HomeMy WebLinkAbout03-09-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
COUNTY, PENNSYLVANIA
Petitioner(s) named below, who is/are 1 & years of age or older, apply(ies) for Letters as specified below, and in
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form:
Decedent's Information
Name: Esther L. Ramp
a/k/a:
a/k/a:
a/k/a:
Date of Death: 05/13/2009
_,
File No: ~ ~ - ~ (; - ... -~~._ ~_
(Assigned by Register)
Social Security No: 200-22-6199
Age at death: 80
Decedent was domiciled at death in Cumberland County, pennsylvania (Stare) with his/her last
principal residence at 1000 Claremont Road Carlisle Cumberland
Street address, Post Office and Zip Code City, Township or Bor ough County
Decedent died at 1000 Claremont Road Carlisle Cumberland PA
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ............................ All personal property $
If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County $
Value of real estate in Pennsylvania ...................... .................................. . $
TOTAL ESTIMATED VALUE... . $ 0.00
Real estate in Pennsylvania situated at:
(Attach additional sheets, if necessary.)
Street address, Post Office and Zip Code City, Township or Borough County
A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated May 2, 1997 and Codicil(s)
thereto dated r.. ..
State relevant circumstances (e.g. renunciation, death of executor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorces
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
Q NO EXCEPTIONS ~ EXCEPTIONS
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1,.,_/J B. Petition for Grant of Letters of Administration (If applicable) c.t.a. ~~ ~.~~ {~
c.t.a., d. b. n., d.b.n.c.t.a., pendente life, durante absentia, durafife minoritate~
If Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
NO EXCEPTIONS ®EXCEPTIONS
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 (attach
additional sheets, if necessary):
Name Relationshi Address
Form RW-02 rev. 10/11/?011 Page 1. of 2
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
the fore ~n Petition are true and correct to the best of the knowledge and belief
i e Petrt' will well and truly administer the estate accordi g to I~w.
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-- Date
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Date
Date
Date
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. ~ _ Officia ~J$e Only
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Petitioner(s) Printed Name Petitioner(s) Pri C` /'~(";~
JeffBouder 17 S. Hi h Street ~1~+'~~~'~~' ~r,~-~ ~~
Newville, PA 17241
The Petitioner(s) above-named swear(s) or affirm(s) the statements in
of Petitioner(s) and that, as Personal Representative(s) of the Decedei
Sworn to or affirmed and subscribed before ~:
me ' da cf_~~~ (1~'. f'~ i ;r~
Y ,
For the Register
BOND Required: Q Y"LS ~ NO
FEES:
Letters ...................... $ ~ ~~ . ~`•~;
(~ )Short Certificate(s)...... ,~
( ~ )Renunciation(s)......... ~ ~ ~'~(~
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ..... , . .
Automation Fee .............. .
JCS Fee . ................... . J
TOTAL ..................... ~ )-l..G -
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
1 ~ _..
~. ~
Printed Name: Mark A. Mateya
Supreme Court
ID Number: 78931
Firm Name: Mateya Law Firm
Address: 55 W. Church Avenue
Carlisle PA 17013
Phone: 717-241-6500
Fax: 717-241-3099
Email: mam(~mateyalaw cnm
DECREE OF THE REGISTER
}
} SS:
}
Estate of Esther L. Ramn File No: ' ~ - I (~ C ~- ~ ;> ~;
a/k/a:
AND NOW, i '~ j (~~ ~ ( .~ 1 ~'~-~ ~ ~ -',~ ~ ~ =~- , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters ~~~ (i-; ~ ; ` ~.~ ~~, ~,_"~ ~~ ~;~ ~ (' l~
are hereby granted to _ ~ ~~ -~' j~'(` c '~ C j
in the above estate and (iI applicable) that
the instrtunent(s) dated _ J ~. `- ~~
described in the Petition be
Form RW-02 rev. 10/11/201 /
to probate and filed of record as the last Will (and CodicilO) vi Decedent.
1 ~~ _ ~ ~{
lZegtster of Wills _
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Page 2 of 2
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t Type/Print In
Permanent COMMONWEALTH O F PENNSYLVANIA . DEPARTMENT OF HEALTH .VITAL RECORDS
'3
1. Decetle nt's Legal Name (First, Middle, Last, Suffix) ~. v~~ r ~ State Flle Number:
2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo)
Gail
L Bouder Female 26 - 840 Januar 15 2012
Sa. Age-Last Birthday (Vrs) 6b. Under 1 Year Sc
Und
1 D
.
er
a 6. Date of Birth (MO/Day/Yea r) (Spell Month) 7a. Birthplace (City and Sta<e or Foreign Country)
Months Days Hours Mi
nutes Carl PA
79
October 15, 1932 2b. Birthplace(cpunTy) r
Ba
Residen
S
.
ce (
an
tate or Foreign Cou n[ry) 8b. Residence (Street and Number -Include ApC No.) 8c. Did Decedent Live In a Township?
PA
Sd. Residence (cp~nty) 2267 Ritner Hi hwa L~3Ye~, detedent eyed In West Pennsboro Ty,
p.
C<snberland
8e. Residence (Zip Cade) ~ 7~ ~ 5 ONO, decedent Ilyed within Iim its of
9
E
.
city/boro.
ver in U.S~~1ACCr''m'ed Forces? 30. Marital Status at Time of Death [] Married ~ Widowed 11
Su rvtyin
S
'
~ V
.
g
pouse
s Name (If wife, give name prior to first marriage)
es I~-NO ~ Unknown ~ piyorced Q Never Married (] Unknow
_
12. Father's Name (Fl rst, Middle, Last, Suffix)
13. Mother's Name Prior to FirsT Marriage (First, MYdtlle, Last)
Frank Culbertson
Marti-ia Wri ht
14a. Informant's Name
o 146. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, Ci
ty. State
Je££rey Bouder
Zip Codej
G ,
Son
77 S_ Hi
h St
- ille, PA
g
7 41
z ............................................................. -"'-..... lsa. P awe p Dear c ¢~
If Death Occurred in a Has tal~ """"""""'"""""-""'r---~--~~-•• .................................... on y one
pi ~ In bent .. .............................. .. ..
Pa
If D
th
~ ~~ ~
° ..
[
ea
Occurred Somewhere Other Than a Hospi[a I:
~~'~~~'-"""""""""" ' """e
~] Hospice Facility Cf Dec dent's Home
[] Emergency Room/Outpatient Q peed on Arrival
Nursing Home/Long-Term Care Facility ~ Other (Specify)
156. Facility Name (If not Institution, give street and number; .16
c. City or Town, State, and Zip Code SStl. County of Death
Forest Park
Carlisle, PA 17013 Cumberland
16a. Method of Disposi<ion ® Bu
i
l
r
a
~ Crema<ion S6b. Dale of Disposition 16c. Place of Disposition (Name of cemetery, c ory, or o her place)
Q Removal From State ~ Dona [ion rema
~ oTher(spe~lfy) 1 23 2012 WcstrLttnster Ceirlat
16d
Locati
f Di
.
on o
e
sposition (City nr Town, State, and Zip) 17a. Signature of F n I Service Licensee o I
C
n
of Interment 17b. License Number
Carlisle, PA 170'13
o 17c. Name and Gom I FD O 1 2633 L
p ete Address of Fun¢ral Facility
Ekn7irl Brothers Funeral Hoene, Snc. 630 S_ Hanover St
C
'
'
m _
arlisle, PA
1
70"13
18. Decedent's Education -Check the box that best describes [he 19. Decedent of Hispanic Ori
i
Ch
k
~ g
n -
ec
the 20. Decedent's Race -Check ONE Oft MORE ra
highest degree or level of school completed at the time of death, box that best describes wheth
to Indicate what
h
d
er t
e
ecetl ent th
e
d
ecedent considered himself or herself to be_
[] Sih grade or less Is S
ani
h/Hi
"
.
~
/
p
s
spanic/Latino. Check the
t_-I ~,hite
[] No diploma, 9th - 12th grade bo
No" ~ ~ Korean
if d
d
O
x
ece
ent Is not s pan
[] High school graduate or GED completed Panish/HIS lc/Latino. ~ Black or African American Vietnamese
~'fJ
t S
O, no
panish/Hispanic/Latino Q American Indian or Alaska Native ~ Other Asian
~SOme college credit, but no degree O Y
M
es,
exican, Mexican American, Chicano ~ Asian Indian ~ Natiye Hawaiian
~ Associate degree (e.g. AA, q5)
Q Ves
Puert
Ri
,
o
can Chinese
~ Bachelor's degree (e.g. BA, AB, BS) O Ves
0 Gua manlan or Cha morro
Cuban O
,
Fill ino
Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Ves, other 5 ~ p ~ Samoan
panish/Hispanic/Latino
~ Doctorate (e. PhD, EtlD
Q Japanese ~ Other Pacific Islander
g~ ) or Professional degree
(Specify) ~ Other
. MD, DDS DVM, LLB JD (Specify)
21..-D.ece~dent's Single Race Self-Designation -Check ONLY ONE <o Indicate what the decedent considered himself or herself to be
22
D
d
'
°"^'t
.
a.
ece
ent
s usual Occu
L~
¢ ~ Japanese ~ Samoan Pa[ion -Indicate type of work
l
~ B
ack or African American ~ Korean done during most of working life. DO NOT USE RETIRED.
~ Other Pacific Islander
Q American Indian or Alaska Natiye Vietnamese
~ ~ Don't Know/NOC Sure PraCtl Cal Nurs
~ Asian Indi
an
es
a Other Asian ~ Refused
Q Chinese
22b. Kind of Business/Indust
Natiye Hawaiian Q Other (Specify) ry
[] FI1IP~nP ~ Guamanian or Chamorro
Nursing
ITEMS 23a - 23d MUST BE COMPLETED 23a. Dace Pronounced Dead Mo Da
Yr) 236
Si
y
.
gnature of Person Pronouncing Death (Onl
BV PERSON WHO PRONOUNCES OR y when applicable) 23c. License Number
CERTIFIES DEATH Januar 15 , 2O 12
23d. Date Signed (MO/Day/Vr) 24. Time of Death
7:35 A. M. zs. was Memcal Examrner pr coroner cnnta~ced? ves ~ N
o
CAUSE OF DEATH
26. PaR I. Enter the chain of events--diseases, injuries, or complications--that directly caus¢d the death
APProximate
DO NOT
t
.
en
er terminal ey nts such a
e
respiratory arresi, or ventricular fibrillation without showin the etlolo s ca rdlac arrest Interval:
g gy. DO NOT ABBREVIATE
Enter o
l
.
n
y one cause on a line- Add additional lines If necessary Onset to Death
IMMEDIATE CAUSE ------------ --> a. $E±pS iS
(Final disease or condition Due to (o eq ue rice of):
resulting in death) r as a cons --- -
b_ Urinarv Tract =n£ection
Seq uentl ally list conditions, Due to (or sequence of):
if any, leading to the cause as a con ~- -
RstedPnrnea. Enc¢r the Multiple Traumatic =n'~ur ies
UNDERLYING CAUSE Due to (or sequence of
(disease or Injury that as a con ) ---- -
s initiated the eyencs reswnng d. Motor Vehicle Crash
In death) LAST.
Due to (or as a consequence of): --- -
S 26. Part II. Enter other signif'ca nt cond't" [ 'b t d th but not resulting In Lhe untlerl
in
ca
i
g
use g
Y
ven in Part I
27- Was an autopsy p rtormed7
Renal lnsu££ic iency O Ve: No
m 28. Were autopsy findings ayalla ble
-
cn
to plate the c of death?
a
29
If Female:
E .
O Yes
Q No
30. Did Tobacco Use Contribute to Death?
~ Not pregnant within past year 31. Manner of peach
o
~ Pregnant at time of death Q Yes 0 Probably Q Natural
~ Homicide
~ ~ Not pregnant, but pregnant within 42 days of death ~ NO ~ Unknown
~ACClden< ~ Pending InyesLigation
Q Not
re
na
t
b
S
i
p
g
n
,
ut pre
u
cide 0 Could not be determined
~ Unknown if pre gnant 43 days to 1 year before death 32. Date of In'u
gnant within the past year J ry IMo/pay/Yr) (Spell Month)
December 8, 2011 33. Time of Injury
34. Place of Injury (e.g. home, cOnstru coon site; farm; school) A rOX 1:25 P _ M.
35
L
.
ocation of Injury (Street and Number, City, State, 21p Code)
Rural Roadwa Williams Grove Road, Mechanicsburg
36. Injury at Work 37. If Transportation In)
PA
S
,
ury,
pecify: 38. Describe Now Injury Occurred:
p Yes Drlyer/Operator ~ Pedestrian Operator Failed to stop at Red Light
No [] P
assenger I] Other (Specify) Struck other Vehicle
.
39a. Certifier (Check only one):
[] Certifying physician - To Lhe best my ledge, de red due [o the cause(s) and manner stated
PronouncingR Certiyin~YSi~,~a y knowledge, death occurred at the time
dat
d
n
,
e, an
Medical Examiner~ r _ O
place, and due to the c se(s) and manner stated
b i f examin 1 and/or I s[igation, in my opinion, death occurred at the time
date
a
d
l
t
,
,
n
p
ace, antl due to the. cause(s) and manner stated
Signature of certifier:
c rtifier: ~OrOnOr Ucense Number:_
39b. Name, Address and Zip Code of Pe on Com Ling Cause of Death (It
26
em
)
Todd C. Eckenrode, Coroner 6375 Basel-lore Road, Suite ~P1 39=. Date Signed (MO/Day/Yr)
4 0. Registrar's District Number 41. Regis(rar's
anti 18 2Q 12
~t ~ ~ -l ~O 42. Registrar File Date (MO Day r)
4 ` R
3. Amendments ~ `~ aO I~~
Disposition Permit No._ l l ~ ~ \ ~ ~ ~ H105-143
- REV 07/2011
t 1 ~
REGISTER OF WILLS OF
Estate of Esther L Ram
RENUNCIATION
CUMBERLAND
/ >
Deceased
~~ Ronald L. Bouder in my capacity/relationship as
nn ame
Co-Executor
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Jeffrey L. Bouder
3 -- ~ !~.
(Date)
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~zecuteaF~in Regisf+e~-'s Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
^'I
rsignarurel Ronald L. Bouder
621 Whiskey Springs Road
(Street Address)
Boiling Springs, PA 17007
(City, State, Zip)
Execufed 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 (~. ~.
of ~.-S,C-~~ ~ ~'1 ~L
Notary Public
My Commission Expires:
(Signature and seal of Notary or other official qualified to
admirnster oaths. Show date of expiration of Notary's commission
COUNTY, PENNSYLVANIA
C.GP•Yts~7NW~ALTH OF P?~~f"d.?~l.VANIA
Form RW-O6 Rey io-is-loos
IVotarfai sea!
Fr7nr_e~; ,, Rum!Iler, ;Nnl~ry ~'ublic
Sizuth Mid~teton awl., Cu~rbc~~lrtr~t; ~:ounty
My Cr,mrnissictr ~x~iree f l~r'c;ao `c, 21714 _
Mamt~er. Penn_,yP.r;r~~.3 A=s „~ti~~.~ of Notaries
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