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HomeMy WebLinkAbout05-31-12 PETITION FOR GRANT OF LETTERS Reset 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: BRIAN K. BROUSE File No: ~~ ' ~~ ` ~~/~ alk/a: (Assigned by Register) a!k/a: a/k/a: Social Security No: 170-72-7286 Date of Death: 12/23/2011 Age at death: 21 Decedent was domiciled at death in CUMBERLAND County, pF.NNSYi.VANiA (stare) with his/her last principal residence at 516 NORTH 2ND STREET WORMLEYSBURG CUMBERLAND Street addraa, Poet Ofllce aad Zip Code City, Towas6ip or Borough Couuty Decedent died at NORTH GEORGE ST & 11TH AVE. MANCHESTER TWP. YORK PA Street addresy Post Olilce and Zip Code City, Towas6lp or Borough Couuty State Estimate of value of decedent's property at death: Ijdomlciltd in Pennsylvanla ............................ All personal property Ijnot domlclled !n Pennsylvanla ........................ Personal property in Pennsylvania Ijnot domiciled to Psnnsytvanla ........................ Personal property in County Vatut ojnal sstote in Pennsylvanla ........................................................ . TOTAL ESTIMATED VALUE... . Real estate in Pennsylvania situated at: (Attach additional sheets, ijnecessary.) Street address, Post Otnce and Zip Code City, Township or ~Cr =~ Q A. Petition for Probate and Grant of Letters Testamentary n~ ~ ~ ~;, ~' Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~ ~ a dr~odicr1 rr; thereto dated~~ ~j State relevant circuantaoca (eg. nwanciadon, dtatG ojuecutor, era) Except as foliowa: after the execution of the inatrumcnt(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 bom or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS ~ EXCEPTIONS ® B. Petition for Grant of Letters of Administration (If applicable) e.t.a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate If Administration, e.t.a or db.n.c.t.a, enter date of Will in Section A above and comalete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds far divorce had been established as defined in 23 Pa. C.S. § 3323(8) 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, ijneeessary): Name Relattonshi Address DEANNA R. SELVEY MOTHER 65 QUEEN AVENUE, ENOLA, PA 17025-2336 TIMOTHY T. BROUSE FATHER 516 NORTH 2ND STREET, WORMLEYSBURG, PA 17043 S 0.00 rya ~p xy+"- rn ~+'`' ~.: ~t ri` Form RW-01 .ev. roillizoll Page 1 of 2 l Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } } SS: } Official Use Oaly Printed Name VEY The PeGtioner(s) above-named swear(s) or affirm(s) the slat is 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 tb De edent, the Petitionegta wi well an ly minister the estate according to law.//~~,,~~ Sworn to r rmed uescribed before Date I c~UI me this ~ , ~~' Date $y Date r the Regis Date BOND Required: Q YES Q NO FEES: Letters ...................... $ ( )Short Certificate(s)..... . ( /)Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bona ........................ Commission. ...... Other oL~, LJ To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed NaBie: ~~lt~ ~"'- • ~'~~~da Supreme Court ~nr L ~ f `j `L ID Number: FirmName: ~~(~-~(~~ ~05-v-/~tlU•~i ! r- ?/sk-' ~ ~~C1dS Address: / D: na yin o_. ~ Phone: ~(~~ GGl'~.Zr'2) Fax: ^ 'ZL'C - ~ Email: ~ d ~~JDOuLflS• cUw~ ... . Automation Fee .............. . JCS Fee ..................... TOTAL ..................... S 0.00 DECREE OF THE REGISTER Estate of BRIAN K. BROUSE File No: Ol.~ _ ~aC ~ Q l0 ~~ a/k/a: AND NOW, J l(.( satisfactory proof having been ~/ ~ ~ i ~" , in consideration of the foregoing Petition, .led before me, IT IS DECREED that Letters OF ADMINISTRATION hereby granted to DEANNA R. SELVEY in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed as the last~Will (and Codi~i~(s)) of of Wills~~ ~l ~ Q Form RW-01 rev. (0/1 //2011 / " Page 2 of t Hlq$?OS REV 101/07) ~ ~ ~ ~~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.Ot1 ~ Thin' is to certify tfiat 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 for permanent filing. P 17 9 2 7 710 ~ of 2 s ott Certification Number callfegistrar ~ ,.;, I~,t~ssued f `.~.~_ ~ ~ ~ rn c7 C~ C~ c7 " f.7 - -IE ? r ~ , r, 1 ;-)' ~ . c~ T ,, r ~r., , V C" ~ T! __ '' i ~ `~ os.1w erv +11100! COMMONYYEALTN OF PENNSYLVANIA • OEPAR711tEHT OF HEALTH • VRAL RECORD8 ~" CORONER'S CERTfFICATE OF DEATH (bee Inehvelbm snd exempMt orv'ararsel arAre wuI auwe>t 1.esaoorl Fla Yr.,bR Yelp xa.1 a91misaa1s1 w11r +, t!/1 aoYa Mewmx rYq, Brian Keith Brouse Male 170.72-7286 December 23, 2011 6.Iglpre+bY1I Uw11 UIMf 0.orlawe 7. 1YYYY rvbYaw.e W OM 11114 YM4 1b>faa ~„~ Street 21 r .Ame 13. 1990 Harrisixug PA ' , ~ C7+wM.n Qelloayara ^nw ^Y4wpap1l ^MMa.s I]oaw•A111r1N b. ClYyaOYb Icdpc.Oae. T4pdOw11 rF~lepabYA•a lyee10.1111 M4a Wae4la. YVIY n1Y1,na+41ra1bo1gn4 N1 Yr 10.1YS:Mrr.aAn Alai11111 ac York Manchester Twp N George St at 11th Ave ~ ~ ~, ~ ~ . . . , ,,, 4 hite n. ubr a.1e a rmmrlr uwY Gera YY»e. 1a OYYYnrssal m101a•11 N.1ar MC1Ylbd a.. aelbl. is 9^M'q splr P4Y. f1Y 1•aU111 Y111ry aw.1 A»peY4r+lrrry 41are~uae Fbrker t~it Aid uswala rwaYZ e111aa411&md1n I412I cern.t++YSlt +'1»I..a dlowal~laA... y - ^.« $lw Never Married 4l AY4ftwArr~,~MbY P~.~aa1b•nrY. an Yas 516 tbrth 2~ St o1e`1w>< pe sr PA uYtir. awwu 1> . .~ a n~^h..oY.snuab ~ ' ~ 4bxm1 ey St u r g , P A 170v3 C~iierlard Ira® °"° C10 1a ~.~y 1b11~1A4MiY1 t`1lrIDleyatlUig ~~1 , a ~ ~y (W ~ s Y ~ , M , xl~llm~+ ~j 13r()118e~ 1111ea4h 111n4~r,niEll; r~tllnfwawQ. . Deanna R. Stare m.1e.11a1,+r11. py1.+n1q Ti h zan bel4.r. Mleq~a.•1e1~a.sM1»1LL a-.zb mary >mt y T. Brcuse SI6 tlbrth &Id St. Fb t lia lwwad»Yr• 'YY1 ^ ar4w1111sw ~ ^C111Yb1 ^OalY r ° ~ °~ " xw Da•aggler Mow YK1Wl zm1ba01»1a1m pYYalMl, aaA,bP4Mrglwq z1G 1aYYl plryl sn, 111b.tiYM a i. ibi,.i rbr i' mYY, "1sz^y„^N, December 30, 2011 Perry Hei~ta C®ete sville PA 17053 fa spYYIaFYY»1 4111141•N11a111 YeeY Yad >7a LkYwIFllew 1111111 YtlAaiYlaruy - ' . FD 012774-L Rid~ard>aon Pureral Hama Iuc. 29 S. Fiala Dr. Fnola PA 17025 myr..rYa.enM.lwanlAg a1,a+.1 b1alYlaYer arlbe 781. ae/b.lbazearllm.YYrr4er..asbmars Wprl..aM111. ~. uYOYiY11e1r zs<M sva f»1Y1: dy; rM alpYrddYF. rYYSYYM1alwrynanl xia.ao.a11 worrmna.l4e o•Y leaq an, wln 3.WrC•Y e11.4Ybwaw eoiYl.+caa4,a.Hsln glwbY t]enaeeaearlalz .ro4ala1olern AppmximebN240A.M, December 23, 2011 ~~ ^~ e~weoroeAn+~il.bwlaw.4ar»eow> , M11ai1aebbRt h1eBw11r bYn. 1111 F. rlrlreeeaesoe-arw,lAaaaa4>1-b1161a, a1Yelri~G01Of/YY1»a YYYfIYAYSale~llea drb01Y1 rMnwe9bMp~(31.Oe~ Ib1fa-bale0ret b ~ i ^ ^~1 wA agrwa,a~e»YY1MYnYY tlnMnMtlOY~UMMOaYW YUMMin. aYr a ~`~~ --- .Multiple blunt force trauma axer«Ya 0p biwY •a1IYRYSa¢ i ^ 1111 i1.71+a •l11P1a71v yY rel lrylE•rymy b. Automobtle accident ' 1 ^ ngaa arrae.e ~ n A11b~YaCAYPY1Y a~: ~ ^Na V11P4a. bufplpNM,leil~2 dlN WI 4 ' Np CNIR YY ~ ~1 a •fYYni~tllYTh u 1 ddw11 d4b Y1a141pm ~ W ~Y ay{b 114•f ^ ab4d1111 d ~ [] arbaallp•p»tMMMpa)1r aolrr YA11111, ~ s1.wY~11»,r 1 ~1.1»4waobe a. oala Nn Pale. YnriM December 23 zo1 r lL d1ab1164.b1A fka11Y g rbYa 1Ia1ti AYlilmy, °'~R" ~~~ ^ 11»„1 ^ , priver of car that struck utility pole Sri ^'a• +1^r» ^w ^ae ~AOw"y ^Pnl~eblallpbn see+r4rbM aY rµrawax J¢lzT1••vaollaiMat~Aaari Y&1°~aaMrl.~114 ag1a.l; aary ^wab ^taa»1ao1»1aw ^ ^ra •^» ^O rl»1o»Ya ^Perylr^1wr1 N. George Sr at 11th Ave, Manchester Twp PA z a.- , a4lrrp+armrairy fE49plb/aa agi11 • oae+aealrYwlnlarlleaMrod..rYlnw4.is.lane»1»1oY11a41+ra1.»Yaprawlel Y.b...r~,....1aaY..»aY...MYr1Y.a..w---------------- --------------- ^ • r - /w ~ ' Deputy Coroner ~ l~rrcaeM`q ~ abp~aw~dleMd~ ~br~ aerd ~Y~1+1 Y1e11YMY1nrraewL-----------------^ aurr»w lM QL Ar4aMaw a».1Y11 ei°1"O10'1/040"'1 AIMYa1aaYNY11•eY/wYYel'Y1 e YrgYlal aY11YYYaaa11MMRN bY NMbIM MN y^ December 23, 2011 , , / . 1»a1 1YIllfY1»»L K.~~~ddti~~~~aWb~14 11 to T1pIRN a nlynln .a ~ - I oZ I ~I o!~1 r 1 I ~, p,b paw ,,,~ Stephen COSey iaZ ~ p // 118 Pleasant Acres Rd, York, PA 17402 wolarlraeer O 6 6'/d ~r ~ 001 u., ~ ~ .. ~ ..,. ~J RENUNCIATION COUNTY, PENNSYLVt~1~T~~ERLAND CO., PA ^~ rn!i nr• -~ REGISTER OF WILLS ~~~~'`~ ~ ~l1~Rr CUMBERLAND Estate of BRIAN K. BROUSE 1, TIMOTHY T. BROUSE (Print Name) FATHER 2412 FLAY 3 I f P1 3~ b i Deceased in my capacityJrelationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to DEANNA R. SELVEY MAY °~ hD 2012. (Date) 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. 10.13.06 ~~ ~~ (Signatwe) 516 NORTH 2ND STREET (Street Address) WORMLEYSBURG, PA 1'7043 (City, Slate, 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 ~hd day of /'-1 a~/ do 12 ~:~,~.. m~d~ ~Nota- ry P c My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date ofexpiration of Notary's Commission.) COMMONWEALTH OF PENNSY VA Notarial Seal Tiffany M. Lenda, Notary Publk Lemoyne Boro, Cumberland County Commisslon res ]an. 12, 2014 MEMBF.µ, PENNSYLVANIA ASSOCIATION OR MOT