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HomeMy WebLinkAbout03-14-12PETITION FOR PROBATE AND GRANT OF LETTERS Register of Wills of Cumberland County, Pennsylvania Petitioner, named below, who is 18 years of age or older, applies for Letters as specified below, and in support thereof, avers the following and respectfully requests the grant of Letters in the appropriate form:: DECEDENT'S INFORMATION Estate of JAMES B. TAYLOR File No~ ~ ~ ~ J I v Deceased Social Security No. Date of Death: February 16, 2012 Age at Death: 84 Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his last family or principal residence at 520 Old Orchard Lane Camp Hill Cumberland County PA 17011 (List street, address, townlcity, county, state, zip code) Decedent died at Osteopathic Hospital 17111 Harrisburg, Dauphin County, PA List street, address, Post Office and zip code city, township or Borough County State, Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property .....................................................................:$ 14,000.00 (If not domiciled in PA) Personal property m Pennsylvania .....................................$ (If not domiciled in PA) Personal property in County ....................................................$ Value of real estate in Pennsylvania ......................................................................................................................$ 195.500.00 Total ......................................................................................................... $ 209.500.00 Real Estate situated as follows: 520 Old Orchard Lane Camp Hill 17011 Borough of Wormleysburq Cumberland Co PA (attache additional sheets ifnecessaryJ Street address, Post Office and Zip Code City, Township cx Borough County, State A. Probate and Grant of Letters. Petitioner avers that decedent, James B. Taylor named Craig A. Taylor, Pamela L Merrow and David W. Taylor Co-Executors of his Will dated March 2, 1977. Pamela L. Merrow and David W. Taylor have both renounced their right to serve as Co-Executors. Petitioner is the Co-Executor under Decedent's Will State relevant circumstances, e.g. renunciation, death of F~cecutor, etc. Except as follows, After the execution of the instrument offered for probate, Decedent did not marry, was not divorced, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce has been established as defined in 23 Pa.C.S.A. § 3323(8) and did not have a child born or adopted and the Decedent was neither the victim of a killing and was never adjudicated an incapacitated person ~ NO EXCEPTIONS ^ EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (if applicable) enter: c.t.a.; d.b.n.c.t.a.; pendent elite; durante absentia; durante minoritate If Administration, c.t.a. or d.b.n.c.ta., Except as follows: Decedent was not a party to a pending divorce proceeding at the time of death wherein rounds for divorce has been established as defined in 23 Pa.C.S.A. § 3323(8) and was neither a victim ofdkilling anus never adjudicated an incapacitated person ~O ~'~' -r; ~~ `a7'Z7 ~ ~ C- C~ ~ "~" ~ --` ^ NO EXCEPTIONS ^ EXCEPTIONS ~ ~ _ ~~~ ~ Petitioner, after a proper search, has ascertained that Decedent left no Will and was survived LS~i~lllowing any) and heirs (attached additional sheets, if necessary) ~aU _- -; ,~ spQu§~-; Name Relationshi Residence ~ , OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND O~'~~~1~ 4~-~-il;F Q~ ~~~ ,itc ~~_w~ ~.. Pri Craig A. Taylor CLERK nr 6 Fairfield Lane }•{AAJ'~ (;©~1RT Mechanicsburg, PA ~_r~ 'AA`` /, ~~i f?~IVn' ~~~ PA The Petitioner above-named swears or affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal represen 've o e Decedent, Petitioner will well and truly administer the estate according to law. Sworn to and affirmed and ubscribed RA/GA. TAYLOR Before m this day of ~~~~/~e~2!sff" i ~ .2012. the BOND Required ^ YES D NO FEES: Letters ........................... $ ~~U { ~/~ Short Certificate(s) $ ~~ }Renunciation .............. $ /~ { )Codicil(s) $ { )Affidavit(s) .................. $ Bond $ Commission $ Othe~/, ~, $ / Automation JCP Fee ...................... TOTAL......... $ $ $ To The Register of Wi//s Please enter my appearance by my signature below: Attorney Signature: ~~~~ b Printed Name: EDMUND G. MYERS Supreme Court I.D. No: 20558 Firm Name: Johnson, Duffie, Stewart 8~ Weidner, Address: 301 Market Street. P.O. Box Lemoyne, PA 17043 Phone: 717-76 i -4540 Fax: 717-761-3015 Email: a m(cr~idsw.com DECREE TO THE REGISTER Estate of JAMES B. TAYLOR ,Deceased. File No~ / ~ ~ t~ Social Securi No: 183-20-6004 Date of Death: February 16, 2012 AND NOW, , 2012, in consideration of the foregoing Petition, satisfactory proof having been presente before me, IT IS DECREED that Letters Testamentary are hereby granted to Crag A. Taylor in the above estate and that the instrument dated March 2 1977 described in the Petition be admyated to probate and filed of record as the Last Will of the Decedent. / I /I i / U/ register of Wills )\ I ~ ~ ~ v LOCAL R~. T.~~ ': CERTIFICATION OF DEATH WARNING: It r `~~3~i`#q ~~ c e this copy by photostat or photograph. :.....J~ Fee for this certificate, $6.00 :~j~~; 2 ~~~ ~ 4 P 18160536_ Certification Number Type/print In Permanent Black Ink ~~ \~ CLERK 0~ CRPHA~31S v~ CIJMRFRi_J~f~'D This is ro certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office f~r ermanent filing. ~~a~ %Q,~,~-~' FE .19 012 --- ' C Local Registrar " Date Issued COMMONWEALTH OF PEN NSV LVANIA • DEPARTMENT OF HEALTH VITAL RECORDS CERTIFICATE OF DEATH State Flla Number: 1. Decedent's Legal Name (First, Mldd e, Last, Suffix) 2. Sez 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) James B_ Taylor male Feb.16,2012 Sa. Age-Last Birthday (Yrs) Sb. Under 1 Veer Sc. Under 1 Da 6. Dale of Birth (MO/Day/Yea r) (Spell Month) 7a. Bln:hplace (City and State or Foreign Country) Months Daya Hqura Minutes Harrisbur PA 8 4 May 1 4, 1 9 2 7 7b. Bin:nplace (county) Dau n 8a. Residence (State or Foreign Country) nd Num ber -In clude Apt N o.) Bb Residence ( SS r eet a Bc. Old Decedent Live in a lrownshlp7 PA p ~ '} t~, 1 [ ~ -j Oa7„ rG'}aar Q Q ~~ a ~B QYes, decedent lived in_ twp. ed. Residence (County) 311 I [i 1 7 1 p , t'I~ l Cumberland ge. Residence (21p Code) 1 7 Q 1 1 0, Decedent IlYed within limits of Worml eysburg city/boro. 9. Ever 5 Armed Forces? 1D. Marital Status at Time of Death ~ Married idowed 11. Su rvlving Spouse's Name (If wife, give name prior to first marriage) ~~ No Q Unknown ~ Divorced ~ Nev r Married Q Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to Firs[ Marriage (First. Middle, last) Wi111am Taylor Mildred Beirl 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Malling Address: (Street antl Number, City, State, 21p Code71 7 R $ 0 g Craig A_ Taylor son 6 Fairfield Lane, Mechanicsburg, G .. ........ . ...... ............ .. ace o eat ... ec ,on y one ...........................-. . . ..'-".. ................. ...... a:.. .... .. . ... 'sl` .......................................................... .. . p npaSlent = If Death Occurred in a Hos ital: •••• • • c w .. .. ... .-..... ....... ..... 1f Death Oc urred Some here Other Than a Hospital: [~ Hospice Facility ~-[~~ Decedent's Home ~~ ~~~ • • • Eme envy Room/OUtpetlent ~ Dead on Arrival € Nursing Home/Long-Term Care Facility Other (Specify) 15 b. Facility Name (If not Institution, give street and numberi 15c. City or Town State, and Zip Code iSd. Coun f Death b ~'i Harris urg, PA 1 71 09 Daup in $ 16a. Method of Disposition r al ~ Cremation p Remgyelfrgmstate p Dpnatlpn 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other Ig~ ) u / g; '€ Other (Specify) Feb _ 22 , 201 Paxtang Cecnetery, Harrisb Z ' PA 16d. Location of Disposition (City or Tdwn, State, and Zlp) Harrisburg, PA 17111 Igtwtu re of Funer I Service Licensee or Person In Charge of Interment Qf 17 b. Ucense Number FD-013163-L ~ 17c. Name and Complete Address of Funeral Facility oOn 3 Musselman Fungal Home& Cremation Services 324 Hummel Ave _ Lem ~ PA ~ 1B. Decedent's Eduction -Check the box that beat describes the 19. Decedent of Hispanic Origin -Check The 20. Decedent's Rsce -Check ONE OR MORE races to indicate what highest degree or level of school completed at the time of death. box that best describes whether the decedent the deced~dered himself or herself to be. ~ Bth grade or less Is Spanish/Hispanic/Latino. Check the "NO" ))d.WIIl1c 0 Korean Q No di a, 9th - 12th grade box If decedent is not Spanish/Hispanic/Latino. Q Black or African American 0 Vietnamese sc hool graduate or GED completed ~ No, not Spanish/Hispanic/Latino ~ Amerlr_an Indian or Alaska Nat We Q Other Asian Q Some college credit, but no degree ~ Yes, Mexlca n, Mexican American, Chicano ~ Asian Indian 0 Native Hawaiian Q Associate degree (e.g. AA, A6) ~ Ves, Puerto Rican ~ Chinese )~ Guamanian or Chamorro ~ Bachelor's degree (e.g. BA, AB, B6) ~ Yes, Cuban ~ Filipino 0 Samoan ~ Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) ~ Yes, other Spanish/Hlspa nlc/Latino ~ Japanese ~ Other Pacific Islander Doctorate (e.g. PhD, EdD) or Professional degree (Specify) ~ Other (Specify) . MD ODS DVM LLB 1D 21. Deced Ingle Race Self-Deslgnatlon -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work Ite ~ Japanese Q Samoan done during most of working Rte. DO NOT USE RETIRED. Black or African American OKOrean Other Paclflc Islander lamp sYloppe owner 0 American Indlen pr Alaska Native ~ Vietnamese ~ Dpn't Know/NOS Sure ~ Asian Indlen ~ Other Asian ~ Refused 22b. Kind of Business/Industry Chinese Q Native Hawaiian Q Other (Specify) 1 amp s Q Filipino O Guamanian or Chamorro ITEMS 3d MUST BE COMP ETE 23a. Date Pronounced Dea Mo Day r) 23b. Signature of Person Pronouncing Death (Only when appllca le 23c. Ucense Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATN (Go Zo IZ 23d. Date Signed (MO/Day/Yr) 24. Time of De th Zo IZ ~ 5 Z /a'.-vim 25. Was Medical Examiner or Cor er Contacted? ~ Yes No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--diseases, injuries, or complications-that directly caused the death. DO NOT enter termin al events such as cardiac arrest Interval: respiratory arrest, or ventricular fibrlllatlon wlfhouY showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a Ilne. Add addKlonal Tines if necessary Onset to Death IMMEDIATE CAUSE > ~ ~ E.$ ~, fwTo tr Ls T0.• ~ c+~-r ~ (Final tlisease or condition ~a D to (or a consequence of): resulting In death) ( 1 b. L<n ¢. Y'~f o VU. S G tw ` Z' r ~. CC r ~ ~.~~ Sequentially Ilsi conditions, Due to (or as a c sequence of): If any, leading to the cause ((11 .r- f I ~ ' $ G:G.. S Q~ listed on Ilne a. Enter the ~ !• (Pn l O SCr\ ~@w o L ~ L ~A/1 Gti o C/p-S Lt~. G.A UNDERLYING CAUSE Due So (or as a consequence of): S (disease or lnJury that initiated [he events resulting d. ~, In death) LAST. Due to (or sequence of): as a con 26. Part 11. En Se r other si¢nlficani cR ndi[lons contributi n g to death but not resulting in the untlerlying cause given In Part 1 27. Was a autopsy pert rmed7 ^ ~ Y ~ l/ ~ S ~ ~ r No ~ w~ - • tT c""i L I dtT SK ~ 28. Were auto PSY flndin gs available _ To complete the cause of deathT F. ~ Ves No ~• 29. If Female: 30. Dld Tobacco Use Conirlbute to Death? 31. Ma of Death E s Q Not pregnant within past year P t t [I f d h [] Yes Q Probably .~a . atural Q Homicide ~' regnan a me o eat 0 ~ Not pregnant, but pregnant within 42 days of death No ~ Unknown 1 ~ 0 Accident ~ Pending Investigation 0 Suicide 0 Could not be determined ti )~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month) ~ Unknown If pregnanT within the pest year 33. Time of lnJury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, Clty, State, Zip Code) 36. Injury et Work 37. If Transportation Injury, Specify: 3B. Describe How lnJury Occurred: ~ Yes 0 OriYer/Opewtor ~ Pedestrian ~ No ~ Passenger ~ Other (Specify) 39a. Certifier (check only one): Certifying physician - To the besC of my knowledge, death o red due [o the cause(s) and manner stated ~ Pronouncing 8. Certifying physician - To the best of my knowledge, death o red at the time, date, and place, end due to the cause(s) and m stated r Q Medical Examiner/ Cor oner - On the basis of ex in ion, and/or Investigations In my opinion, death occ u r re d at the time, date, and place, and due to the cause(s) and manner stated , l ~ - e Signature of certifier: W Title oT certifier: n/~ \ / License Nu mber~ /Y~ t 7 p f 6 26 7 39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 39c. Date Signed (MO/Day/Yr) 40. Registrar a District Num a 41. Registrar' ature 42. Registrar FI a Date (MO Day r '-/- ~ ~ i9~.a~oiz a3. Amendments Disposition Permit No. L~ (O ~ Q / ~ ~ H305-143 REV 07/2011 ~~.~t ~i11 ~n~ C~PStrzmPttt I, JAMES B. TAYLOR, of the Borough of Wormleysburg, Cumber- land County, Pennsylvania, make, publish .and declare this to be my Last Will and Testament, hereby revoking any and all Wills by me at any time heretofore made. 1. I direct the payment of my just debts and funeral expenses as soon after my death as may be convenient to my Exe- cutrix hereinafter named. 2. I give, devise and bequeath all the rest, residue and remainder of my estate. unto my wife, Joanne IY. Taylor, pro- vided she survives me by a period of thirty. (30) days. 3. Should my wife, Joannel~~. Taylor, not be living on the thirty-first (31st) day following my death, then I give, devise and bequeath all the rest,. residue and remainder of my estate unto my children, Craig A. Taylor, David W. Taylor and Pamela L. Merrow, in equal shares. 4. I name, constitute and appoint my wife, Joanne D. Taylor, to be the Executrix of this, my Will. I:n the. event my said wife shall fail to survive me, or fail for any reason to. complete the administration of my estate, I appoint my children, Craig A. Taylor, David W. Taylor and Pamela L. Merrow, to be the Executors of this Will, and I request that .they be excused from entering security in any jurisdiction in which they may be called upon to act. this IN WITNESS WHEREOF, I have hereunto. set. my hand and seal, day of March, 1977. f `' (SEAL ) ames. B. Taylor h' (`~ -~y~ --p ; ~~ J~~ !. ~!} '=r^~ ~~ ~J~,JTY i~ ~,.~., ,~ n "Y ~~.y i. :iw .t. ~~ L: i '~ '~ ~l , ~_' _I ,w ~) f ~ -1'~ ~7 ~ ~ ~ Signed, sealed, published and declared. by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. - 2 .- ACKNOWLEDGMENT.. COMMONWEALTH OF PENNSYLVANIA ) ) SS. COUNTY OF CUMBERLAND ) I, JAMES B. TAYLOR, Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, da hereby acknowledge that I signed and executed the instrument as my Last Wi11 and Testament;. that~:I signed it willingly; and that I signed it as my free and volun- tary act for the purposes therein expressed. James B. Tay to Sworn or affirmed to and acknowledged before m~e/',' by JAMES B. TAYLOR, Testator, this ~~~.,p~, day of ~~~/~ , 1977. Nota y Pub is My Commissi Expires: AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ) SS . COUNTY OF CUMBERLAND. ) We , ~(~ and ~ , the witnesses who names are signed to t e foregoing instrument, being duly qualified according to law, do depose .and say that we were present and saw the. Testator sign and execute the foregoing instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the pur- poses therein expressed; that each of us in the hearing and sight of the Testator signed the. Will as witnesses; and. that to the best of our knowledge, the Testator was at that time 1.8 or more years of age, of sound mind and under no constraint fyr undue influence. Sworn or affirmed. to and subscribed to before me by and , wit- nesses, thi ~ rd day of Q4~~'~+ , .1977. r No.ta.r rural My Commission E~pires: