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Home My WebLink About10-14-11IN TIIE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS p PETITION FOR PROBATE AND GRANT OF LETTERS Estate of 110 ~ O ,Deceased ESTATE NO: 21- a/k/a: n n (~ a/k/a: SS NO: ~ ~0 1 ~ ~ G~' `1 b a/kla: T- 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 ~' '•~ ~ ~ rte- ... _ . n-; ._._ (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 execut~en of the_ instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person; add'~ivas npt a _ party to a pending divorce proceeding at the time of death wherein grounds for divorce had been establis~d as def#tT~d in . -_ ,:-r 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 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:- N4.... Address Relationship to Decedent ~Ci.._..._ nr ~ ~ (q I r u son ~ ~ i I( A du USE ADDITIONAL SHEETS 18rNF.CF.SSARV THIS SECTION MUST BE COMPLETED: Decedent was dQmi fled at ath in u ~berl At 831 L ~ n~~e ~oQ lvania, with his/her last family or principal residence (Street address with Post Office and Zip Code,~Munincipality: Township, Brorough, Clity) (1~,, p ~n Decedent, then ~ years of age, died ~~~ ~ ~;J ~ oG~ ~ I at Y D res 1 P(,~rk ~~ f ~ h U~11~~IC. lX~r ! Js(~ ~(o (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 $ 0.00 Location of Real Estate in Pennsylvania: (Provide full address if possible.) D 3~ L i ndseu LUI.t ~ r` ~ S I~ ~[ Signature(s) Name(s) & Mailing Address(es) rV lse i U~ 0 - I Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 1 of 2 OATH OF PERSONAL REPRESENTATIVE c7 - Commonwealth of Pennsylvania SS ~-nT, _ -r ~-' County of Cumberland -~~c7 F_~ __ .:>~ -,-, _.._ . ~,, ~.. . , , ,. _ _. ,~: , The Petitioner(s) herein named swear or affirm that the statements in the foregoing Petitioq a~~;~-ue and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal represtive(s)_df the . ~-.' Decedent, Petitioner(s) will well and truly administer the estate according to law. _,-~} ` j ;.;.; ,~~ ~,' Sworn to or affirmed and subscribed b fore me this da of 7 ~ For the Register DECREE OF PROBATE AND GRANT OF LETTERS Estate of ~o ~~ ~. ~ I l o ~ ,Deceased File Number: 21- AND NOW, this day of , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters -Testamentary _ of Administration are hereby granted to: (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) in the above estate and that instruments(s) dated described in the petition be admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. Glenda Farner Strasbaugh, Register of Wills FEES: Letters ....................$ Will ........................ Codicil(s) ................. ( )Short Certificates ( )Renunciations...... Bond ............................. Other ............................. ................................. Automation FEE......... 5.00 JCS FEE ................... 23.50 TOTAL ................$ 28.50 Atty's Signature PRINTED Name: Supreme Court ID No.: Address: Phone: Fax: Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Signature of Counsel Required to Enter Appearance Page 2 of 2 ~~~ f~ wee i ~ a m~ ,, ~ ; ~~~ Ue ~ ~~~ ~ Qi'Irai'~~ss~e ~~1., . s~ ~ J°~ c7 _~, ~--, -, :~=, _~_a - - L_. ~_ ~_, .~ :~,,, - - _ -- '-'i , . .'~ ~. _~~ OCAL REGISTRAR'S CERTIFICATION OF ~lE~+w°~1 V~1~F~NWG: It is illegal to duplicate this copy by photostat or photc~gr~~~r~~~~. ,, trr Ilti~ ,~r[jid~:IiL, ~i(1. its P ___171,15 8 3.5 L :+-(ill ,l,n[1 `~ I 'tint ~~~~ Sim ~~ ~'~<~` ~ 2~ y~~ H1051e3 REV 11/2006 TYPE! PRINT IN PERMANENT BLACK INK 0 OFp jN I~ h)~. i~ tt ll ' I n'~kyrln.)tiym i~Llc t~i~cn i~ _ ~ 1 ~I~~,~_.- ~Yy~j A ~'I II~~II, 1, k t !;il~li l ,' r11lf~tlt~ till 1)~~i11h ,~~ ~ ~~~`t1;~ ill n f lrl.i ~. ,i };t~..l~i r,u~ i't7~~ uri ~fn~)1 ~ z~% ~t ;III,"Lll~ ( cL.•:I !ly the Sltlte 5/ital u' ~I ~I ,;~ a: ` t. ~ , i 1.~ i i ~~ rti~ I , - ~ I~ilin~ ~. Tt ~,~, ~ ,. , xF ~ - ~ , ~ o`~g9j~1ENT CE~~P~ ~ ., ~~~we M 1 5 2011 . --~- I .~ iz~ iliLl 1,~ueLi ~ ~ ~ ~~ _ -C7 " = ~ C - .. > f + ri'? -__ _ ~ ^^ __ __ 1 -~ , . ) ~~ -- I ., _~ r ___ .. _ .~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) RTATF Fn F NI naRFF i. Name d Dx tleM (First mNtlle, last, sub«1 2. Sex 3. Social Senaiy Number 1. Date of Deem (Mmm, day, year) ROBERT B. GALLOWAY Male 267 - 42 - 9819 March 5, 2011 5. Aga (Lest aMMyf Under 1 a UM« 1 de fi. Date d Bits Modh, err 7. Bits G end slate « coon M. Place d Deem aleck m one 75 M«aa ~~ ~ M~ HosPKal: r: Yre Dec. 31, 1934 Sopchoppy FL ^mpatiem ^ER10u~etient ^DDA NursirgHane ^Reaidence ^Omar-SPedry Bb. Canty d Deem lW;. City, Boo, Twp. d Deets Bd. Fad%y Name (If not ins0lwon, gve street end number) 9. Wes Decedent d HHpenic Odgin? ~NO ^ Yes 79. Race: American Ir16en, Black, WhM, etc. Cumberland Carlisle Boro Forest Park Health Center Me ~ s ~ (B e i canow 7an,ek.) lack • 11. DeceMnl's llsuel lion Kintl d work tlare ~ most d Ne. Do not stab mtlretl 12. Was Decedent ever H me 13. DecetleM's Etluratlon (Seedy mry hgtlest grade mrrp leled) 11. Mantel Status: Marred, Never M«neQ 15. SulvrAng Spo use (tt wife gNe maiden mama) Xxtltl Wo/k Truc vet ItiM dBuslrleu llMuslry US. aned Fares? Elementary I sin (012) Cdlege (1d a 5+) WbOw°d. Diwviced (Spepryl , Transportation ®yea ^ ~ --------11--- ------------- Divorced 16. Decedents Meting Address (Street dry/mwn, state, zip code) DePed«,re Penns lvania oie oeaedam ~ South Middleton State y Live in a Achal Residence 17a 837 Lindsey Road . 17c. Yes, Decedent Livetl in Twp. Townehi°? Cumberland nd.^NO, Decetlem Livetl wlmM 17h 0oin Carlisle Pa 17015 ry xtwlumrced cinlBaro t6. Famels Nerve (First, mitlde, IaN, aumx) 19. Mdhets Nerve (Fkat, (nldde, maiden eumeme) Jessie Calloway Essie Mae Sermon 20e. mfomrer8s Name (type / Pnnt1 200. Inlormant's Mailing Address (street, dry /lows. dab, dP cede) Marcia Calloway 42 W. Henry Place Iselin NJ 08830 21 e. Method d Oiepoye~rtlon ^ Cremetan ^ ~~ (~ &rrHl CJ Remo alf m5tal I 21 b. Dale of DispwNan (Mmm, My, yee0 21c. Place of Disposition (Name of cemetery, «emalory or other place) 21 d. Location (Ciryf sown, stale, zip cotlef v m e weeraernetlon«DwredonANhodmtl ^ ~ D 1l dk l E i ^ ^ March 10, 2011 Tallahassee Memorial Gardens Tallahassee FL y e e xem ner/COrowrt pdrer - res No 22a Sgnetu rrerel Service j~ereee (oF acMg as aurh) 22D. Lkerwe Number 22c. Naha and Address d Facility . ~ ,7; ,-, / ~~~~ FD-012909-L Ronan Funeral Home 255 York Road, Carlisle, Pa 17013 Carplele - 23ac oNy when ceniying 23e. o llesl d my knowledge, des acuged time, date ant place slated, ISIgIeNre eM title) 23D. License Number 23c. Date Signed (Mmm, say, year) plryeldan Is not aVBilHbb at tees of deem ro aaay Pe119eddeam. /) „ 1 /C,(v R~1 ~:~38~ty cic<~ ~4 Apr ~ Mme 2426 more W wmpleted h parsm 24. 25. Date Pmrlwnced({ Deed (Month, dpy, year) ~5 ~ ~ 28. Was Case Relerred b Medcel Examiner / Carmar la Reeem Other men Cremation or Donation? wia prarrau¢es doom. ~~ M. ,, (/ ~~ `i1l Q l ~ tea ^ No CAUSE OF DEATH (See inslruesb eM ezampNe) r Approximate Interval: Pen II: Enter other 26. D'd Tdleaa Uee Canldbute b Deem? Item 27. Pan L Enter me Meld d evade -diseases, iryunes, «mnpkcedow ~ drat tiredly caused the deem. DO NOT enter terminal evens such as car6ac anent. Onset to Death ' hd not resNtlng b fire uMerlykrg cause given In Pan I. ^ Ves ^ Pmbehy respiratory awal, «vantriculer fibriMtion witlwd showing me eeomgy. L et Dray one cause « each Ihle. - ^ Na o-~known IMMEDIATE CAUSE Fret dseeae a - c«deion resukkg in ~eamf C n 29. 6 Female: ~ ~ a. ~"--_ ~ /T'G;'M'me ^ N Dw m off: Ysl mldilnw, H mY. b. ~ti '^.;.y ~ Ot caws Baled m ins e ~"'~'"V'""--" ~ a J d Pregnant within pest year ^ Pregnant et time d deem ^ . DERLWNO CAUSE Due to (« ss e conse9uarrce oft: Enbr UN Nol pregnant, Dot Pre9nenl wimin 42 days (BSeaee « iryury dot nklab0 eta c events reNdting In tlwm) LAST. of deem ^ Dw to (or es a wnaegwrca on: Nol P/eTenf, but Pre9nan 43 tleYS m 1 ywr d, Oefore deem ^ Unknown g pregnant whin me pest year 309. WBB m AWapry PMOmed7 30b. Ware AUlopay Fndngs A J l P 31 Memer d Deem / 32e. Date d Injury (Monk, day, year) 32b. Describe How Irryury Oavned 32c Place of IMurf. Hann, Farm, Street Factory, ve eb rbr b Cartplatim e ~ ^ HarYdce 'ct wlural O6ice Buildrrg, dc. (SpetlyJ of Cause d Death? ,.,/ ^ Yea L'7 No ^ Yes No ^ Actitlanl ^ Panting Imrestlgellon ~~ Tine d Irrjuy 32e. Injury at W«k7 321 If Treneponetlan Injury Bp«vfY/ 32g. Location of injury (Street, dry / hwm, state) ^ Sukkle ^ Caultl Nd DB Delemwwtl ^ Yee ^ No ^ DrNar/Operet« ^ Passeng« ^ Pedestrian M Omer ~ Spetlry' 33a. CeroYer (tl 1c ody and 330. Sk,~eNr Tilk of Certlfier Cartlying pny.larn (PhYmcen mA use of deem when arpdwr ~ a phyekden Ms pmrwtnced deem one axrgkted Mm 23 _ _ , " ~ To its bets d my krrowNtlpe,M•m oaurred tlwto drs awgs)entl manner es netetl_______________!_________________~ ~ i ~'` "~~"-`- Promurrdng rM eedzying phrMCYn (Phyeiden both pmrwNkrg mom erd wrtllyerp to eeusa d deem) 33c. Lice ' Number 33e. Date Signed (Mmm, tley, year) To dxrbMdnry brawNdpe,tlwthotturtetldMetlma,tlaPo, erd lrlace, and tluebfMesuage)ant menneru Weretl__________________^ • MstlblFxemNrsrl Coroner /1C Gi! , C/ J 'l dJ,~~'_// / ~° On the 0aW d exeminatlan end / «Inveaflgatbn, in my aplnbn, tleam occurred att tl M ma, dsk, and place, and des to tM awa(sl end runner as orated. ^ 3q. Nem B/ and A)prese d P«sm WhoCarnlaled Cauca N Deem (Item 27) Type / Pnnl f/ U , .. / ~/ g 1 3fi. R 1cSgneture erN ntril~l rAx ,,~ber I `"'Y' ` I ~ ` I ~ I , / 1 ,r „ / „/ J rR /" J /' 36. D to Filed (MOdh, day, year) ~ ~I 5 ' Y`'~ I L ~ S/ / (~ G ( Y ~~ ~ K L G kti [ l „ (~ 7 ~ / / %) 2 /~ GU ]/ ~ LG ~ V Dispositon Pennd No.... ~'1 ~ ~1 O.) RENUNCIATION REGISTER OF WILLS COUNTY, PENNSYLVANIA ~ ~ i ;i ;; l7 f I Estate of ~ - f/ ~ ~' ;I r ~~ ,, ~ ~, i~~ i , "`' ~~~i ~ I, ~j~ ~ ~~/(~ , in my capacity/relationship as ~~ (PrrntName) of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to i ~,~ (Date) Executed in Register's Office Sworn to or affirme and subscribed bef e me this day of '~E~ Deputy for Register of Wills 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 ofrpope~s stat~ed~hin on this ~ ~ day ~C1 ~( , Notary Public My Commission Expires: ,~. ll.),~~y (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.!3.06 C7 -.~.~ ,,. r-~ ~ = - ;-~ ~~ - -- . ~,-, ~- _~~ --- _ _ ,._ -- --- --a __ . , ~-~ .Deceased ,~`°~''"''•- CHERYL D. CONTE :'r°. ~~e`~= Notary Public - Stete of floride My Comm. Expires Jun 10, 2014 ±~. d,~`~ Commission ~ DD 1000475 ,~~''~~~ ~" ~ Bonded Through National NotaryAien. ~~ ~/~/~s ~ ~~ (City, State, Zip) RENUNCIATION Estate of I, ./~~ REGISTER OF WILLS COUNTY, PENNSYLVANIA administer the estate of ~~ ~~ (Dare) and respectfully Executed in Register's Office r Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills i~,~ ~~~~ ~~ n ___ _. = = ~, , ; .~ , - . zi __._ -- ., , _ . ~. _, • ~ c -;., Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to uest that Letters be issued to rv : i (Srgnature) - ~~ ~~~% (Stree~Addre J ' 1 ~ ~ ~ ~ ~~~.- (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 renuncia }}__on for the purposes sta ed within on this ~~~Y, day ~c~C~° ,~r~'~G~C Notary Public My Commission Expires: 3' `:~ ~ ~ Z (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 RENUNCIATION REGISTER OF WILLS COUNTY, PENNSYLVANIA n ~~ " _~ ~ - -' 7 't~t7 _ _~!-' '- T ~~ ~- _,~.. ~, v ..~_, y- Estate of ~ r/ ;.. `l -t .~ ' ~~~ _~~ 1 4~ i,; -_ ,r,= ~~~o -Y, I, ~~e~ ~~~1 ~~ T- Deceased in my capacity/relationship as 'Name) of the above Decedent, hereby renounce the right to administer the Estate of the ece ent and respectfully request that Letters be issued to (Date) (r re) (Street Address) ~ /~ ~~~ar~('l/~~3r~G~ (Cuy, State, Zip) ~ Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills 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 purpos s stated within on this Z ~~~ day ofJUl ~v~..~~` ~_, ~ ~ 1 ~i'otary Public "~ My Commission Expires: (Signature and Seal of Notary or other official qualitied to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 ADRIAN MICAH STEWART Notary Public ~ Cammo~wealth of Virginia iafr Finn Np n Rcg._ a.._.. .73_9524 My Commission Expirsslune 30, 2014 C ~ `_z-r z. __r r'j _T~ .. RENUNCIATION ~ T' ~.~ _. -" - -. --- _, _- ~ , , . _ ' REGISTER OF WILLS ~, ,..; ,= PENNSYLVANIA ~ .~Cti~~ COUNTY r ~; `-'`' ~ t ~ , . Estate of ~/~(I~ Deceased in my capacity/relationship as (Pant Name) of the above Decedent, hereby renounce the right to Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL LLOYD P. SCHROEDER, NOTARY PUBLIC SUSOUEHANNATWP., DAUPHIN COUNTY MY COMMISSION MAY 02, 2013 Form RW-06 rev. 10.13.06 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 ~_ day ~~/~ ~ Notary Public My Commission Expires: 5`, L~ 13 (Signature and Seal 01' Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) OATH OF PERSONAL REPRESENTATIVE ~-> _~_7 Commonwealth of Pennsylvania ~ SS ~ - County of Cumberland '- c~ :: , ~:~-- :~.., _. . _._ ~_~ The Petitioner(s) herein named swear or affirm that the statements in the foregoing Petition a~~~rue and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal represer~}tive(s)„of the - Decedent, Petitioner(s) will well and truly administer the estate according to law. „ -~ ~-;:; ;.`. --~; Sworn to or affirmed and subscribed b,~fore me this ~~ da of ~~'~ ~~r , 'r ~~ '' ~ For the Register DECREE OF PROBATE AND GRANT OF LETTERS Estate of ~U ~ ~ . Vii ~ ~ ~ ~ ,Deceased File Number: 21- i ! - " 1 •~` '-~~ ___ AND NOW, this ~ '}ll `day of _ "~' '~ ~ t.{l~ 1~ i-~ ~.-i~(.- l•~~.~ , in consideration of the Petition on the reverse side hereon, satisfactory proof having be presented before me, IT IS DECREED that Letters Testamentary t,% of Administration are hereby granted to: (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) a. , - . - r ~~., E 1 . , ,>g , , in 1 ~ \ l- ' the above estate and that instruments(s) d ted descri< e In t e petition e admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. r , Glenda Farner Strasbaugh~,_ ~ r ~~ _ `'~,~~ ~~ ~, r.`~,.~ ~ f ,~ ~-~-~ Register of Wills .f i FEES: ,!_ Will ........................ Codicil(s) ................. (`~ )Short Certificates (i- ~) Renunciations...... d rte' ~~ ~ a"".. ( i Bon ............................. Other ............................. ................................ Automation FEE......... 5.00 JCS FEE ................... 23.50 TOTAL ................ $ '2~g-~Q Signature of Counsel Required to Enter Appearance Atty's Signature PRINTED Name: Supreme Court ID No.: Address: Phone: Fax: Page 2 of 2 Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court