HomeMy WebLinkAbout04-13-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF G~~~,~RL.¢j~/,~ 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: JDV/~,c ,¢~1//1/ ,?SVi~i2m,¢s-/
a/lv'a. 7U11F_ E A~1/ ~?'JU,c,p ~
a/k/a: ~
a/k/a:
Date of Death: _ /f _ t~l o~-D ~ ~/
Decedent was domiciled at death in ~~%C/~1~~[,~¢n/~
principal residence at CO/KC-~? P,,¢;t~K y~L~/ ~~
Street address, Post Office and Zip Code
Decedent died at ~iQ~3"T p,¢,~,~ /~~-~L
Street address, Post Office and Zip Code
File No:~~_
(Assigned by Regis
Age at death: _ ~~
County, ~~ (Stare) with his/her last
.Q,
City, Township or Borough ~7~~s~- p~
City, Township or Borough L.'uIrX:ICn«jfounty
Estimate of value of decedent's property at death•
County /7v-i3
'~i 7D/.3
State
If domiciled in Pennsylvania ................. .
If not domiciled in Pennsylvania. ' ' ' ' ' ' • • • • All personal property f / QS'~ 99
Personal roe $ ~
If not domiciled in Pennsylvania ........................ Personal property m Pennsylvania $
Value of tea! estate in Pennsylvania .......................... . . .. P P ty in County $
//n TOTAL ESTIMATED VALUE.... $
Real estate in Pennsylvania situated at: /V kl
(Attach additional sheen, i~necessary.) Street address, Post Office and Ztp Code
City, Township or Borough County
(~ A. Petition for Probate and Grant of Letters Testaments
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~~ ~ ~/
thereto dated - and Codicil(s)
State relevant circumstances (eg, renunciation, death of executor, etc.)
Except as follows: after the execution ofthe instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § :f323(g), and did not have a child born or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
~$ NO EXCEPTIONS ^ EXCEPTIONS
^ B. Petition for Grant of Letters of Administration (If applicable)
c. t. a., d. b. n., d.b.n.c.t.a., pendente bite, durante absentia, durante 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 1)ecP~ant iow ..,..~,:,, __ ~ ____ . _ ,. .
Form RW-02 rev. /0/11/2011
Page 1 of 2
Oath of Personal Representative r;~i J, ,: ~,, ; ; . ~) ~ only
COMMONWEALTH OF PENNSYLVANIA ~~~ ,, ~ C
} F~ .~ ...
/r :.t.!J
COUNTY OF (~'GLlj7~nZL~y1//~ } SS. ~~~~~~a33
Petitioner(s) Printed Name
~~~, v ~ ~ /.~ /-Z~ 7..57 N~2n!
~,
/Y!/Dl>L~TDyI/ /20,~ ~r~Gf.~tL=~P /7 3
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 De edent, the Petitioner will well nd trul}~ administer the estate according to law.
Sworn to or affirmed nd subscribed before
me this day o , ~ ___ Date ` - j ~-
By' ~ ~ ~_ Date ~
Fort a Register ~_ Date
Date
BOND Required: ^yES ~NO
FEES' To the Register of Wii7s:
LeJ,Iers ...................
( ... $
)Short Certificate(s)... .. .
( )Renunciation(s)...... .. .
( )Codicil(s) .......... .. .
( )Affidavit(s)......... .. .
Bond.... .
..........
......
Commission ......... ...
......
Other ___(~'i (I .. .
r/
......
Automation Fee .............
JCS Fee . ............ ..
.. U
'
......
TOTAL ................... ..
.. $ ~!
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of
a/k/a: ~ 1 ~~l ~. t~~ File No: ~- - - ~ t
__r_____
AND `
satisfactory proof havtn been presente before me, IT DECREED that L~1 rs ~ idet' lion of the foregoing Petition,
are hereby granted to (~
the instrwnent(s dated ~ ~ ( in the above esta and (if applicable) that
described in the Petition be admitted to probate and filed of record as the last Will (and Co 'its of Decedent. ~
Register of
Forn7 RW-01 rev. 10/!I/1011
Page 2 of 2
~F~Ori ~ , ,4-~{ L REGISTRAR'S CERTIFICATIONI OF DEATH
,`~ (4 . ~ IJ NING: It is illegal to duplicate this copy by photostat or photograph.
Fee for ttrY$~c~er~i~,ie,a~~$6Ri"f >~Q~ ~ J
~-ER~{ Q
(~RAHAfV'$ COt1R r
__ P ~. ~ ~ ~'~~~ ~'~
~~(~7t Certification Number
~+'r Type/Print In
Permanent
76
G
s
z
~'
This is to certify that the information here given is
correctly copied from an original Certificate of Deati
duly filed with me as Local Registrar. The origins
certificate will be forwarded to the State Vital
Records Office for permanent filing.
L . ~~t~~1~.,~,'~x' ARk 20~t2
Local Registrar
COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH . VITAL RECORDS Date Issued
Last,s~fflx) CERTIFICATE OF DEATH
JOYCE A . DYAg-MAN z. sax 3 s i i s State Flle Number:
V sty Number
p ~~~ 16 D t f g F 1 ab 28 ~,t ~ ~ 4. Date of Death (Mo/Day/Yrl lc.._n .._.
s. Residence (Street and Nu April 3, 1936
mbar -Include APL No.)
7~ North Middleton goad
Yes @CNO - • "'r I lOO D+Ital status at Time of De
Q Unknown
th N (FI t Middl d ~ N
A7-bert t s fn )
.Inform,....•..,_~_ Bruce Myers
Forest Park ~ n t1O^• give street and
Health Center
a. Method of pisposition ® Burial
~' Removal from State C
~ Other I<..__.~.. ~ Donation
Carlisle, pA 77013
0 Unknown
Aprz_1 10, 2012
Yes, decadent uyed'na Town~rl
No, decedent Ilved within limits of
17013
We8ht1~-nstar -~...~•~rv, crer
i.._ ~.___ MetDpri-al Gardens
Ighest degree or level of school completed at th
Q 8th
a
f 19. Decedent
f
e t
me
grade or less
lea h,
Q No diploma, 9th - 12th o
Hispanic Origin -Check the
box that best de§cribes whether th
grade
[~ High sthooi graduate e decedent
is Spanish/His
Panic/Latino. Che
k
"
or GED co
~ Some colic mpleted
ge credit, but no d e
the
NO"
box if decedent is not Spanish/Hispani
/L
Q N
egree
Ass
O ociate degree (e.g, qq
qs) c
atino.
o, not Spanish/His
O Ye
n
~
Bachelor's degree (e.g. BA, qB, BS)
Q Master'
d s, Mexican, Mexl an
gme Icon, Chicano
Q Yes, Puerto Ri
s
egree (e.g, MA, MS, MEng, MEd, MS W, MBA)
0 Dottorate (e.g. Ph O
Ed D)
P can
0 Yea, Cuban
0 Yes
,
or
rofessional degree
. MD DD9 DVM LLB JD , other 5
Panish/Hispanic/Latino
.. Decedent's single Race Self-Desi
® While Bnatlon -Check ONLY ONE t
I (Specify)
o
Q Black or gfNCan American ~ ~ oPanese
0 America
~ K c ndicate what the decedent considered himse
~ Samoan If or
an
n Indian or Alaska Native
Q Asian Indian ~ Viet
amese 0 Other Paclflc Islander
e
Q Chinese ~ Oth rgslan
~ Flliplno ~ Natiy
H 0 Don't Know/ryot Sure
0 Refused
e
awaiian
0 Guamania
: 0 Other 5
( PeclfV)
n or cham
MS 23a - Z3 MU
PERSON WHO PRONOUNCES O
ED 23a. Date Pron u c
R
n orro
R
a Dea
TIFIES DEATH ~j ` ~ ~
~ Mo Day yr 236. 6lgnature o Pere.... e._
t. Date 61vn~w ,.._,_ - 'Y /1 /_ O
FIJ-p 12909-L
LwP.
the decedent considered h mOSelf or herspelf to be to Indicate what
® White
Q Black or fifrlcan American
~ American Indian or Alaska N 0 Korean
~ Vietnamese
atiye
Q Asian Indian 0 Other ASlan
Chinese Q Native Hawaiian
Flliplno
O lapane:e ~ Guamanian or chamorro
O sampan
0 Other (Specify) _ 0 Other Paclflc Islander
e during most of working Ilfe nD0 dicate type of wor
F8C t0 NOT USE RETIRED.
]yy 1^7orlcer
Shoe Factory
- -~~~•-~.~ .+e ~ -
/ - ---~~-.. ..~a°ie) 23c. Lice
nse N
U
m
26. PaK I. Ente
h ds- Was Medical Examine ~
+
a
~ ~~ ~~ ~~f~'° ~
~
r t
e h
respiratory arrest
P~ a disea
or r or C
CAUSE
ses, in)uries
or co
l
O
A
H ! ..
r~a
~
~~
O y
,
,
mp
ventr
leatlons--[hat dlrectly
a O d
th
flbrlllatlon without showing the eti
a death
DO
l No
0
~
IMMEDIATE _ _
CAUSE
(Final disease or condition _--_-_-~ a. .
o
o
NOT en
J~ IiY- DO NOT AggREVIgTE. Enter onl ter terminal events such as cardiac arrest qpp
~ roximate
r-~ I
r Y one cause on a line
qdd
S e/`
rcwlting In death)
~ ~ ,
nterval:
addltlonal lines If ne
pessary O
b ~
(or as a con
sequence of):
~ nset to Death
If
l ~ar CJ SC ~ ~~ `
anY, leading o the <a
use
listed on line a- Enter the ~
D ~ 5
[ (or as a consequence
of): -'-
UNDERLViNG
GUSE c ~
°C (disc
r inl ry that
Initiated the events resulting
Due to (o
r es a consequence of): --
d
In death) LAST.
26. Part 11. Enter other slanifl
--~~cond
H
Due to (or es a consequence of): ~~
~
m ~ 5_ t ib
[I t~e• but no[ resulting In the underlying cau ---
29. If Female: se given In pa rt I
27. Was an autopsy performed?
s
~ Not pregnant within
past year
~ Pregnant
[
30. Dld Tobacco U 2g. Were a Co No
ps findings avalla
to com
) t
l
~
a
time of death
~ Not pregnant
b
t se Contribute fo Death?
Q Yes p
o the cause of death
T
Q Yes
3
'- ,
u
Q Probably
Q Nat pre Pregnant within 42 days of death ~ No
gnant
b 1. Manner of Death No
,
ut pregnant 43 days to
Q Unknown if pre ® Unknow
n
1
Year before d ~ Natural
~] Homicide
gnant within the
eath 32. Date of In
past year Jury (MO/Day/yr) (Spell M
34
Pl ~ Accident O Pendin Invests
~ suicide
gallon
-
ace of Injury (e.g- home; constructi°.. en_. onth)
.____ 0
Could not be determined
°e)
O Yes p Drwer/O ^ °rv, sPeclry: '
No Perator ~ pedestrian 3B- Describe How Injury Occ
~ Passenger ~ Other (specify) urred:
' certifier (Check only one): -~
Certifying physician - To She best of my knowled
0 Pronouncing g CertlfYing physician -T He, death occurred due to the ce use(s) and m
^ Medical Examiner/Coroner- On th basis of exst of my knowle e, death occurr anner stated
nation, and Investl 5dat the time, date, and place, and due to the causes s
signature of certlfler- - in my opinion, death occurred at the time, date, and place, and due totthe cause(s) and manner stated
Title of certlfler:
b- Name, gddrcss and Zip Code of Person leting Cau e o Death (Item 26)
td• I, ~` f ~1 i ~ ..~r.__ v2 i _ License Numbar~ M 17~~ 7 i i --.
DlsPOSition permit No. O- '( J
- - - - - ~~~ H305-143
- - - - _ REV 07/2011
1
LAST WILL AND TESTAr~EDTT OF JOYCE A., DyAps,~N
I, JOYCE A, DYARMAN, of North r7iddleton Townshi
County, Pennsylvania, declare this to be my Last Wilp, Cumberland
ment, in manner and form following; and Testa-
1• I hereby expressly revoke all Wills and Codicils
heretofore made by me.
2• I hereby direct my Executor to pay all my just debts
funeral and administrative expenses out of my estate, as soo '
practicable after m n as
Y death.
3• Should my husband, Robert E. Dyarman, survive me for a
period of thirty days following my death, I devise and bequeath
the remainder of my estate to Robert E. Dyarman.
4• Should my husband, Robert E. Dyarman, predecease m
die on or before the thirtieth da followin ~ e or
Y g ~y death, I devise
and bequeath the remainder of my estate as fo:Llows:
A• One-Third (1/3) thereof to my daughter, .Roxanne
D. Shank; and to her issue per stirpes- ii' she is not then
living,
$• One-Third (1/3) thereof to m
Coover; and to her issue Y daughter, F,ita D.
living. Per stirpes if she is not then
j c,,
._-~
~l ~
~ ~_: _~
~, ,.. --
~• r
)E1~
.~
0
.~
e7
,-~
~3y
~V
C. One-Third (1/3) thereof to my daughter, Tammy D,
Gage; and to her issue per stirpes if she is not then
living,
5• I nominate and appoint my husband, Robert D. Dyarman, as
Executor of this my Last [Till and Testament; and as substitute
Executrices I nominate and appoint my dau hter~;
g , Roxanne D. Shank,
Rita D. Coover and Tamm D,
Y Gage. I further direct my personal
representatives shall not be required to file bond or securit in
any jurisdiction. Y
ti ~ IN taITNESS WHEREOF, I have hereunto set my hand and seal
a`
~~ 26th day of P~Iay, 1981.
cn
:~~
(I OV oy e A . Dya rma ~~ (SEAL
- 1 -
WITNESS:
~,'^ 14'!CE E
~~ ,~ „
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND SS'
I, Jo ce A. ,
attached or foregoingminstrumentrix, whose name is
accordin having been duly qualified the
g to law, do hereb
executed the instrument asymacknowledge that I signed and
willingly; and that I Y Last Will; that I signed it
signed it as my free and voluntary act for
the purposes therein expressed.
Sworn or affirmed to and acknowledged bE~fore me, by Joyce.
Dyarman, Testatrix,. this 26th day of May, 1981. -
A.
~_''~-~~-;,° c~ t`I~TA,RY PUBLIC
~`~~~'.-i C~'°~ar~7ty Carlisle, PA
air,n Expires Jant,~ary 27, 1983
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND ~ SS'
Sworn or affirmed to and subscribed to before me by Tom H,
Bietsch and Roger M. Morgenthal, witnesses, this 26th. day of Ma
1981.
Y,
We, Tom H. Bietsch and Roger r~ or enthal
g the witnesses
whose names are signed to the attached or foregoing instrumen
being duly qualified according to law, do depose and sa
were t.
present and saw Testatrix Jo ce A. Y that we
execute the instrument as her LastYti~lil); thatmshe sgnednwillin 1
and that she executed it as her free and voluntary act for the
purposes therein expressed; that both o.f us in the hearing and g Y
sight of the Testatrix signed the T4ill as witne~
the best of our knowledge the Testatrix was at that anc~. that to
more years of age, of sound mind and under no constraint or undue
influence.
_r
~ ~''~` ~ "' i' i 71_FR, ~-nTARY PUBLIC
;~ ;:.' "°:~~.~nty Carlisle, PA
~"n'F Cornmi sien Expires January 27, 1983
tartness
AIi ess
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- 2 -