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HomeMy WebLinkAbout04-03-12y LL r r.;;i , ~ PETITION FOR GRANT OF LETTERSF~n~~~ ~ rlcJf OF REGISTER OF WILLS OF CUMBERLAND COUNTY PE Ngy V~IIA ~i~ b;r'R -~ F~9~3= .~o Petitioner(s) named below, who islare 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the following and respectfully requests the grant of Letters in the appropriate form: CLERK CF Decedent's Information ~RP~'~ CO1~;RT ~/, ~~ ••~~ Name: Charles H. Hockley File No: ~l )~~,~~~ L~J~~.' ~~. p a/k/a: (Assigned by Register) a!k/a: a/k/a: Social Security No: Date of Death: 02119!2012 Age at Death: 88 Decedent was domiciled at death in Cumberland County, pA (Stare) with his/her fast principal residence at 217 W. Pine Street, Mount Holly Springs 17065 South Middleton Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Forest Park Nursing Home, 700 Walnut Bottom 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 !f domiciled in Pennsylvania ...................... All personal property $ !f not domiciled in Pennsylvania ................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ................ Personal property in County $ Value of rea! estate in Pennsylvania ................................................................... $ 90,000.00 ® TOTAL ESTIMATED VALUE $ 90,000.00 Real estate in Pennsylvania situated at 217 W. Pine Street, Mount Holly Springs 17065 South Middleton Cumberland (Attach additions! sheets, if necessary. ) Street address, Post Office and Zip Code City, Township or Borough 10/24/1972 County ® A. Petition for Probate and Grant of Letters Test?men~rv Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated thereto dated and Codicil(s) Renunciation was sinned by Mildred P. Hocklev on March 20 2012 thereby ao oin inq Malcolm D Hockley~$ Executor 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 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. § 3323(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., pedente Irte, 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 comol t list of henter date of Will in Section A above and t list of h ice. Except as follows: Decedent was not a party to 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 a 9udicated 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 Relationship Address Form RW 02 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2 • S Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } ~,f~(~ J,~ , (/,r-rjL, - i IUseOnly C,;`,i~- -~. ~+' - Petitioner(s) Printed Name Petitioner(s) Printed Address !. ( ~ Malcolm D. Hockley 1 Peach Court Gardners, PA 17324 CLERK OF 'S C4UFiT 1 ne Netlttoner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition re true, d correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the a ition ( will d truly administer the estate according to law. Sworn to ffjrimed and s ribed fore /~ Date ~~3 _ /~ me this day of ~ Date $y: Date r e egg er /' r ~ Date -_ BOND Required? ~ YES dNO FEES: Letters .......................................... ( ~ )Short Certificate(s)......... ( ~ )Renunciation(s) .............. ( )Codicil(s) ........................ ( )Affidavit(s) ...................... Bond ............................................. Commission .................................. Other Automation Fee ............................ JCS Fee ....................................... TOTAL ......................................... $ ~+" ~~~ ~J To the Register of Wills: Please enter my appearance by my signature below: Attorney Sign Prinf~llfame: Bradley L Griffie Supreme Court ID Number: 34349 Firm Name: Griffie 8r Associates, P.C. Address: 200 North Hanover Street Carlisle, PA 17013 Phone: 717-243-5551 Fax: E-mail: bgriffie~griffielaw.com DECREE OF THE REGISTER Date of Death: 02!19/2012 Social Security No: Estate of Charles H. Hockley File No: 21 a/kia: AND NOW, ! , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Malcolm D. Hockley in the above estate and (if applicable) that the instrument(s) dated 10!24/1972 described in the Petition be admitted to probate and filed of record as t I t Will nd Co il(s)) of Dece t gister of Wills a (// Form RW O2 rev. 10/11/2011 Copyright (c) 2011 form software only The Lackner Gr c. ~ ~~.._ `~ ~~ Page 2 0£2 i~- %:~ 7 LOC~~~f~.OI~AR'S CERTIFICATION OF DEATI~ WARM~~,~,It.rscitte~~~-tb duplicate this copy by photostat or photograph.. fee for this certificate, $6.00 -'~ ~~ J t7 ~:~~~ ~~~ ~~ TfSis is to ec~rtify ;hat the information her; a~icn is correctly cupied frurt~) sin or)ginal Certificate Of Death C~RK ~+F dt lv filed with ul )~ L(~~al Registrar. Ih ~ original ~~~~ ~ ~iO~~T ce)hficate will h~ `(rw sided to thr_ State Vital C~~~lt'~iF,~~ ti~~n ~`(~ QA R~.u>rds Office ii,i 7(;;l~,f)n~nt filing. --- ~ 18 21 Q 9 8 ~ ___-- Certification I~fumber Type/Prin[In Permanent Black ink 4/33-199 s G ~y s r, ,~ --r------ l~ocal Reg)strar ~~~~~ Date Lsued COMMONWEALTH OF PEN NSVLVANIA ~ DEPARTMENT OF HEALTH VITAL RECORDS CERTIFICATE OF DEATH 1. Decedent's Legal Name (First, Middle. Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (Mq/Day/Yr) (Spell Mo) Charles H Hockle Male 209-1 2-5 27 Febr a 1 1 Sa. Age-Last Birthday (Vrs) Sb. Under 1 Year Sc. Vnder 1 Da 6. Date of Birth (MO/D ay/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Months Days Hours Minutes Pine Grove Furnac 88 Au ust 27 1 2 ]b. Birthplace(COUnty) Adams Co 8a. Residence (State or Forelgn Gou Wiry) Bb. Residence (Street and Number- Include Apt No.) Sc. Dle Decedent LiYe in a Township? 21 7 W. Pine St. Ves, decedent lived in S. Middleton twp. 9d. Residence (County Cumber 1 and Ha. Residence (Zip Code) 1'l 0 .5 ENO, decedent lived within limits of city/born. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death Married ~ Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) Yes Q No ~ Unknown ~ Divorced ~ Never Married ~ Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, last) Harve Hoclcle 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) g Mildred Hoclcle G _ ......... ........................................... .......................................... 1 a. P ace o Deat ec on _ _ _ ....... .....................................Y.one ............................... ...................-..........-..... aa+ .... ... .. ....... ..... ¢_ . If Death Occurred In a Hospital: ~] Inpatient ; . . If Death Occurred Somewhere Other Thar a Hospital: ~ Hospice Facility L,J Decedent's Home Q Emergency Room/Outpatient Q Deae on Arrival _ Nursing Home/Long-Term Care Facility Other (Specify) _ 15 b. Facility Name (If not Insf lLUfion, give street and number; lSC. City or Town, State, and 21p Code 15 d. County of Death Forest Park Nursin H e Carlisle PA 17013 Culnberland 16a. Method of Olsposition ~BUrlal ~ Cremation 166. Dale of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) Q Removal from State Q Donation other (sPeafv) 2 2 3 2 l 2 Mt 1 1 Z 16d. Location of Disposition (City or Town, Scare, and Zip) of Funeral Service Licensee or Person in Charge of Interment lla. Signature 1]b. Vicense Number ~ Mt. Ho11y Springs PA 17 p 65 7 __. eL 011589E E 17c. Name and Complete Address of Funeral Facility 18. Decedent's Education -Check the box that best describe [he 19. Decedent o Hispanic Origin - Check t e O. ant's - Che s to in ca a what i- highest ^egree or level of school completed at the time of death. box that best describes whether the decedent the Decedent considered himself or herself to be. 0 Bth grade or less is Spanish/Hispanic/Latino. Check the "NO" White 0 Korean No diploma, 9th - 12th grade box iF eecedent is not Spanish/Hispanic/Latino. ~ Black or African American ~ Vietnamese High school graduate or GED tom plated Nn, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native Q Other Asian ~ Some college credit, but no degree ~ Yes, Mexican, Mexican American, Chicano ~ Asian Indian 0 Native Hawaiian ~ Assgciaie degree (e. g. AA, AS) Q Yes, Puerto Rican ~ Chinese Q Guamanian or Chamnrro ~ Bachelor's degree (e.g. BA, AB, 65) Q Ves, Cuban 0 Filipino Q Samoan ~ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino 0 Japanese Q Othar Pacific Islander ~ Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other (Specify) _ _ . MD DDS OVM LLB 1D 21. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work White Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. ~ Black or African American Q Korean ~ Other Paciflcislander 2 Maker 1 & D ' ' ~ American Indian or Alaska Native ~ Vietnamese Q Don't Know/Not Sure 1 00 I ~ Asian Indian ~ Other Asian Q Refused 22b. Kind of Business/Industry Chinese ~ Native Hawaiian ~ Other (Specify) p Fulplno O G~amanlangrcnamgrrq Manufacturing ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead Mo Day Vr) 23 b. Signature of Person Pronouncing Death (Only when applicable? 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH Februar 19 2012 23d. Date Signed (MOJDay/Yr) 24. Time of Death 6:35 A. M. 25. Was Medical Examiner or Coroner Contacted? Yes Q No CAUSE OF DEATH Approximate 26. Part I. Enter the chain of events--diseases, injuries, o mplications--that directly caused the death. DO NOT enter term Lnal events such as cardiac arrest Interval: respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a Ilne. Add additional lines if necessary Onset to Death IMMEDIATE CAUSE > Hypertensive Cardiovascular Disease (Final disease or condition Due <o (or as a consequence qf): resulting in death) - b. Sequentially Ils[ conditions, Due to (or as a consequence of). if any, leading 20 the cause listed on line a. Enter the UNDERLYING CAUSE Due to (or as a consequence of): (disease or injury Chat "nitrated the events resulting d. s In death) LAST. Due to (or as a consequence of): ~_ 26. Part II. Enter other sl nifica nt onditi n ntributin d th but no[ resulting In the underlying cause given in Part I 27. Was an autopsy p rf rmed? D Yes No ~ CAD 28. Were autopsy findings ayaila ble to mplete the cause of death? co o Yes ~ No ~ 29. IL Female: 30. Old Tobacco Use Contribute to Death? 3 Manner of Death 0 0 Not pregnant within past year 0 Yes ~ Probably Natural 0 Homicide Q Pregnant at Time of death ~ No ~ Unknown Accident ~ Pending Investigation ~' ~ Not pregnant, but pregnant within 42 days of death ~ Suicide ~ Could not be determined ~ ~ Not pregn t, but pregnant 43 days to 1 year before death 32. Date of Injury (Mq/Day/Vr) (Spell Month) Q Unknown it pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; co nstru ttion site; farm; school) 35. Location of Injury (Scree[ and Number, CI ty, State, Zlp Code) 36. Injury a[ Work 37. If Transportation Injury, Specify: 36. Describe How Injury Occu rretl: ~ Ves ~ Driver/Operator Q Pedestrian ~ No Q Passenger ~ Other (SpeciTy) 39a. Certifier (Check only one): ~ Certifying physician - To the best of my knowledge, death o red due to the cause(s) and m r stated Q Pronouncing ffi Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, antl due to the cause(s) ane manner stated Medical Examiner/COro ~ ~~ 1( +~ Y~/~f~ is Inatl nd/pr investigation, in my opinion, death occurretl at the time, date, and place, and due to [he cause(s) and manner stated n e / / / ~ Signature of certifier: i'UQr Title of certlflerChie£ Degut}_r Coronenl~en:e Number: 39b. Name, Adtlress antl Zip Cotle of Person Completing Cause of peath (Item 26) 637 5 $a5 ehOrEt Rd . s $uitE`441 39c. Date 6lgnee (MO/Day/Yr) Matthew S. Stoner Chief De sit Coroner Me hanicsbur PA 1 O O 21 2 2 40. Registrar's District Number 41. Reg" 5 Signature 42. Registrar File Oate (Mq Day Vr) ~i- F..e6. a o a3. Amendments /} ~j H105-143 Disposition Permit No. v ~ L I q ~ REV 07/2011 ?~.1Sr.~ T;~TII.L ~LdD T'~S"L'^1 t,-~ ,T r,~ ~~-~,,a~, ?-;~5 I1. 7~;C~<Lt?..`~ Cs`-`.^:~i.~'-;S li. 1?(?Cl~'LL:Y, of Soi~.t' l`~idd.leton ~o~hms':,ip, Cl~snberl~nc7 -- Cotlr~.ty, ""'e?~r.sylvar:ia, declare th~_s ins Lrtzrlent to be rly L,~~st ?•1i_1_1 ..lnd `1'es~t~.rnent, in manner ~y.nd form. following: 1. 1 hereby expressly revol;.e all mills ~-~rld Coc'icils heretc- ~i fore n}ade by me . !i 2. 1 hereb-:, direct m,T ;~•.ecutrix to p4y a1.1 ~~.y ,just debts, '~ funer<^.1 ^ncl ad.r.inistrative e.xper;.ses ol.~_t of my c.stt_te, as soon as pr~.ctic^1~7_e after my death. 3. 1 "ive and bee~l_,.eath r1~.- ~aooclG~or'~in~; tools ; :~+~.d ra.v huntln~; dogs, ~~ear alid. erL'ip:r.et~t, to ;z~;? son, ?'~'Ia1C01m D. IIoclLlcy. 1+. Shou7_c! ply ti~Ilfe, TTildred '-'. I%oc'r7..ey, survive rle far ~*:. peri._od ~o f t'rirLy days follo~ain~ my death, 1 clevi.se and be<y~?eath t;::e rer.lainder of ray est..^.te to T~~i1dr_od. i-~. I~ocl~:l.E~y. _= . ~~hould my c<<if ~^ , p<<-~_ldrect ;:`:. ~- ocl;,l_ev, t7:redccc _> e r.1e or d -_e on or ~e_io_,e t~~e th_irtietl~ d=~v ~-017_o~,~ir~r-; any doa~tl_, x c'~.evi se ~~nc. i ^ C n i'' Z T ~~ , 1 G' - 11 be ~~:e~:.tla t'.~le rer:~.ainc'er of ray .~~t_:te to ,1 ~.~st_ie lv_n; ors ~,.~e I t _s rt. ~;~-_! ~_rst d ~~~_ ~_ ~Y .r,1.y deg r,l_;. ~-rer st~._rr~es . 5. J~~.ou1c1 ray w~ fe, i ~i_ld.re d -' . ?:?ocl:ley, ~~~ ec'..^cease rle or it C'lE C?r"' Or ~~'e~~Ore tale t'.lrt7_eti"1. d~~y f0110~?ing ~?1y d~-'_tl`., an e. Sii.Ot'.'_d i 11<S:VE:'. r1C ]_SS11c t ~ ~~, ~ ~" ~ ° ^N' ' ~ ° .''_le ' ~e rerC:c.lnC~e7' ' ti"len 11V1.n % GC'.Vl~c r,ii.Cx J...C at 1.',. ,~ ' Of r^jT ~~5~'.LE'. 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C•T1tr1ESSC'S. \~ ~ ICS[ f„J.~.~~t ~ -1~-,~~-,~--- OA-TEI O~ NON-S~JBSCRIBINO WIT'NESS(ES) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Charles H. Hockley ,Deceased Weft S S~ der and G~lc_r~ /7 • (~LCG~I Q~"~ (Pont Name) (Pont N e) (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well- acquainted with Charles H. Hockley and am /are familiar with the handwriting and signature of the decedent, and that the signature of cnaries H. Hockley to the foregoing instrument purporting to be the Last Will and Testament/Codicil of Charles H. Hockley is in his /her own proper handwriting. (Signature) ~~ ~ ~. (Street Address) ~-~lnfloycr, ~P/ac 1 ~ 33 ~ (City, State, Zp) Executed in Register's OfiFice Sworn to or affirmed ~d subscribed me thief-~-`~'~=day ~~-C.I-~C,c. (Signature) aG~ ~f~ ~~o4d (Street Addre (City, State, Zip) n r,.a _`~ ~a ~ ~~ ~ s• r-.-t r- ;, r~ ~ ~~ ~ _~ ~ `~~ J ~1 ~ vi ~ ~ w _ _. _ _.. ~ J `-- ~ D ' _~_ ~~ c~> p p',. Form RW-D4 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. r C ~-' RENUNCIATION ~~ir ~~'~ ~3 F~ 3~ 30 REGISTER OF WILLS ~LcRe ~~~ O~PNAh' „ ~C~JPr CUMBERLAND COUNTY, PENNSYLVAN~~'" ~~ ;~~•;n rn PA Estate of Charles H. Hockley Deceased I, Mildred P. Hockle , in my capacity/relationship as (Print Name) Wife of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Malcolm D. Hockley /~~ r~ ~ ~ c~ I ~ (Date) Executed in Register's Office S Form RW-06 rev. 10.13.06 ~~ day ~• ~~ x~ (Signs re) ~ a~7 _JPS P„ S~~ t (Street Address) !" ~'~'~ I ~e~ ~~, .S~rir~e r Pro ~ 7a~~ (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 purposes stated within on this day of ~ ~) ~~f ~~~ : 7G~!•~- -7I . I Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NpTARIAL RQBIRt ~. BASSETT, Notary Pubbc CARLISLE ~'rtRGUGH, CUMBERLAND CO. Com~isssQ!: Expires Apr,17, 2015