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Home My WebLink About01-04-12IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Charles B. Ewing a/k/a: ,Deceased ESTATE NO: 21- d <?- ' L'lr'' ~ (i,~ a/k/a: a/k/a: SS NO: 176-56-0714 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 l]Administration c.t.a., or d.b.n.c.t.a. (co>~lete Part Calso) and aver that Petitioner(s) is/are entitled to the aforementioned Letters the last Will of the above-named Decedent, dated ~_ "-under ~-~ -________ and codicil(s) dated ,~~' --- - t~ -. _ m (State relevant circumstances, e.g, renunciation, death ofexecutor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after ~xeeution of t~lr'e instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated personnel was Trot a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been esta~ished as d 1 T 23 Pa. C.S.A. § 3323(8): e€ped iri' ~ `-~', D B. Grant of Letters of Administration See attached Renunciations (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 (lf 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: N/A __ Name Charles S. Ewin '°°"'° Relationshi to Decedent g 500 Gloucester St. #C, Mechanicsburg, PA 17055 C~16e-~-Eyd1~1g- Son , bur Ew° ~~ 1'S ~; AllDITIONAL SHGG"CS IP NL .F,SSAnv ~' 61411 ~/_ H~! Pe H_ .i~ THIS SECTION MUST BE COMPLETED: ~ ~'Jd7~ ~J Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At 137 Blacksmith Road Lower Allen Townshi Cam Hill PA 17011 (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then 45 years of age, died 11/5/2011 at Harrisburg Hospital, Harrisburg, PA Estimated value of decedent's property at death: (Month, Day, Year of death) (City and State where death occurred) _If domiciled in PA All personal property _If not domiciled in PA Personal roe $ 4 000.00 _If not domiciled in PA P P rtY in Pennsylvania $ _Value of Real Estate in Pennsylvania Personal property in County $ $ 645,000.00 Total Estimated Value $ 649 000.00 Location of Real Estate in Pennsylvania: (Provide full address if possible.) 137 Blacksmith Road, Camp Hill, PA 17011 128 S. Locust Point Road, Mechanicsburg, PA 17055 and 823 S. Cameron Street, Harrisburg, PA 17104 ~ ~ I 7+ Sign~re(s) Name(s) & il7ailing Address(es) Shandra Ewing, 5500 Gloucester St. #C, Mechanicsburg, PA 17055 (717)802-2113 Interim form RW-02 revised 7226. 10 by Cumberland County pending action by the Court Pa~~c I of OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania County of Cumberland SS 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 ~~ ";r ~? +~'~ir; :~,' ~ , <`~O day of For the Register <-- ~ t ~ ~~ =c ~ _ _, DECREE OF PROBATE AND GRANT OF LETTERS `' Estate of Charles B. Ewin ,,.~ Deceased File Number: 21- ' ~. AND NOW, this ---1___1 day of ~(~ ~ '(, , the reverse side hereoq, satisfactory proof havin be ~ ~~ ~ ~ , in consideration of the Petition on Testamenta I,,/ g presented before me, IT IS DECREED that Letters ~, ry ____ of Administration rI are hereby granted to: 1 ~ / ~v ~ r , ~- (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) )))1 1. 1 ~ ~_ ~~ ' ~ [ the above estate and that inst nts(s) dated __ in admitted to probate and filed of record as the last Will and Codicil(s) of Decedent ribed in the petition be FEES: Letters ....................$ "~ ~,. ~~~ Will ................. Codicil(s)............ (~) Short Certificates ') ~" (~) Renunciations....... , 7 ~ ~. =%~~ Bond ............................ Other ............................ ................................. Automation FEE......... 5.00 JCS FEE ................... 23.50 -~ 7~ `, TOTAL ................ $ '~' C -, . /~'~ Glenda Farner Strasbaugh,'~r .~~' ; ~~ ~ ~ ~ ~ ~~..~, Register of Wills ~ ;~1 ~ ~`'~~~~`~ i''`- Signature of Counsel Required to Enter Appearance Atty's Signature l PRINTED Name: Craig A. Diehl, Esquire Supreme Court ID No.: 5z8o1 Address: Phone: Fax: Interim Porm KW-02 revised 1226.10 by Cumberland County pending action by the Court 3464 Trindle Road Camp Hill PA 17011 (717) 763-7613 (717) 763-8293 Page 2 of ~ Itl"=rn~ i<!.~ ~, , LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee fn(~ phis certific,itL- 56.O(1 ____P 17645987 CelCific.aiorl 'd(nnber ~~ Lbnnu Dan Hors Miruxes - - a lace ~ antl skk al ~ ncan 6a. Place d Deem Chedt ore v V/ 45 vrs. 3/6/1966 Harrisb H.o~sp~kl: Dthac Sb. County d Deam &. City. Bom. Tvq. d oeam Btl. Fadlity Name (d nil iredulkn, Urg E PA `LJ' Irgatlent ^ ER / OugwMnt ^ DDA ^ Nursing Homo ^ Reatlenca ^ Olhn - Spaply. give street aM nunmep 9. Was Decedent d Hlspank Odpn? ' Dell h1n fd Yas, apecily Cuoan. ~No ^ Yes 1D Race: American Irgian, aadc, White, em. P Harrisburg Harrisburg Hospital Mexican, Puerto Rican, em, (~~ 11. Decedents Usual tion King d work done tlu' most d Me. Do na skk retiretl t2. Wasp atlent ever In ryy 13. DaceOanYS EduWGOn (Spealy Wy nighagt grade mmpaladl 14. MarRel SkNS~ Marled, Never Mamea, 15. Survry S ~lte Kind d Work Kwd Business/Inmktry U.S. Amkd Forces? xg pause (K wife. Self to ed Construction Elemenkry /Secondary (0-12) 1 cakge (t-a or s+) w. ~a~d IsDaeN~ gna maims namal ^ Vea ~ Na Divorced 16. DecetlenYS Mdkrg Address (Street ary /sown, skte, zip ails) Decetlenrs 823 S . Cameron St • Moral Resideae 17a. Skte PA Ditl Decedent lire in a t 7c. ~ vas, Decedent LiveO n LOwP_.Y' Allen Harrisbur PA 17104 176. caanry Cumberland Two? Twp 17d. ^ No, DecMenl Livetl within 76. Fathers Name (First, rtkddle, ksL suffix) qa~ ~~ d -t13L-1P.S D 79. Molhefs Name (Fast. mitlOk maitlen wmema) Cm// Boro EWin H706-113 REV 112006 TYPE / PRINT W COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PERMANEM BLACK INK CERTIFICATE OF DEATH (See instructions and examples on reverse) t. Name d Decedent (First, mitlde, lest, wlfix) STATE FILE NUMBER Charles B • ~lIl 2. Sex 3. Social Security Number 4 Dak 9 Male 176 _ 56 0714 ~, ~ . ~'r'"~r) 5. Age (Last BirttkaY) Untlar t rear i LN•r r n,,, g Donna Bowermaster 20a. Inknnad's Name (Type / Prep Charles D . Etx7ing 20b. mlormanra Meiling Addr~eac!shad, illy / tuwn, akk, xp aoae) 135 Pin Oak Dr• New Ctunbesland, PA 17070 27a. Medkd d pispositbn ^ Cremation ^ Deletion 21 b. Dak d D • ^ O~tlkr Burial isPasdlan IMam, day, year) 2tc. Pace d DLsposition (Name of candery, aematay a ogler 4 Renwval hen Skk i Was Cmation a Donation Austgr¢ad Dkce) 2ttl Laaaon (City/ lows, sloe. zy mtle) ~ ~ar^+ndYC«otwr ^ vaa^ Na 11 /9/2011 Rolling Green Memorial Park - ~ k"~F ~ arNCe aanry~~) zn.I.icenseNpmlkr Camp Hill, PA 17011 a ~ - / 22c. Narrk and Address d Palley Neill Funeral Hone Inc FD 013239 L 3401 Market St. Camp Hill, PA 17011 Cmplde ~ 23et mry wfkn certitykg 23a. To the beat d my knowledge, deem occurred d 8k time, dale and place skkd. (signature and title) Dln~lan na avatlable ar tare d loam to adry d seam. Bdm 2x-26 must be compkkd by persm 24. r ne o rAp prakurx:es deem. /-~ i M. 23b. LKBrNe Number 23c. Dak Sigtktl (Monet. day, year) CAUSE OF DEATH (See InatnwYlons arM examples) ~r~ ~01~ Kan 27. Pan I: Enler tlk dkin of a ~k -diseases, irpudes, a mrtpicatiaw -mat Erectly caused me deem. Dp NOT inter terminal ewxaa such as cartlkc anent, r ~x~ le~ respiretay anal, a Insular flxNaean witlkut sMwirg tlk etrobgy. List any ale reuse on assn Ina. Omd k gam IMMEDWTE CAUSE (Final disease or ~ ,~v artdiuon reaultlrg in loam) -~ a. Due m for as consequence oq: , fry Nsi mnabare. n arty, ,. i ; ~ ~ -~ k cease Laced a ark a. Eder UNDERLYg4D CAUSE Due k (a as a~~ft. (disease a njury mat initiated me 1 events resulting n e~ml LAST. c ~ f I rP ' Due k ( as a consequence ory. P fn 30a. Was en Autopsy 30b. Were Autopsy F kMUam,~~ t Penomkd? Available Pro Cmpletion 3„ / r d DeaM 37a. Dak of Inryry (IAOnm, day, Yeat) 32p. Descdbe Haw InWry Oc<vrrcy of Cause of Deem? (~yN Nrd ^ Ibmkjde ^ Vas ~ ^ ^ ^ Accnenl ^ P 32d Time f I ' -~ ri -this iti tt~ cc,lli~ th<rt Uac inlttrln~(t(Ltli mere ;`i',en l'(,rt-eCllb ~UOi~,kl };~U11i ail? L~7~J~TIt:~tt t~f'r1111~~~1ie (1` 1)Cti caul} Ellett .~il'~ 3;~~ ~~~ 1-(~C1U 1Z~r~istl~u. "hhe (~rir~in: certificate vs,} ~L~ tt~rria~;zrdecl tl1 the date Vic. RecOrd~ C)Ilil~t~ .,) nc~rnuuu'nt filirsr .~ , ~~~ Lucal Re~~i~~lr.:,, ! ~an~ Issul°d was Case Refenetl ro Medial Exankkr / canner for a Rceson Other man Cematon or Doiktnn? ^ vaa Qty but nil resudplg in m0 urkerlymg cause given n Part I. U Yes ^ Probaby ^ No ^ Unkrkwn 29. H Female: ^ Nil Dregnant wimn past year ^ Pregnant at 6me d deem ^ Not pregrknL bN pegrent within 42 tlays 0l deem ^ Not pregrknt but pregnant 43 tlaya to 1 year berore deem ^ Unknown g pregnant within tlk pall year 32c. Place d Iry'ury~ Honk, Fans, Street, Factory, Office Bulldog, etc. (SpecvNl Ves No endrg Imestigatian ~ ° nWry 82e. Inlury at Work? 32f. p Transpaletion Injury (Sperryl 32g Location of injury (Sired, dry / mwn, ^ Suilde ^ Cold Nat be Ddermined M ^vaa ^ No ^ Driver/operator ^ Passenger ^ Pedestrian 3:se. Caroller (alkck ary noel omen -Spedry: CMftying pnyskkn (Physician cerdyng ruse d deem when another physilan has 33b. Signature antl rile d Gasifier • To me bust m my knowledge, seam acauned ens ro me a pf0fg1II1Bd deem and canplrnetl Ikm zs) _ • Pralauntln and use(s) and manna u rnakd_ _ _ _ _ _ _ _ _ _ _ _ g cenlying physldan (Physican bom _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ pmrounlrg deem and ce .. _ _ _ _ ^ To me bed d my knowktlge, deem occurred d the lets, d.k, atM plea, and dueo m cease d deem) 33tl Signal • Medial Ezemker/Caortsr uss(a) and manner as ddea_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ . on me Dais d.xamirwlm aria / ar mvedigation, m my apmwn, loam occurred d tM Nine. ask, am plea, and sue k me a use(a)and merxMr as skled_ ^ g4.N n/dJ~tl mod/ ,~~.~p/~/s.~/~~~ /y~y {p/elm/,~' 36. Reoi4n s~gnaWre aM tuber ~jM1 ~/V ~`~' i/ / ~~V // C.a~TYDe/Poor/ Dispositim Pennd No. - ~ ~~ ~ ~ ~ 7 0% CI/ REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA RENUNCIATION IN RE: To the Register of Wills of Cumberland County, Pennsylvania: I, the undersigned, hereby renounce any right to administer the Estate of CHARLES B. EWING, deceased, and respectfully request that Letters be issued to Shandra Ewing. Witness my hand this I ~' day of ~ ~ ~r,n b e~ , 2011. /f_f Charles S. Ewing .r~ +/ ~r~ Address: 5500 Gloucester Street #C Mechanicsburg PA 17055 Sworn to or affirmed and subscribed before me this ~' ~1 day of ,1~e c~ m b~.r , 2011. ~L~ ~~71 ~~ _ ~~ ~7 -_- ;.__ N ary Public . ; . ,_; -r, ~_ . My Commission Exppires: COMMONW~L ~~INSYLVANIA _, ~_ NOTARIAL SEAL Public Kathleen A. Sweeney, otary _-;~ - • ~ Y Hampden Twp. Cumberland County 7~_, ° • , .-, _ ; My Commission Expires June 9,2015 (00132638/1) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA RENUNCIATION IN RE: To the Register of Wills of Cumberland County, Pennsylvania: I, the undersigned, hereby renounce any right to administer the Estate of CHARLES B. EWING, deceased, and respectfully request that Letters be issued to Shandra Ewing. Witness my hand this 1 ~ day of ~ece.~~b~ , 2011. ~` ~? ~ ..% ~-l 7z onna M. Ewing Address: 135 Pin Uak Drive New Cumberland PA 17070 Sworn to or affirmed and subscribed before me this ) / day of 2cew, b ~ : ~ _.,_., 2011. ,_ ~ -. ! T ~_ 1 ,. _ . ~,-, N ary Public ~ -~~ My Co CoMM~~VE'AL~~~ PE~s t~A l~ NOTARIAL SEAL --.-~ _ -- Kathleen A. Sweeney, Notary Public -~ ~ - _, --. Hampden Twp. Cumberland County ~ ~ =~ My Commission Expires June 9,2015 {00132638/I} REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA RENUNCIATION IN RE: To the Register of Wills of Cumberland County, Pennsylvania: I, the undersigned, hereby renounce any right to administer the Estate of CHARLES B. EWING, deceased, and respectfully request that Letters be issued to Shandra Ewing. Witness my hand this ~ ~ day of ~2e.(" , 2011. ~ r ~~ --- Charles D. E ink`-' Address: 135 Pin Oak Drive New Cumberland. PA 17070 Sworn to or affirmed and subscribed before me this (~ day ....~ of , Lam,., ~' , 2011. a ~--~ Q~,-~ ~c ,~ No~ary Public ! My Commission Expires: (p -q - )rJ' COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Kathleen A. Sweeney, Notary Public Hampden Twp. Cumberland County My Commission Expires June 9,2015 :~ -o ::;.: I_ {.~ r - ~ ;` -1 {00132638/1)