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HomeMy WebLinkAbout10-18-11 (2)IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of John R. Adams a/k/a: _ a/k/a: _ a/k/a: SS NO: 185-20-5903 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 e.t.a., or d.b.n.c.t.a. (complete Part Calso) and aver that Petitioner(s) is/are entitled to the aforementioned Letters ___ : ~+nder the last Will of the above-named Decedent, dated and codicil(s) dated ~? - ?~ 1. _.... __ ~_ r _.`, T~ i ~ ~1 ~ -~~ - (State relevant circumstances, e.g. renunciation, death of executor, etc.) `~ i - - F_~ '1...'.~ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after exe~.~tfl~on of the instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person{_;zrdliwas not a _ _ party to a pending divorce proceeding at the time of death wherein grounds for divorce had been estab~li~ped as de~'.i-~ed nt 23 Pa. C.S.A. § 3323(8): _.; ,_ - ~ -~ `~ ~- ---; D 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 (If Administration e.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 .~ pending divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(8), except as follows: ti..me Joan D. Adams .vuuress 339 W. North St., Carlisle, PA 17013 Relationslhi to Deced~ Wife Jeanette Schoonover PO Box 1660, Carthage, NC 28327 DaughtE~r Jennifer Gusoff 311 Highland Ave., Jenkintown, PA 19046 Daughter Richard Adams l SIi :~DDfI'IO\a I. titn~ t~ "r~ n: Ott, ~~r~ cc. nv~ 13275 86th Ave., North, Seminole, FL 34646 Son __ ent Elizabeth Wilson - deceased 220 Cherry Lane, Lansdale, PA 19446 Sister-deceased THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At 343 W. North St., Carlisle Cumberland County PA 17013 (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then 73 _ years of age, died 5/10/2002 at Carlisle, Cumberland County, Pennsylvania (Month, Day, Year of death) (City and State where death occurred) Estimated value of decedent's property at death: _Ifdomiciled in PA All personal property $ 25 000.00 If not domiciled in PA , -~- - Personal property in 1 ennsylvania $ If not domiciled in PA ~ -- -- ---- - I ersonal property in County $ _Value of Real Estate in Pennsylvania $ - ----- Total Estimated Value $ ~- 25~JU0.00 Location of Real Lstate in Pennsylvania: (Provide full address if possible.) Signature(s) ~~.......~.., e. ,~~._:~:..._ r~. _ Joan D. Adams, 339 W. North St., Carlisle, PA 1.7013 Interim Form RW-02 revised 12 2(. 10 h~~ C'n~nh,~rl:,.,~ r,,..„~, ,.o.,,~:..~ ..,.:~_ ~....~- "-- Deceased ESTATE NO: 21- (- I Ll~~ ~,9~ Page I ot2 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 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this j~_ da of -~ __~: ~~ For the Register ~~ -. - s ,_~ _~_. r-. DECREE OF PROBATE AND GRANT OF LETTERS ~--;`„ a~ _1 " Estate Of John R. Adams ,Deceased File Number: 21-~~ ~'_ ~ ZJ ~ ; ~, r• 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 x of Administration _ are hereby granted to: Qr applicable, enter c.t.a., d.b.n., V. b.n.c.t.a., etc.) Joan D. Adams 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 ~`~' ( ~~'~CCIt,(.~'a~GO ~~p FEES: Letters ....................$ ~ 5 ~ Will ........................ Codicil(s) ................. ((k) Short Certificates _..~ U ( ) Renunciations......._ Bond ............................. _ I ~7 Other ............................. Automation FEE......... _ 5.00 JCS FEE ................... _ 23.50 --~- TOTAL ................ $ Signature of Counsel [tegy~jr~~to ~t$~ Appearance Atty's Signature "/ v~~/~~'`'v~ ~ PRINTED Name: William A. Duncan Supreme Court ID No.: z2o8o Address 1 Irvine Row _ _ _ Carlisle, PA 17013 717-249-7780 _ 717-249-7800 Phone Fax: Interim Form RW-0? revised 1226. 10 by Cumberland County pending action by the Court _` ~' _ -T:~: L'J .._s7 i~a~e 2 ~~~~~ his is to certifv~ char r~~(° inl=ormation here given is correcrl~~ ~opir~t~rc~nl un ori~;in~l crrtificarr of~ L~~a;h duly filed with me as Local Registrar.~~ hr uri~tn;tl certificate will be forwarded r,> the Srtre Viral RI°cords Office for pectna(ienr tiling. WARINING: It is illegal to duplicate this copy by photostat or photograph. H 105.117 Rav. 2187 INT ENT NAME N lee for thi, ~1'nihrare, ~?.(1l) ~H OF ~' o~/ ~s~ =, - --- - r,, ~; °J~ lG ,.ucal 1ZIr:ri~,crar (`w ,~1 a ;? * * , . ~ - -~, -~~ . ; _~ T ~ --~ ~ ;~ ~' r-n _ __ ..= ?? c:) (". ~ ~~ - - ~- ~ - ~..~ `, ~ ~ t !'. COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH K v ..~..~,.~~i lr.v...ao~e sal SDCIAL SECURITY NUMBER _m SEX DATE OF DEATH,Mnrlm. Osy.'~aarl ,. John R. Adams 2.Male ]• 185 - 20 - 5903 1' Ma 10 2 AOE (Leal BwmoaYl UNDER 1 YFAR UNDER 1 DAY DATE O~F B IRTH BIRTHPLACE (CM anp PLACE OF DER V ICtr,ca a'IY r1M-YCa nalrrC40n nn n ~ r a a al veal Man,M r Days Hours • MYaAq !MOntn. ~-I. Merl SMIaa FGegn Cawryl 'q~~ ' OTNER: .• 73 Y^. Aug.2271928 Philadel hiayP '^~»^'~ ERIQApatI.MG DwC Ha"vn"r°. ^ R p e ^ O - . 7. auunu hl ^ w. COUNTY Of DERM LYTY, BOIq, TMtP OF DEATH FACRfTV NAME 111 rla mWUnon. O^'•anMarb rrrnoar~ WAS DECEDENT OF HISPANIC ORIGINi RACE-Amanean Indian, Bhek, woes. xG. Dauphin Harrisburg Harrisburg Hospital ^» ~ ~• G Xy.NlacdTQbn 1~°`ai1 . . ~. k. „• MaaKan.PwneRkan."r:. White DECEDENT'S USUAL OCCUPRgN KIND OF BUSINESSIINOUSTRV YMS DECEDENT EVERIN ~• 10. IGira lalpdaora Day pM most U.S. ARMED FORCES? DECEDENT'S EDUCRION MARITAL STRUS-Mart»p SURVMN63POtISE d wurain! IMa; po nd ~ ( can Naves Maniw, V/f Wrap, Iry rh Orv• mbdn ru ral w ® Ne ^ E'"^'""'y''9'L0f0iry ~1•>a• D~c.d lspacryl - must Complia~ leer Banking 1a,t1 n-1as, _ ,,. diCEDENT'S MAILING AOORE5815trrrat. ClyRpvwl, $,ab, Z9 Copt) DECEDENT'S 1 ,]• ta• 17. AeruAL n.. sx. PA tXd ne.^ M., a.eaaM a..d in 343 West North St RES . IDENCE Carlisle, Pa 17013 ~^^ ^^ • w;„;' ~" a ~ t` t7s. ~L` , rnhFarland n"r'""' "1° f l ~ . na. K Em Nd FRMER'$ NAME 1Fi%. Maas. LaNI r0aro c•' ,E. Howard Adams . / MOTHER'S NAME (FwY. MEp4. Marden Surname) WFORMANT'S NAME (TypNRtr) +•• INFORMANT'S MNUNO ADDRESS (StrM, C1y/TOwn, SMM, 2+0 Copal Joan Duncan Adams METHOp OF dSPOSITgN ~• 43 W _ II~~ DRE OF dSPO$ITgN PIACE OF dSPOSRgN • Nama a Camxary, CMmatory LOCRgN - Ciryrt . Slx. ^ (Milan, Da); Marl Zo CoW ^ Cremation tom Rarrorx here Stx P d . , a a l,at MCa Dartbn ^ OtMr ^ "` :,t. ~''~Y 14 y 2002 21eYorktowne Cremation Serv ' SIDN FU LSERVICE Yo k P . :,d. r A S PE AS SUCH LK,ENSE NUMBER NAME AND ADDRESS OF FACILITY o man- o Hera Home ~ anpl.te~.nlaM at. 010343 ~- c Dory roan urtifyinq dmy anow»dgs, raextM ttM.dna anp pauR IW. LICENSE NUMBER Wgaeian' nil setae x ume of uxn q (Sy,,.,,,e arle Tnel RE SgNEO • ranty uuwda..m. `~j2~ ~ ,. paa+n ~j ~ Dax wrl ` a ,,,, , ~ . S -03 ~~~ -L u~a'L. (/ ~S Xeme 2428 max M compxad o Y TIME OF OERN GATE PRONOUNCED DEAD IMOnm, Dey, Marl paraon,db pronounces a.m. VMS CASE REfE IO MEDICAL EXAMINERICORONER7 ~-1 . 2a d ~ ~~ 0 /'t'L " • I(' 'Z C~V Z ~`('` ( • • . ~ , / M. 23. ( j ~ NOtJ 17. TART 1: EMx,M aa.aa.s, irpuiroa a compeca,brro wniNr uusaa IM uatn. M no, enlx IM mob of M• Lix OMyorla Gus.On aaU Tina. pl'•W. x,cn as Grpiat a rsapralory xreat, slack er Msrt 1aauM. i Apgpaimata PART R: OUNf signiBCaM unplliona opnplpylyly b uat8 aA , YIIETIUTl CAUSE (Foal jarx anp uael not r•sutlirrpnpr uMxlykp cxr Pranin PARTI. gaMY a eonWierl DUE IO ASACONS EWENCE OFJ: D ~ M anlL Maar,p b ^.^aa.u ( Dl1E 10108 AS A CONSEOVENCE OF): I • arr. Enbr IINOERLYINO ~ c CAUSE lDsrr a ryMy i • tW ttOalW Mrrb qUE T010R AS ACON$EOVENCE OF): raas,SmrTaamILAST ' -_ 1 d. V11s.4 AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OFIWURY TIME OFIWVRY IWURYRYKIRK7 DESCRIBE FIOW INJVRY OCCURRED PERFORMED? AWLABLE PRKXI IO M . I mm, Day. ,tar) COMPLETpN OF CAUSE ^ OF DERH7 Natwx /lorllkide Accident ^ ParMirq Irr•exiyallOn ^ ~••• ^ Ne ^ ~rrrrA~~~~y.~~~/~~ `M ^ No Vs! ^ N• ^ Suicide ^ Count nMMd^rminad ^ PLACE OFIWURY- ]a. M. ~, 70d ( AI Mme term ores, lad 8k , . . ery, o t e LOCRgN ISaeal. LM/torn. S,xel ~•• 28t. M. Ga,anp, xe. l5pxM1 CERTIFIER ICnsd arM art ~' ]d. 'CERTWI,Ka M1Y8N:lAN 1PnyMUln cxlaywrg uuyadua8r wean anane•dryacum Has aanamced peam ano comaxe0 ryem 271 Te,M Mat el my knorladge, deem ettuned drw b me eau •e(al and mann.r as an,w SgNQ^UR~E AND TITLE OF ERTIFIE ~]"" r ~ ~ . ..................................................... ^ • . ~ ~' i C `"L~~J~2~ Yl ~1 L~ /•~ s ~V p,a. PItG1gUNCING ANO CERTIFYING PHYSICIAN IPnyacen nom aaornc ceam e.~rour,a.duaml ' To,MMxelmyXrrarrladtlw.dsaMOeeu•raAatlMtlnra dxa and l ~ M LICENSE NUMBER _ © , ~,~tG _ ~ DRE SK3NED1 Marl gav - - ® . . ar dr.bm. P •Nel and mannerna„tw ................... ~ ~, ],e. ~ // Z a,d. ~O • 'MEDICAL EXAMINER/CORONER NAME AND ADDRESS OF PERSON wH0 COMPLETED CAUSE OF DERM (Item 271 Typap PrMt man Neu ata,W ~minatlon anNOr inreatigatien, M my opinion, death occurred al IM lima, dxe, and place, and due to tM eauw(a) and Mark Osevala ^ ],.. .................................... ............... REGISTRAR'S SgNATURE AN R 1 h. Street 22. • ~ A, ~C~L.~~ DRE FILED ( onm. Day. M,ary~ r