Loading...
HomeMy WebLinkAbout10-17-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of George S. Corbin, II a/k/a: a/k/a: a/k/a: Deceased ESTATE NO: 21- ~ ~ " ~ ~- ~ ~ SS NO: 191-40-8489 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~lso) C7 '-' and aver that Petitioner(s) is/are entitled to the aforementioned Letters ' ~ °~nder-z the last Will of the above-named Decedent, dated and codicil(s) dated =~, ri -1- n - a ~,~ _ _ ~ t n --- ;-f, (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 eztt on of the `~`~, instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person,=~d was n~ a '- - -`-` party to a pending divorce proceeding at the time of death wherein grounds for divorce had been estal~shed as defined in`~~' n 23 Pa. C.S.A. § 3323(8): r• ~ B. Grant of Letters of Administration pendente lite (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 (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:- Name Address Relationshi to Decedent Mari D. )ones 173 E. Penn St. Carlisle, PA 17013 common law wife Karen Reid 500 E. Prospect St., Apt. 1, York, PA 17403 sister Jerry Corbin 3831 Wilcox Blvd., Chattanooga, TN 37411 brother see attached for additional names USE ADDITIONAL SHEETS 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 940 Walnut Bottom Road, South Middleton Township (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then 62 years of age, died 3/9/2011 South Middleton Township, PA (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 Estate in Pennsylvania: (Provide full mess if possible.) Name(s) & Mailing Address(es) ~~~~~ ~l ~~n~~ ~~ John R. Zonarich, Esq., 17 S 2nd St FL 6, Harrisburg PA 17101 Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page I 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 represents) of the Decedent, Petitioner(s) will well and truly adminis~he-e,~tate according to laves ~ Sworn to or affirmed and subscribed bef re.~e this ~ ~ ~~~ day of ~'c-I'~(' ~ , ~- For the Register Estate Of George S. Corbin II ,Deceased File Number: 21- T~ ~, - ; -- ~_, r`.: --- AND NOW, this ~ day of ~" -~-Q ~~ ~r/' ~ ~ , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREEC- that Letters -Testamentary X of Administration pendente lite are hereby granted to: Qf applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., e[c.) John R. Zonarich, Esq. 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. FEES: Letters ....................$ 20.00 Will ...................... Codicil(s) ................. (.~) Short Certificates I ( )Renunciations....... Bond ............................. Other ............................. ................................. ................................. Automation FEE......... 5.00 JCS FEE ................... 23.50 ~CVG. ~jC0 TOTAL ................$ ~JO - -z:~ DECREE OF PROBATE AND GRANT OF LETTERS ~ --, 1> Glenda Farner Strasbaugh,. ~ Q~C~;~~ ~~ `'`xf ', Register of Wills Signature of Counsel Required to Enter Appearance Atty's Signature ~- G/~ PRINTED Name: Bridget M. Whitley, Esq. Supreme Court ID No.: 33580 Address: 17 S 2nd St FL 6 Harrisburg, PA 17101 Phone: Ill-233-1000 Fax: 717-233-6740 Interim Form RW-02 revised 1226.10 by Cumberland County pending action by the Court Page 2 oft ADDENDUM TO PETITION FOR GRANT OF LETTERS OF ADMINISTRATION PENDENTE LITE -ESTATE OF GEORGE S. CORBIN, II Continuation of list of next of kin Name Address Relationship to Decedent Vivian 521 S. West St., Carlisle, PA 17013 Sister Coleman Jack A. SCI Huntingdon, 1100 Pike St., Huntingdon, Brother Corbin PA 16654 David Corbin No fixed address -general delivery, York, PA Brother ~J~AL REGISTRAR'S GERTIE6CAT1(3tU GF ~~ ~' WARNING: !t is illegal to duplicate tt)is copy ~y photostat 0l~ ~#~zat~=r°~~~a~. Fec ;tit t~~i~ cl°~T=fic;fi~ ~+(~.0~) P 17263560 C~:ri1l1_ .lice "i'c;nbc'-- ~uN Q ! li, ~ =~ ~~~ ~,~~, ~ 1 ~. i' t: t , y, ~ ~ z ~ .nJ~ ,,'. ;~ ~ ~ ~ , . .,, r ~ ~~ I . , m o ~ - ;~ 4~~~4~- ~~~~~Al . r 1 ~. . ~ ~° ~ ~ ~ .. . ~ I ~iTI - l ~ _`}~~ 'r c -,~ _N _... _ _ ;..: _. -~T r_. . COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH ISee Instructions and examples on reverse) H10S143 REV 112006 TYPE /PRINT IN PERMANENT BLACK INK Q C ~. `~ 0 1. Name of Decedent (First, mitlde, qsl, au0a) 2. Sex 3. Saiel Severity Nunder 4. Date of Death (Month. tlay, year) George S. Corbin II male 191 - 40 -8489 Myrrh 9, ZOll Ape (Last Binhdey) 5 Umler i ar Untler 1 de 6. Dale of Binh , de , r 7. BiM ce C' eM state rn for e coum Ba. Pkce m Death Check onl one . 62 Yrs. • Montle pays Hours Mlnmes OCt • 27 + 1948 Carlisle, Pa • Hospital: ^ Inpatient ^ ER / Oulpaliant ^ DOA Other: ~ Nursing Home ^ Residence ^ Omer ~ Spec4y: lib. County of Deam &. City, Boro, Twp. of Death 8d. Fac9iry Name (h not uaNlWbn, give street and number) 9. Wes Decedent of HLSpenic Origin? ©No ^ Ves 10. Race: American Inden, Black, Waite, etc. C4anberlartd Middleton T'wp. (n yea, apedty cahan, (spe~IM black Maxtor Care Nursing & Rehab Mexkan, Puerto Rican, etc.) 11. Decetlem's Usual Oceu ibn Kintl of work tlone tlmi moll of rrorkin Poe. Do 1x01 slate retired 12. Was Deratlem ever m de 13. Decedmn'a Etlucelion (Spesily onty highest gratle completed) 14. Marital Smtus: blamed Never Mertleq /6. Survidng spouse (h woe, gNe maiden lame) witlaved, Divorced (seedy) IOntl of ork Nmd of Business/ IMuslry ~ U.S. Artretl Forces? E ntery I Sltgondary (0-12) College (1-0 or St) rricever married disab].e gl Yea ^ No ILL 16. Decetlenl's Meikrp Address (street, dry (town, state, zip code) Decedent's A ~ ~n ~m Srnlth Middleton T Decedem LNed in ~ - wp. ~ Yes 17c Y"' 940 W3llnt BOttC1i1 Rd. , . Aquel Residerce 17a. Stele Township? Livedwhhin t land 17d.^ ce ~ Carlisle, Pa. 17013 o ,7b.coumY cty/eom ihs ACtua~L ar 16 Fabler s Name (First, middle, last, suhfx) 19. Mother's Name (First, middle, maitlen surname) Hwrard th M R J~res E. Corbin . u 20a. Informant's Neme (Type / Pnm) 20b. Inirnment's Mailuq Address (Street, dN' / imm, state, zp code) 17403 Yot~ Pa Pros ect St 500 E ~.~ Rid , . . p . 21a. Method of Disposhbn ®Cremation ^ Donation 210. Date of Disposition (MOnm, day, year) 21c. Place of Dispositon (Name of cemetery, crematory rn other place) 21 d. Location (City /mwn, slate, zip code) _ sunal ^ Removeitromstala ~ ~~ ~t 2011 March 12 Inc. g3[l Funeral Hrnle & Cse~etory A> Shippensbttrg, Pa. 17257 ^ ~r ~~~~ Fssminer roner7 ®Yes^ No , , , 22e. Signature of Funeral service Lkensee (rn person actlng as ouch) 22b. Liceree Number 22c. Name entl Address of FaciNy FD-012884-L Atgart Funeral Hone & Cramtory Inc. Shippensburg, Pa 15257 _ ~ Complete Nems 23a< aMY whence ' 23a. To the hest of my krwMetlge, deem occurred et the tune, date (Signature end pile) 23b. License Number 23c. Date Signed (Month, tlay, year) phys~an is not evaiahle m time of death a . ~ /fin • / ,~~/1 rV ~ ~~ ~~' L ~n ~Z ~ ~~ cendy cause of death , ` '^' , , Time of Deem 24 26. Date orpunced Deed lMOr~. ~Y~ Y~r) 26. Wes Case Relertetl to Medical Exemirrer /Coroner for a Reason Omer Ihan Cremation or Donation? hems 24-26 mull Da compleletl by person . ^Yes ^ No who prawunces tleath. ~ a p M. 9 a ~ ~ CAUSE OF DEATH See Instrudlons end examples) r Appmximale interval: th O D Pan II: Enter other s m team condeio2 cantdbc4no to dealn. in cause iven m Pan I l not resuhir In me underh h 20. Did Tobacco Use Contribute to Demh7 ^Y ^ P b nset la ea Item 27. Pen is Enter the tlram of events - tliseeses, injuries, or compllcatiam ~ that tlireclN wusetl me death. W NOT enter Nmirel events such es certluc arrest, . g y g g u es roba ty respiratory arrest or ventrkuler fibnllalion wnrom showing the etbbgy. List onty one cause on each Gne. ^ No ^ Unknown IMMEDIATE CAUSE IFinel disease or contlhgn reauhimg m death) I ~ rN i n ~ (~ 29. tl Female. ^ Not pre nant wahn past year _~ a Due to (rn es a consequ ce o1): g ^ Pregnant al lhne of tleath h an ll h Mhions ti t s r ^ y, b y , equen a s co IearAng to the cause fisted on M1ne a. Due to or es a consequence ol): i Erner the UNDERLYING CAUSE ( I Not pregnam, ON pregnant within 42 days of tleath (diaeaae or iryury that Inkialetl the r nant nant 43 tla s to 1 ear re bm Not re c evenly resulting in tleath) LAST. , Due to (or es a consequence d): , p y y g , p g belrne death r ^ Unknavn h pregnam whhin me past year d • 30a. Was an Autopsy 30b. Ware Autopsy Findings 31. Manner of Death 32a. Dale of Injury (Momh, day, year) 32b. Describe How Injury Occurretl 32c. Place of Injury: Home, Farm, Sueel, Factory, Olfua Building, etc. /sPed/y/ Pedomretl? Available Prbr to Completion ^ Neluml ^ Homicide ' of Cause of Death? ^ Aaidem ^ Pending InVeslgalion 32d. Time of Injury 32e. Inryry at Wrnk? 321 h TrensporMtion Injury (spawyJ 32g. Laatbn of Injury (Street, chy / awn, stele) ^ Yes ^ No ^Yes ^ No ^Yes ^ No ^ Driver/Oparamr ^ Passenger ^ Pedestrian ^ Swcide ^ Cant Nm Oe Detrnmined M ghar ~ Spedfy 33e. CenMler (check Doty one) 3 ~. Signature Cenher ., `~ / ' f [/ V • CenKying physician (Physican cenitykg cause of death when ano0rer physician has pronounced deem antl completed Item 23) _____________ ^ the ceuse(s)and manner es sMted d d t h r ' ____________________ oaurre ue o To the heel of my knowledge, Ifetl ~~ Lice u 33d. Date Signed (Month, day, year) • ProrrounNnp arM ceANy4ng phyalclan (Physician both pronouncug death and cendying b cause of tleath) ^ ( ( ' 3 ( c p ~ Y 1 To the Oeat of my hnowktlge, death occurted el the time,dMe, and pace, end due to the ouse(s)and manner as etaletl__________________ OD ~ ~ L S • Metlkal Exnminerl Coroner On the besie of esemintlion and I a Invealigatlon, M my opinion, death oaumed m the lime, dale, entl place, ant due m the cause(s) arM manner as atale4 ^ 3 4. Name acct Address of Person Who Completed Cause of Death (hem 27) Type /Print L7Grr s7r 1 G~..~~~~~-r- ~J 1~_ RepiMmrs Signs re nd rb1 Number I /1i I (~ I ~ ly I ~' le Filed (Month, day, ye~) / / Z l y _ ~'yv ~{ ~' ~ 1~GiS` ,, 15 ,~ / ~ r Disposhion Pennh No. ~ ~/ ~ ~ S