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HomeMy WebLinkAbout07-03-12Reset 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: TERRY R. HOSTERMAN a/k/a: a/k/a: a/k/a: Date of Death: June 16, 2012 File No: ~ I I~ _ ~~ (Assigned by Register) Age at death: 61 Decedent was domiciled at death in Cumberland County, penn5ylvan;a (stare) with his/her last principal residence at 76 East Louther Stree[. Cazlisle, PA 17013 Cumberland Street address, Post Oftice and Zip Code City, Township or Bor ough County Decedent died at M.S. Hershev Medical Center. Hershev PA 17033 Dauphin PA Street address, Post Ofnce end Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: Ijdomiciled in Pennsy[vania ........................... . All personal proPertY $ 2,000.00 Ijnot domiciled in Pennsy!vania ....................... . Personal property in Pennsylvania $ !f pat domiciled in Pennsy!vania ....................... . Persona] property in County $ Value of real estate in Pennsylvania ..................... ................................... . $ TOTAL ESTIMATED VALUE... . $ 2.000 00 Real estate in Pennsylvania situated at None (Anach additional sheers, ijnecessary.) Street address, Post Ofnce and Zip Code City, Township or Borough County © A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/aze the Executor(s) named in the last Will of the Decedent, thereto dated and Codicil(s) State relevant circumstencea (e.g. renunciation, death of executory etc) Except as follows: afterthe execution ofthe instmment(s)offered for probate Decedent did notmarry, was notdivorced, was notaparty to spending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child bom 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.h.n.at.a., pendente lire, durance absentia, durance minoritate If Administration, c.ta or d.b.n.c.Ga., enter date of Will in Section A above and comBlete 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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTTONS ®EXCEPTIONS Petitioner(s), after aproper seazch has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and ~}s (attach additional sheets, ijnecessary): - ~~ O "" ~ -ri Name Relationshi Address t~-t e ~ '' f r Todd R. Hostennan son ~_ ~~ i ~.;: 28 Nicholas Ave. Danville PA 178 1 rr"';' t'`~ C?C~ a ~~ -o_-~ _ t- m C> .:D c~: i r" c~ c;_: m' ~t Farm gw-oz rev. lonuz°l/ Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } } SS: } Rf_CO?Lt'~ Cii=FiCE OF r~ , Petitioner(s) Printed Name Petitioner(s) Printed Address Todd R. Hosterman 28 Nicholas Ave. Danville PA 17821 ~(-L~' v n n~aFai and The Petitioner(s) above-named swear(s) or affirm(s) the statements' the foregoing etition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Dec ~t, the Petiti r~r(s) will well and truly administer the estate according to law. Sworn to r affirmed a d ubscribed before \ Date 7^-S " 1 ~ me this d, y of 0~2 Date By: Date Forte egister -_. _. Dale BOND Required: ®YES Q NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ...................... $~~ (~ )Short Certificate(s)...... ~i`~ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ Automation Fee ............... JCS Fee . .................... ~°1 St~L-c~- TOTAL ..................... $ _. -11:00 ~-a Attorney Signature: Printed Name: William L. Grubb, Esq. Supreme Court ID Number: 72661 Firm Name: Law Office of William L. Grubb Address: 3R03 Gettyshurg Rnad CamT Hill,~,9 17011 Phone: (717)763-5580 Fax: (7171763-6848_ Email: g hlxw ~anl rnm DECREE OF THE REGISTER Estate of TERRY R. HOSTERMAN File No: ~t I ~ a - ~ ~ '7 a/k/a: AND NOW, satisfactory proc `7 ~/~~ , in consideration of the foregoing Petition, presented before me, IT IS DECREED that Letters of Administration _ are hereby granted to Todd R. Hostetman in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed as the list Wjll (and of Form RW-01 rev. /0//!/201/ P 0 2 Of 2 LOCAL REGISTRAR'S CERTIFICATION OF DEATH 11~~)4fP~~~1 to duplicate this copy by photostat or photograph. "~_ n II .L Fee For this certificate. $6.00 ?~12 JUL -3 AM 11 ~ 36 ,_:L .I'. ORPt1AN'S CURT P 18 6 2 6 3 9~~RLalvo co., ~ Certification Number 3` Typo/Print In cknn This is to 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 he forwarded to the State Vital Records Office for permanent filing. ~~ J 18 2012 Local (Registrar Date Issued OF PENNSYLVANIA • OEpARTMENT DE HEALTH VITAL REGORDs CERTIFICATE OF DEATH O <.a.nt•. L.ga rvvme (First. MltlOlq laa4 suMa) utlq Numbs. ei OotM1 (Ma/Oay/YrJ (9pa11 Moj 35 a 185-38-1.963 Jlzna 16, 2012 Terry R. Hosterman Mala sa. qge-teat glrtneay ryrq sb. tins.. l Yee. s<. una..1 D wt. ar glnn tMa/Days...) (svu Mantra >a. mnhmaw taN ana sate.. Farelsn eaanem 5 61 angina mva Haar Inu< July 24, 1950 Ca lisle >b. 9lrthvlacv (counts ar an e.. Romen<e est.<. ar Faralgn caantryJ gib. Resle.npe Is< .na N mb.r- masse qv<rva.j Dla D <.e.nt uy. m. n.wn,bm~ PA 76 East Loather St_ Oy.,, e.<.e.n<u.,.am_ tw v ga. R ,m.nw IcauntN a a, a.<.a.nt uy.a wrznln umlt, ar Carlisle CVml:Darland e.. Re.Ia.n<. IZI caa.j 17013 ppN =kv/baro. . m.a Parcesa 1 aI sumo a<rlm nt D.am O M. N a o w w. . su..nvln{ svauaa'e Nama Ur wlfn {roe nvma v.lo. m Rra m..naael D r l D " ® Ha o Dnknpwn ~~ wa o rv .. M..rla o DnknawD t~ o ~ ya ss- Faxber•a N.m. IFI Mlaale, L.:c saxla ' a<n.., N.ma Pao, m Nrtc Mar.Lge Inrst. MIaaL, u,u HOaterman William Sean M. Bails v Inm.m.ne, Name lAb. Rel.clommp co Deceeent 2e aOC. Informant Maning Aearess Isn.ee one Num CIN, s<aa, ene.l s , yE Todd Hostarman son 20 Ni cholaa Ava .., Danville, PA 17821 F~ _ ....... If DeatIM1 OCCUreE ~In ~~XOxPital:~~~~-~~~~~-[]In ~~~~-~~-~~-~~~~~-~~~~~~~~-,..,..,.,,. pvtlent ~ - ..........E~.....c...:......~...... ^.`...^^.Y.. 1 t ~~ ~a pbl:~~~ []HOSPICe Faclllry ...[7 Decetlent's HOme~~ rDaa M1OCCUrrea SOmewnere O<FerTM1Vn Has1 Ema anry Reom/OUtpa<lent Oaaa an Arrlvvl Nursin{ Mome/LOn['Term Cire Faclllry Otner (SpeclN) 1 b. Fvc111N Name (If not InstltvtlOn, glva street vntl number 35c. CI<y Or Town, stvte, and Zlp GOaa 19a. GounN Or Oavth y M.S. Hershe Medical Center Hershe Pa. 17033 Dau hin .. Maanoa of Dismos Inn O g as .em.uan c a 6 abb. Dave f Dlappa <m n s<. vL<e of DNpaatmn (N m.. ar wme<.rv =r•m.mry or atn.r vlaca) 1 O R ya 1r t. o Danam^ otn.asp•cIM 6/21/2012 Hoffman-Roth E'uneral Hama 6 Crematory nca<lon o/ Olaposltlon (Oty Or Town, 6tete, ana 21p) L e 1>a. sign of Funa.al Servle O. Perso t 1>b. Llcense Numner Carlisla, PA 17013 138504 gaara„ or Faner.I F.ngry ~ 18CD<eOent•s EOU<+tlen-Coach tM1V box cM1Vtbast dascrlbesthe 19. Decetln k[M1e l l eck ONEOR Inalcaty whet t nl{M1Ut aagraa or level ar scnool completetl st eM1e elms ai tlav<n. boa MVt bast tle c rlbes wne[Fartne aecetlem [na ee<eGe n[consleeretl M1lmsel(er Ferself to be. O ern grvaa ar la,a Is SpanlsM1/Hiapenlc/Latlna. Check eM1e "Nn' ~ Wnl<a O Keraan 0 Na tllplome, 9[M1 - 13tM1 eratle boa I(aacetlent Is oat Spanlin/Hlipanlc/Le[Ino. Black Or African Ameacan ~ Vletnama,e O Nlgh,cnnal grvauvte or GEO completetl ®N at6p+nian/NI n14LV ~q Inalvn or glvaks NVtNa OOMa AZian l • ® 5 college cre014 b ea s g ~ Y vxlcan. M an Ameacan, Cnlcvno Olan 0 N wallvn ~ Art•n l. m p q a p. q ~ ° ° ~ O y t.n ~~e:~ R e: o cnm O G an or cnamorro , a::~. a` g5) o g:<: e ~« ~ e o y : o f o 9 ene e I ene +s MEng, MEe, MSw,Mgp pM '.ee{rev le.g~ . py atn.r svanlan/wspmm/Canna a acmc lsanaa. OJ. > re po O Doapae (e.{. vnD. EeD) pr pmf..,mwl a.g.e. (swclNl O Dm.r IswclN) . MD DDS DVM LLB JD 1. Oacetlant's Sln{le Race Sell-Oealgna<Inn - CM1ack ONLY ONE to Inalcata wnvt the tleceGent consltleretl nlmselt or M1e.selr to be. 33v. OeceOent's V sual Occvpatlpn - Inalca[e type o1 work ® Wnl<e ~ J O Svmaan v 'a tlpne auang most o1 worklne life. DO NOT V9E RETIRED. oDtM1.r pann<In.mer p gm<k arAmwn gm.awn Alco e. 911 Diapntcher o q IneLn ar ALaka N.nye o y o D w/Na<sa.e a « . ::,~:n o R.rv., a p Anon roman o D ub. Kma or Bann :anmomry ~ Dmer espetlNj ~. aoac O aoamo O ~~.m County 0ovarnmant and a n.marra M 3 - 1 sye{wgDN wwD anorvgoguE CEZpo~D a ay r Igna<urc o Person PronounclnB Deart OnIV wnen app (cab a Sa~06/16/zo/Z 33c. Llcense Num .r Germans DuTH 29a. D.<. slmea crap Dav/Yrl nm. of D..m O f-I /3 a K,r m.mwl Ew tteax O r rea rv CAUSE OF DEATH P.p^roxlmae 2 .<ne m.Ina t,--elseae.a,Inlvrlea,<r wmpuwnan.-[M1a<ao-aly =aa,aa m. a..<n. D nnl.y.n<. aa<n ., w.aL<..r.,t I 0 r onaline. qOa stlaltlonel lines lr necessary [ nae<tn Devtn O respna[Ory arregt. nr vent, ulcer nnallenan wlthau<,nowing <ne etlolagy. DO NOT AggflEVIATE. Ente only one csuse IMMEDIATE GAD6E ---------> a. vH4a).r~ .H~r3«r (Final elaa.ae ar <amm~an Due o la. as s conxpumce Ong i resuRing m eeaen) co 4^N e.?n/ oe=a2 1 i seaaentLnY u,t <anemana, Dos to car.:. tanaeoaena on: j v.ny. Ia.aing to me tau:e I n,tea on one a. Enter me j V MOERLYIN6 rauzE Due to mra,a<ana.Raen<e an: ~ (tllseasa or Inlury that tea me ey.nta re.wnng a. i 8 mee.[nj tASr. Duce <a car,,. <an,eRa.n<. an: 36. PaR IL Enter Dena. bu<no<rasultln{ In the untlaaying cause glVen In Pert 1 3>. Was an tapry perfarmaOT z ,v nneing...,.II.bI. g w <a • [M1] <M1 t'u' t N Ya, O 39.11 Female 30. OItl To- cco Vse Contabute to Deven> Mv I DevtM1 3 P ~ N t ra8nant wltnln past Year ' robablY 1 o -<Y f= ~ N ~ H clan 0 Pregnant at elms of Oev[M1 Q NO 0 Vnknown ~ gcclOent 0 Pentlln{Invastlga[lon $' ~ N re[nant, OUt pregnan<wltM1ln A2 tlvy, of aav<n ~ Suiclae ~ coultl no[ba tlete.minetl 0 N 3 avys to 1 year barore tleetF 33. Date of Inlury IMn/Oay/Vr) (spell MoneM1) ~ UnkP wn If pro{n nt wltnln eM1e past Vesr .Time or Inlury 3A. Place of Inlury (e.{. home; cons<ruttlan sge; M1rm; scnool 3g. Lacatlnn Of Inlury (E<reet ana Number, GI<y, 6evte, Zip COael 36. Inlury v nrk . If Traniporta<lon Inlury, SpeclN: . Daacabv How Inlury Occurratl: 0 V Q D er/O to ~ P p Nn O vsen e. O D< mispe<IM nine. (<be<k anq an.p 99 G C rtlNmg envslcun -Te en. ba.e of my knowl.aw, ae.m oacurrea sue ro <na <aua.(al. o pEf P• cln{ S CaKlNing pnYSltlen -Ta the beat a1 my knewleagv, avvtF occurretl at the Nme, tlate•antl place, ana tlue to eM1e ceuselsl vntl manner sbtetl 0 Metl cal Eraminar/Gn - n [Fa bas of a mina on. ne/or gatlnn, In mV nplnlnn, aeatn a race a [ha tlma, auto, vntl plow, antl aua to [M1a cvu a(ce) vna m vba rt a ~t-~~'f / MD~• HD y32F 19 ~ -~i D • ~a f l ,s one of wrNn.r: or wrem.r: s{n.<a e ny Nu ` naar.,,.na nv=sae a.P.rsan campL[mg o'll l°S°Ti24<5712~. Medical Center Hershe Pa 17033 51g a1Ma/o. vrJ °' 39c Y , y, . D~ ROD~•r'iT 2r000Ct"/tS 06/t4/ iolL 40. Reglgtrers Oat tt um er a{rtra.s ~~ 9 ReFIsVar Fle DV[e Mo Dry r ~ \ -a~6 R d 20\a-. Uu.t~c \ . gm.nament: DlspaAtion Permit NO. O.1 3pLa~ REV D> 1C3 /2011