HomeMy WebLinkAbout09-19-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of _ ~. ~~ , r„ ~ ~ ~ ~ s
a/k/a: ~ ~ ~ ~ ~ y ~{ ~ ~ ~ t ~ ,Deceased ESTATE NO: 21- ~ ~. - `~~ ~ `j ~'
a/k/a: E~ ~ R R u ; t-t ~ c c ~ ~ is -
a/k/a:
sslvo:_ a~`i- ~ a- ig~}s
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 Calso)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters
the last Will of the above-named Decedent dated to under
' - ~- ~i_~ y~_) ~ a oc8_ 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):
O B. Grant of Letters of Administration
(If applicable, enter d.b.n., pendent life, 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 ([f 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(8), except as follows:
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uc,e,attonshi to Decedent
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USE ADDITIONAL SHEETS IF NECESSARY ~~~
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THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principaj'i•esidence ''
At l e~- 4.1+UC1itrS ~(~ RRb~S LR(~i.1S~.r=
P i 7d l'
(Street address with Post Office and Z,p Code, Municipalit)~: Township, Borough, City)
Decedent, then ~ ~; years of age, died S L p i . ! 3 Z.~J 1( at Cr,~ ~, sz€ r' ~t .
Estimated value of decedent's roe (Month, Day, Year of death) (City and State where death occurred)
_If domiciled in PA p P ~' at death:
_If not domiciled in PA All personal property $ ~ ~~ ~ o
Personal roe O ' O b
_If not domiciled in PA P P ny in Pennsylvania $
_Value of Real Estate in Pennsylvania Personal property in County $
$ -o-
Total Estimated Value $ 36 D o 0 ~ G
Location of Real Estate in Pennsylvania: (Provide full address if possible.
Signature(s)
Name(s) & Mailing Address(es)
Riv~ku. ~, um tYl ~ LCc:, L. 3.2.2'76
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by thf; Court
Page 1 oft
LOCAL REGISTRAR'S CERTIFIC:ATION (JF pE
WARNING: It is illegal to duplicate this co p ATH
pY Y photostat or photograph.
F,°c tin- this certif`i~•atc. ~b.fi(~ -
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H105-143 REV 11/2006
TYPE / PRIN7IN
PERMANENT
BUCK INK
I 1. Name of
5. Age (Last &nhdayj
86 yr6
1 : Bb. Counry or Deem
. Cumberland
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
lass, sunixl
(See instrRTons aAndEx~mpDEon reverse)
E. Ruth Davis 2 SBfi STATE FILE NUMBER
Untlar 1 year 3. Social S«uriry Number
urger ~ ~r s. Data or ann Female 209 _ 12 ~ 945 4 Date °r Death (Moran, dayy ar)
rasa pan Hmx,m MinWea (Month day, year) , September 1•~ -
. Birthplace Icily and slate or lorei n country) ga. Place of Daalh (Check only ono) ~ 2011
Oct. 27, 1924 Philadelphia, pA H«pdat
&. Ciry, Boro, Twp. of Deam Olhec
N. Middleton Bd Facary Name (If not imutnuti«, ^Inpstienl ^ER/OUlpalient ^Dpq
rf4.... l~ W . 9^'e street antl number) ^ Nursmq Home (~ Residenco
`^Y lnchester Gardens, s. waB De<adam or Hispanm ongim ~j Np va6 Oomer-spe°iy:
xms Usual Dqu Iqn Kintl of work done euri Carlisle (II Yes, speciy Cuban, ~ 70. Race: Afnerican Indian, Black, N
Kill of Work most of world life. Do not stale renree 72. Was Decedent ever in the 1 (Sped/)q
Mexican, Puerto Rican, 91c.)
Bookkeeper KintlrBusiness/IMumry U.S_ArmedFOrces? 3'De<edent'sEducatiW(Spera on h lte
C stet Mf ~x~, Elernenlary/ Secontla 0- ry ry ghesl gratle C01°plaletlJ 74. Maras Slalus: Married, Never Maenad,
16. Decedent's Maikng Arltlress (Street, cry r sown, stall, zip rotle) ^ Yes ~y rye ry ( 721 College (7~4 ar Sa) Wklowetl. Divorced (Specyl 15. Surviving Spouse (If wile.
104 Winchester ~ s"e maids"name)
Gardens °~~"I'B ---- 2 Divorced
Carlisle, PA 17013 ArualReaidWCe 17e gale P-_ A _ Didoa°eeent
Cumberland -'- `1Ve in a
1B. Father's Name (First, middle, Wsl, suNix) 17b. CWnly Township? 17`' ®Ye6. Decetlermt Lived in
John Alexander M ~,• na^"o, Derodent Lowed wnnl°
zoo. Intbrmant's Name eCuen 19. Mother's Name (First, midela, maaan wmeme) Actual Limits of
(TYPe / Pnnl) Ciry r
E. Fred Davis Edna May Diezel
21a. Method of Dis lob Inlortnanfs Mailing gdtlress (Street city, /town. slate, zip c«e)
Stan 1584 Newville Road
^ ~^~ ^ Removal tram sate ~ [}~Crematbn ^DOnaOO'' , Carlisle P
^ aner - sperry was cremnatkn ar Donanen aamodxetl zm. Data nl~Bposii SMonm, day. year , A 17015
i by Metlical Examiner/Coroner? $ep 6 2011) zlr Pl«a or aBpnsni°n lNama m <amatary, oar,~a,ory °r °Hr pO
22a. SignaN of Funeral Sarvi Yes ^No ~ Hoffman-Roth zttl. LacaT
_ , or parson acting as such) Funera 1 & ton (Ciry /town, slate, zip code)
2'2b. Licenw Number 22m. Nave andAWreBB nr Face Cremato Carlisle, PA 17013
compote„amBZ3a<ony 138504 '" Hoffman-Roth
Pnyaidan 5 rKK avaaable al lime of deem Io
w' n9 23a. To ~ best of my kmwletlga, deem attuned al ttre lime da~tl Place sbtetl. (Sigretwe and line) Funeral Home & Crematory
mkniry cause of deem.
Ilemr524 ~~ 23b. 'tense u bar 1 7 13
% must be canpletetl by person 24. Tme of Deam, A 23c. D to Signetl (MWIh, tla ,
~0 P10f1OU"~ death. + 25. to Pronounced peed ,'3~ ~ LJ o ~ L Y Year)
f i x V/ Mon~m,,ntleY, Year) L f I
CAUSE ~ NI C.~ ~ ~ q~,~J ~ I zB. was Case Referrer Qo Metlical Examiner /Coroner for a Reason Omer 7 an Cremation or Donation?
nom 27. Pan I: Enter Ina OF DEATH (~ InsLructlona and examples) yr-,J(
GB910-4( 2YBD15 - tlkeazes, injures, or tUmplcatipts _ mat alrectly ~Yas I N
respiratory arrest, or vermicular fibrlblion without sh causetl the deem. DO NOT enter terminal awash such as cartliac arest,
IMMEDIATE CAUSE fFinal diBaase or °~ ma e'er' ~t only one cause « each Rne. r APProximata interval: Pan n: Ener nigher
contlinon resJtmg m deem) Onsal to Death slggigcant m rye
nut rat resularg in the umltledyey cause Ira n m n' 28. Ditl Tanaroo Use Contribute tb Deam?
->• a / ,A,fj~ lV' 1 -r-1 c d'/ grre Pan 1. ~F~rah,,.,.~ Pmbabry
segaanoauy kst roMalims, R any, Due to (or as a epnsaqueppe y(g LY'W ~ Unkrawn
leaMpameaanseuBled«araa. b~ j\' 1(~J ~,J ~~KK~' ~ ~•TEQFt~RTI}/Z (
Emar me UNDERLYING CAUSE Due to or as a ron T 1 j 29. tt Fe
eveanis iesun"g°y trot inmates the ( sequence op: ; ' L.9Z $' i~ '/ P V N ~ Not pregnant vimin peal year
rg i deaml LAST. c_
' ---~ ~` ~'~'7 / ~ ^ Pr ynar at nma of deem
Due k (or e6 a ronseque«e of):
d' m Al"i2 i !}-L ~ 1 2 i ^ Not pregnant an pregnant wimm 4z day:
30e. ees r "i ~-l~m~y/ of tleath
an Autopsy 30b. Ware Autnpsy FimMings 31. Manner of Deem
P dometl? Avaibbe Pror l0 7 ^ Not pregnant, but pregnant 43 days l0 7 year
Complelgn 32a. Date of injury IMOnth, da --~~ belore death
°I Cause M Death? U rvaNral ~ H°micYJe Y Year) 32b. Dascnbe How Injury Occurtetl ^ Unknown n
Yes pregnant within the pall year
I--I 'x° ~ Yes ~ N° ^ Acci«nt ~ pendimg Imesligafi"n 32d. Tme or Injury 32c. Plata °l Injury: Moms, Farts, yyreat factory,
32e. Injury al Works Ollice Building, etc. (spaudy/
^ Suicitle ~ CWId Not be Determine0 321. n Transportation Injury (Spen.Yl
33e. Certifier IcneGc amry oriel ^ Yes ~ No ^ Driver / Operato p 9 Location o I ry IBIr9el
r ^ a 32 I In u , my r town, slate)
M' ssarger QPetleslnan
' Certlrying physkian (Physk;ien cenitying cause of deem when aWmer ^Omer ~ Speryry:
Tome neat of my knowledge, death a«urtetl due to the cause(s) antl manner ny sm1W°°`_ed death antl 93b. SignaNre armd T of Ce
• Pronouncing all cenllyln9 Phyakian Ph c«pletetl Item 23)
To the heal of my knows I Ysaian both prpaundng deem and mxnirying to cause of death) - _ - - _ _ ~.
• Metlical Ex I atlge' death «curted et the time, date, antl place, all tlue to the cauae(a) antl manner as Btated- - - - - - - - - - - - - - - - ~. - - ' ~~- G1NY?
am tier / Cor rarer 33c License Number
On the basis of examination and/or lnvesligalbn, In my opinbn, death -___-----"-----
«curretl at Ile time, rata, and b VL1 0- , ` ,( y 33d. Dale signed (Mon day, yea
35. Registrar g Iwe antl Dia51~ 1 P tt and tlue to the cause(s) antl manner es Bbinl ^ lJ T ~~ S ~ "-~ ~~ f/ ~ 4 ~ / r)
• ` i ~C 34. Name and gddm of Person Who C mpleted Caua of Deam (Item 27) Type / Prnt
+++"""TTT ~~~~ I 1 I I ' ~ I ~ I ~ f 3fi; Dale Filed (Mmth, day, Year) ~/~p~ 1. L 1 i~L'~l ,Sr , ~/~~ I~iil ~y
Lim , , IS ~ I 1 1 Z { ` p /~ ~/!L~(,,•'nN V
Disposition Permit No. `~ ~ J ~ I L2'~ ~ I~i~~ ~'rf Y'`L'L
~ o_~_ jlf Y'!~ l1J l3
LAST WILL A]01D TESTAMENT
I. E. RUTH DAMS, of 107 Winchester Gardens, Carlis
County, Penns lvania le, Cumberland
understandin y ~ being of sound and
g, do hereby declare this to be disposing mind, memor
and all wills heretofore made by me. mY last will, hereby revoking any
Item I. I direct that I be cremated and that m
the mountain winds at the top of Waggoners Ga of Carl
his Harley, if he is able to do this for me. I y ashes be thrown to
this decision tom prefer no viewin by my s°n Fred on
,p } y children to make it as eas g~ however, I leave
~f,5~ ashF?,, a~ -~
4 ` €" be: •,n ~,~,ith vour t~v c, y as possible for them. Throw
e - Remember only the ood times we had watt
Item II. I direct my executor hereinafter named to
and funeral expenses.
pay all my debts
Item III. I give and bequeath all the rest, residue an
my estate to my two children, E. d remainder of
Edward) Fred Davis and Deborah Susan Davis.
If one of them should predecease me, I direct their sh
child. If both should predecease me, I ive are to
brother, Donald g and bequeath my~~ {irehstate to m
1• McCuen of Micco, Florida.
Item IV. I nominate, constitute, and a
McCuen as executor, and I direct that he serve without bon y brother, Donald j.
predecease me or be unable to serve, I a oint m
substitute executor, and I direct he shall serve w' d. If my brother shall
pp y son, E. Fred Davis, as
ithout bond also.
IN WITNESS WHEREOF I have hereunto set m
~- day of March 2008. y hand and seal this the
A r
~~
E. iCiAti'1 La~~S ,
Signed, sealed, published and declared by the above-name
her last will and testament, who at her request, in her r
and in the presence of each other, have he d testatrix, as and for
p esence, in our presence,
attesting witnesses: reunto subscribed our names as
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COMMONWEALTH OF PENNSYLVA:[vIA )
COUNTY OF CUMBERLAND SS.
and
witnesses whose names are signed to the attached the
or foregoing instr ent, being
duly qualified according to law, do depose and say that we were present and
saw tes~atrix sign grid execute ti
e instru,,~;ent as her last wily, and that she signed
willingly and that she executed it as her free and voluntary act for the ur
therein contained, that each of us in the hearing and. sight of the testatrp s poses
the will as witnesses; and that to the best of our knowledge, the testatri fined
that time 18 or more years of age, of sound mind and under no constra n s at
t or
undue influence.
Sworn to and subscribed before me
this ~~ day of March, 2008.
,:
Notary
iN` `! wnp sa,idx3 no~sss~+awo~
~M~/Y~{wgwn~'y6no~ca a
~Ir ~IgoN `xo~ •W quay
M~ IN~WoN
Notarial Seal
A11Mir. COU, Notary Publk
Ml- COeMa1Mi011 CIS ~M >~ !IM
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND ~ SS.
I, E. Ruth Davis, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my last will, that +I
signed it willingly, and that I signed it as my free and voluntary act for the
~~"..irgC)St~ tl.er°ili c' rr-~
. xn. ssed.
/~~~~
E. Ruth Davis
Sworn to and subscribed before me
this ~ 5 day of March, 2008.
1...~
Notary
Notarial Seai
M1MM. Cox, Notary Pus;'°
90rough, Cw~mberlaEa+.S i:vunty
sion Expires June 3, 200