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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Petitioner(s) named below, who is/are 18 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: Scott Alan Dunmire
a/k/a:
a/k/a:
a/k/a:
Date of Death: September 14, 2011
~ - /' '` l
File No: ~~ - ~~ r~' ~~~
(Assigned by Register)
Social Security No: 164-62-0718
Age at death• 46
Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last
principal residence at 310 Third Street, Apartment 3, New Cumberland Borough, Pennsylvania
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Harrisburg Hospital, Harrisburg, Dauphin County, Pennsylvania
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 $ 5,000.00
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.... $ 5.000.00
Real estate in Pennsylvania situated at: None
(Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County
Q 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 ~ and Codicil
thereto dated ~-` ~--, '"'~' ---: ;-'~
_-_
State relevant circumstances (eg. renunciation, death of executor, etc.) '=; ? _ ~~ ~7 -r'
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Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced', z}t$s~t a pay to a pending..
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), arrd:djdyto~have a,ghild born °r
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. "-'~ ~' ~~'' --•- - ~ j
® NO EXCEPTIONS ~ EXCEPTIONS ~ ~ `~~y
G
B. Petition for Grant of Letters of Administration (lf applicable)
c.t.a., d.b.n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate
If Administration, c.t.a. or aLb.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 Q 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
Doris Dunmire Mother 9 South Fayette Street, Shippensburg, PA 17257
Robert W. Dunmire Brother 9 South Fayette Street, Shippensburg, PA 17257
Barbara Thompson Sister 7 South Fayette Street, Shippensburg, PA 17257
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Form RW-02 rev. roillizo~l Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
}
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Official Use Only
Petitioner(s) Printed Name Petitioner(s) Printed Address
Barbara Thom son 7 South Fa ette Street Shi ensbur PA 17257
The Petitioner(s) above-named swear(s) or affirm(s) 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 Deced nt, the Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before ~ 2R .~ Date 3~ - )
me this (J'f`' day of ~ ~'C~~~ ,~''l-~ Date
i3y: °i~ ~~' ''~.C `~-- G'111,~ P_~--' Date
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For the Register ~ :~ mate ~' T? ' =~
BOND Required: Q YES NO
FEES:
/~~ ~ .~
Letters ...................... $_ l/ . C,'L%
( _~ )Short Certificate(s)...... /aZ -L'L
( !~ -)Renunciation(s)......... ! ~ . f'~ [~+
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ........
Automation Fee .............. .
JCS Fee . ....................
TOTAL .....................
't'~C7 SJ `-
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To the Register of Wills: ~ ~ r~ ~-`
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Please enter my appearance by my signa~ur-e, low:...., _
Attorney Signature: -%'~ c,,, , ^= j~
v -- `n
Printed Name: H Anthony Adams
Supreme Court
ID Number: 25502
Firm Name: H. Anthony Adams
Address: 49 West Orange Street
Suite 3
ShippensburQ, PA 17257
Phone:
U Fax:
~~ Email:
$ $'C • ~Z~ ~:b6"'
717-532-4=3270
717-532-6673
htadamslawnemharnmail -cnm
DECREE OF THE REGISTER
Estate of Scott Alan Dunmire File No: <~~ _ / ~ ' ~~ ~ ~~~
a/k/a:
AND NOW, ~ ~~~t~~~ I~~C~I'~~~ ,~ C~'/ ~-- , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration
are hereby granted to Barbara Thompson
in the above estate and (if applicable) that
the instrument(s) dated N/A __
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
i~- ~
Register of Wills ~_ ~~' i ~l, ~~l j~. ~C~1'1;- ~~?
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Form RW-02 rev. /0//1/ZO/1 ~. Page 2 of 2
Hlu>sii~ I<F~ iill'~p
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photog°aph.
Fce for this ce'rtficate 56.0)
P ~.76~54~8
Crrtifirttion I`Jumber
-Ibis iti tIT rrs„ il::.t :! r ;,~1~ 1 ) :,;tit r;e L~;t~ «~ ~y_
correctly ~tlni;~,; rem i11 ~/rr_in ~ Cw. '„~.,tr of i?rat
((lt~V fl~e(i t'.91%7 'L, ll~ i,uC21i ~< "t`~I fat~ )11c t51IL'ErYJ
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H10S143 REV 11/2006 COMMONWEALT7i OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS A --f a e `~
TYPE/PRINT IN CERTIFICATE OF DEATH
PERMANENT
BLACK INK (See instructions and examples on reverse)
STATE FILE NUMBER
a
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1. Name of Decedent (First, middle, last suffix) 2. Sez 3. Sodal Security Number 4. a of each Modh, de
ye r)
~
Scott glen Dunmire Male 164 -62 - 0718
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5. Age (Last BiMrtlay) UMer 1 year Under 1 tley 6. Date d BIM (Month, day, year) 7. Bintlplap (Chy antl state or brdgn country) Ba. Place d Death (Check only one)
uacala nays Kars M'muleq H
os
pital: Other:
,~
/
4 6 Yra. 1 1- 1- 19 6 4 C h a m b e r s b u r , P R I,Q lnpatienl ^ ER / Outpafient ^ DoA ^ Nursing Home ^ Resitlence ^Other - Specify:
8b. County d Death Bc. City, Born, Twp. of Death fitl. Fadlhy Name (II rld insllldion, give street end number) 9. Was Decedent d Hispanic Origin? ~] No ^ Yes 10. Race American Indian, Blade, While, etc.
(It yes, specify Cuban, (SpedM
Dauphin Harrisbur Harrisbur Hos ital Maxican,PuertoRican,etc.) White
11. Decedent's Usuel lion Kind d wale dace Burin most of workin Ihe. Do rid slate retired 12. Was Decetlent ever nthe /3. Decedent's Education ($pedry only highest grade mrtpbletl) 14. Marital Sletus: Monied, Never Marred, 15. Survmng Spouse (If wife, give maitlen name)
Kind d Wark Kintl d Busmeu I mtlual
ry U.S. Ameed Forces? Elements / Secron Widwve4 Divomstl (SpadM
ry dart (0.12) College (1-4 or Sa)
Lab Technician ALS Global ^vea I~NO 12 years 4 years never married
16. Decedent's Mailing Address (Street cdY /town, stale, zip cotle) DecetlaM's Ditl Decedent
3 1 0 Third Street Apt . 3 Actual Residence 17a. sate P q Live in a 170. ^ Yes, Decetlenl Lived in 7pg.
New Cumberland, PA 17070 Township?
nh.Couny Cumberland 17d.~NO,DecedentlivetlwMin New Cumberland
Actual Umits of CM / Bao
16. Fathers Name (First, mi0tlle, last sunk) 19. Mdhar's Name (First, rtdddle, maiden sumeme)
William H. Dunmire Doris M. Hedge
20e. Informant's Name (type / Pdnt) 2~. InfamieM's Maiing Adtlress (Street city /lawn, stale, zip cotle)
Doris M. Dunmire 7 South Fa ette St. Shi ensbur PA 17257
21 a. Method d Disposition ®Cremation ^ Dauaon 21b. Date d Dspceaion (Manlh, tley, year) 21c. Pl~e d Dispositgn (Nance d cemete aemalo a other
ry. 7 place)
21d. Location (City /town, stale, zip code) 1 7 D 6 5
^ Burial ^ Removal from State ;Wee Crematbn a Donalbn AWrorized rX~
^ Other - Spedly: i try MMIpI Enminer /Coroner? L• :1 Vas ^ No 9 -1 5 - 2 01 1 H o 11 i n e r Crematorium
g M t . H o 11 y Springs , P q
22a. Signature o nerel Se (or person acting az such) 22b. Ucense Number 22c. Name and Adtlress d Feci6ly
- ~. FD-012984-L Fogelsanger-Bricker Funeral Home Inc., Shippensburg, Pq 17257
Complete Items 23a-c ody when cenayirig 23a. Ta the hest of my krcewletlge, death occurred at the time, tlale ant place slatetl. (Signature antl Mle) 23b. Cleanse Number 23c
Dale Signed (Manlh
tle
ear)
physiden is not evadable al lime d death to .
,
y, y
cenhy cause d Beam.
hems 24-26 must M completed by person 24. Trace d Death 25. Dale Pronouricetl d (MOMh, tley, year) 26. Was Case Refened to Metlipl Examiner /Coroner for a Reason Other then Cremation or Donation?
wM praxxmces death ` 2 _ ` S ~ M. _ (°~ / L/ .ZA ~ ~ ^ Yes ^ No
CAUSE OF DEATFI (See Instructions and examples) , Approximate interval: Part IC Enter dha sand'p t cenOfo tribal na to death, 26. D0 Tobaao Use Conldbute m Deslh?
hem 27. Pan I: Enter the tlcein d eyenLa - dseases, injuries, a canplications - that tlireaty caused the Beam. DO NOT solar terminal events such as prtliac arrest, r
Onset to Death
but not resulting in the untlenjeng cause given in Pan I.
^ Yes ^ Pmbady
respiratory anesl, or ventricular IibMlatbn whhod showing me etiology. Ust only one rouse on each line. '
IMMEDIATE CAUSE 1Final disease a ~~ ~ ^ No ^a •tlnknown
contlnion resuting in death) _~ a. C ~ Q n 1 () ~ ~~ ~ C' ~' ~-{ Q ~~ 29. If Female',
Due to (or as a consequen
ce
oQ: ^ Nd pregnant within past year
o
~
Sequenlialty I'sl caMitions, N ant, b. C' Cr ~ 1TL A RY ~ 11 ~-G ~tR II (? ~% G: O C G lL(.f $(~
leading to the cause listed on Gce e. ^ Pregnant anima o1 Beam
Due to (or as a wits
EMa the UNDERLYING CAUSE e7e'a~ 00~
r ^ Na pregnant nut pregpnl within 42 tlays
(tlisease a inNry that indialetl the ,
events resuhing m death) LAST. of tleath
( q ) i
Due to w as a copse uence or ~. ^ Nd pregnant bd pregnan143 days Io 1 year
d, ' bdae death
r
^ Unknown it pregnant whhin the past year
30e. Was an Autopsy 306. Were Adopsy Findings 31, Manner d Deam 32x. Dale d injury (Month, tley, year) 32b. Describe How Injury Occuned 32c. Place d Injury: Home, Fame, Street Factory
Pedamletl?
Avageble Prbr to Compkgion
,/
LJ Natural ^ Homicitle ,
O6ice Buil
dug, dc. (SpedtyJ ,
d Cause d Death?
^ Yes ~ ^ Yes ^ No ^ ACCldenl ^ Pentling Investigation 32d. Time of Irqury 32e. Injury at Wak? 321. II Trsnsponatioo Injury (SpeciiyJ 32g, Location of Injury (Street, dly /town, stale)
^ Suidde ^ Could Nd be Delennined ^ Ves ^ No ^ Dover / Operala ^ Passenger ^Pedeslrien
M ^Olha - Spedly:
33x. Certhier (dreck Doty one) 33b. signature and Title d Candler
• Certifying physiclen (Physidan cenirying pose d death when arrolher physkien has prmouncetl death antl complded Item 23) ~ ~---~...
9
To the best of my Nrwwletlge, deem occurrstl due to the uuae(s)arM menrxrusletexL________________________________ ^ - ~~_
~'~
• Prorlwrwing end certhying physician (Physkian both pronourldrlg death and cenilying to pose d tleath)
To the best d my Mnowkdge, death occurred et the time, date, end place, ant due to the cause(s) eM manner es cUted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Medkal Examirur/Coroner 33c. L' Number 33d. Dale d ( th, tley, year)
^n n` Q Z ~ q O~ _ ~ O~ I ~ ~,z,Q ~'
I. 11, / Ll
On me baste d exam M / or invesUgMlon, In m , death attuned el the time, date, ant place, end tlue to the cause(s) arM manner as eletetl_ ^
~ Name and Address d Person Who
Completed Cause of Death (hem 271 Type / Prml
35. Registrar's Si re a strict Number 3fi. Dale F' etl (Month, tley, year) ~ f r J ~5 ~ WUn fete,;: y,; H , "D ,
~y / L ay •'/'
Disposdbn Permit No. ~/ 66 • / ®JO
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RENUNCIATION ~ ~= ~ ~~ -
~~ ,~
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REGISTER OF WILLS ~"` ~ c
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~v..t.~~o-~u-~tti ti ~ COUNTY, PENNSYLVANIA ? - `~' c'
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Estate of ~=~ C G ~~ ~ ~ P~ t~ ~ ~ c.~ ~ti1 ~ ~ ,Deceased
I, ~-,c3 ~ ~ S ~ ~ ~t~ tJ M ~ tY~ - , in my capacity/relationship as
(Print Name)
{~U ~~ 'r of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
G ~ ~ ,~
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
of
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
day
(Signature)
~ ~ ~ t~
d J
(Street Address)
~~~~)
(City, State, Zip) ~
Executed 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
pure ses stated within on this ~ day
of ~ c~ ~ b (~ / ~.
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other otticial qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
H. Anthony Adams, Notary Public
Shippensburg eoro, Cumberland County
My Commission Expires May 31, 2014
Member, Pennsylvania Association of Notaries
RENUNCIATION A ~'
~:. ~
~_i~r
- -~ rn
GISTER OF WILLS `"~
~ II,^, i ~-,~~-,~__~
~Y t~ ~i~l~llt COUNTY, PENNSYLVANIA - J '-'
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Estate of ~aC ~~~ ~ ~ C~.4'~ ~ ~Ly~
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Deceased
in my capacity/relationship as
't (Print Name)
~~' of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
(Date)
(Signature)
`1 ~ ~~
(Street Address)
n
phi ~~~~~5~'' ur'r~ ~ ~ ~- - ~ ~ ~ ~
(City, State, Z )
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form RW-06 rev. !0.!3.06
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciatio for the
purposes stated withi on this ~ L day
--- ---->
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other ofticial qualified to
administer oaths. Show date ofexpiration of Notary's Commission.)
LTN OF PENNSYL~ ~
COMMONWF-~ o~~al seai
H. Anthony Adarr~, Notary Public
Shlpfsen~ur9 g~~ro, Cumberland ~p14
Comtnt~ton Expires ~ ~ of Metaries
M~m~r. f~~i~'~i`~~~Ii~ lea