN NOTAR(q~ SEAtNSYLVgNIq Shelly M, Green, Notary public Fanned Townshi MY Commleslon Ex p' Franklin County pfres Septemb Copyright (c) 2006 form software cn~y the Lackner Group. Inc. 9r 2Q, 20 r ~ REGISTER OF WILLS OF Estate of Saundra L. Thomas RENUNCIATION CUMBERLAND COUNTY, PENNSYLVANIA Deceased '~ Karen J. Thomas n ame in my capacity/relationship as Dau hter of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Kevin R. Thomas ~-3--/% (Date) --, L.__ -~ rt` _~. L:1" - LL- -- - :.. __. L: i . ~-_ _ 1 ~ 1 ~~:~ -- _ ~...~ 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. >o-~s-loos Shippensburg, PA 17257 (City, State, ZipJ Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the ren nciation for the purposes stated within on ttus~,_ day of ~u~~s~ ~c // ~~~ ~~ ~~ 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.) ------_ ©anal~ei~~.. -- _ Linda K. Klein, ~~~tary F(.s~,6ic Shippensburg, PA Cumberla~ ,County My Commisss_~ires A~±:~~+st15, 2012 Copyright (c) 2006 form software only The Lackner Group, Inc. 19 White House Road (Streef Address) ~-~ i REGISTER OF WILLS OF Estate of Saundra L. Thomas RENUNCIATION CUMBERLAND (:OUNTY, PENNSYLVANIA Deceased ~~ Scott Thomas nn ame in my capacity/relationship as Son of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Kevin R. Thomas ~_, q--~a,---- j I --r~t~7 .z __ ~'= t_~_ ~ - -, _- -=~ ~L ~ .~ 1 i ~_ i - (1.. -.. Ci . __._ C_3 =--. C Executed in Register's Office Sworn to or affirmed and subscribed before me this- day of Deputy for Register of Wills r atur Scott Thomas 41 Middle Spring (Road (Street Address) Shippensburg, PA 17257 (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 executE~d the renunciation for the purposes stated within on th~s~day of -S`n~~~~f Z o 11 Notary Public My Commission Expires: (Signature and seal of Notary or other official administer oaths. Sh xpira ion o `f~lb~~tf~P'~I°n , Linda K. Klein, Notary Public Shippen~sburg, PA Cumberland County My Commission ~xpire~ August 15, 2012 worm RW-O6 rze~. ~o-~3-zoos Copyright (c) 2006 form software only The Lackner Group. Inc.