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HomeMy WebLinkAbout07-16-12 PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA K6S6i 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 II 2 Name: Taylor Jean Bolen File No: ~ ~ ' 1~ Y ~T a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 204-72-4785 Date of Death: June 30.2012 Age at death: 20 Decedent was domiciled at death in Cumberland County, penngylvania (stare) with his/her last principal residence at 39 North Old Stone House Road. Carlisle. PA 17015 Cumberland Street addraa, Post Oince and Zip Code City, Township or Borough County Decedent died at 1101 Claremont Road. Carlisle. PA 17013 Cumberland Street address, Poat Ofnce and Zip Code City, Township or Horough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ 0.00 Ifnot domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ (1_(10 If not domiciled in Pennsylvania ........................ Personal property in County $ 0.00 Value of real estate in Pennsylvania ......................................................... $ 0 (M TOTAL ESTIMATED VALUE.... $ 0.00 Real estate in Pennsylvania situated at: (Attach odditiona! sheets, ijnecessary.J Street address, Poat O[flce and Zip Code City, Township or Borough ® 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 thereto dated State relevant circumstances (eg. renanciadon, death ojexecator, eta) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not diw divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS ®EXCEPTIONS ...~ .t a pg~+to hav~chi: .. County B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendente life, darante absentia, darante minoritate If Administration, c.t.a. or d b.n.c.l: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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. EXCEPTIONS ©EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (ifany) and heirs (attach additional sheets, if necessary): Name Relationshi Address Melody A. Bolen Mother 39 North Old Stonehouse Road, Carlisle, PA 17015 Roger E. Bolen Father 570 Reservoir Road, Gardners, PA 17324 Farm R W-02 rev. !0/I1/2011 Page 1 of 2 .1 < Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } To the Register ojWills: Please eater my appearance by my signature below: Petitioner(s) Printed Name Petitioner(s) Printed Address Melod A. Bolen ,,, •, 39 North Old Stonehouse Road Cazlisle P t_t `. '' 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~~c~Aed"^ent~r, the Petitione will well and truly administer the estate according to law. Sworn to r ffirmed and subscribed be ore / rl~~~ ~~ Date Tlll'l 2 me this y of ,~13- Date gy; Date Fo It Regis Date BOND Required: Q YES ~ NO FEES: Letters ..................... . $ 0 ~ (J~ (3 )Short Certificate(s)..... . ~~~ ( )Renunciation(s)........ , . _~ ~ )Codicil(s) ............ ( . ( }Affidavit(s)........... . Bond ....................... . Commission ........... . ..... . Other ....... . Automation Fee .............. . JCS Fee . ................... . ~,3~ TOTAL .................... . $~~G~ -0.A Attorney Signature: r` Printed Name: Leslie M. Fields, Esquire Supreme Court ID Number: 29411 Firm Name: Costopoulos, Foster & Fields Address: R31 Market Street Tyr PA 17043 Phone: Fax: Email: 717-761-2121 717-761-4031 lfi .Idc rnct~nnlncrnm DECREE OF THE REGISTER Estate of Tavlor Jean Bolen File No: _~„1 - l'~ - ~ / ~U a/k/a: AND NOW, e1,! ~_,~y/off , in consideratigp Qf the foregoing Petition, satisfactory proof having been resented before me, IT IS DECREED that Letters a~ f-fDl /72 ill i5>~G~i~U~ are hereby granted to P y o c n in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of as the of Wills Form RW-01 rev. 10/11/1011 Will (and odicil(s)) of Decedent. .1-i~(119L Page 2 0 2 F~E~iR~~r,C r:r;CE OF ,,.~ ~... ~,~./l! lS ZOl2 JUL 16 PM i ~ 05 RENUNCIATION ORPHAN'S COl1Fi REGISTER OF WILLS a1MBERLAND (~J,1~ERLAND COUNTY, PENNSYLVANIA Estate of TAYLOR JEAN BOLEN Deceased I, ROGER E. BOLEN _, in my capacity/relationship as (Print Name) FATHER of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be: issued to MELODY A. BOLEN (Date) ~ (Signatures Executed in Register's Office Sworn to or affi d and subscribed befor mI~ t-his ~~ day for of Wills 570 Reservoir Road (Sneer Address) Gardners, PA 1'7324 (Clry, stare, ZipJ Executed out of Register's Offzce purposes stated within on this day of , Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the 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.) Form RW-06 rev. 10.13.06 •c\' LOCA~C~~I~~R'S CERTIFICATION OF DEATH WA ~ s i Y duplicate this copy by photostat or photograph. REuIS i c" 1,., , , ..>rx~ Fee for this certificate, 9.6.00 ~~~~ ~~~ ~ ~ ~~ ~~ ~~ This is to certify that the information here given is correctly copied from tin original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital ~p~~~` ~ ~~1~~1T Rearrdr: OO ice for permanent filing. ~ 1 ~F" `". P 18614941~~~~'~ Certification Namber pe/vx .CJ ~g i Coca] R'.egistrar Date Issued cDMMDNWEALTH DF PENNSYLVANIA-D TOG HEALTH.VITAL REC.DRDE eTkCEf`ATC IIC EIIFATM lack In k r'~.P~v, ciss D t 3.s a. aceeent'a Lap1 Name (Post MMJIe, Laat SuXI„) ek oclU securlN Number a e of Oaeth (Mn/Oay/vrj (3pell Mot S~ Ta for S Bole ~ F¢ ala n pm<e (oN .nm st.ce or GorolH connwl wge-L.n gbem.v Ivrrj sb. onset 1 year timer 1 Da E. owe ni elnn (Me/Dav/Yearl (spell MomN . Hin sa . nncm D.va Nou m,.< Harri abut PA 20 Au >e. elnnpl.=e (cnunNr Dauphin ee. ReNa.na Istnte n. F..elen co„n<rv) ge. Raeena (so-eu ana Number- menee Apc Np.l e< Dle o.=.aem uve m a mwn,mpa EYf vez. ae=ea.n<u.,.am_ Silver Spring ea. Resiaen<e( ontyl N. ld to u ¢ Cumberland a Inp wael pNO, aaeamt Iroea wrtmn mm~z of <,N/bo.o- n VSArmetlF O. MaNta15[e[za[Tlme ofD e[n ~M letl ~W wetl SUrvlvln{Spouse's lVamellf wi/e, glVename peor[onrR marrragel rr S Ou OD cetl ~N er Marrlee pw mn pu VO w , Idtlle, Last, 3uM.l . FatM1eYS Name (FI t M r 13. Mo[M1eYa Name Prior to Flrs<MSreage (FI . Mltltlle, Lastl et Eu ene Bolen Ro M¢lod Ann Mi 11er law. Iniarmen['s Name lab. aela<lananlp <o Oecetlent lac Inrorment's Mslling Atltlress (Strce[ ana Number, CIN. state. ZIp Cneel Ma1od Ann Bolen Mother 39 N. 01d Stonehouae Road Carlisle PA 1701 CYTp.nent ._ =p.reas _ .......................... .. ....._._ _..._......................... ............ ......... .......... .. ._. a eat rTnen a Hn tai: [] Hospice Gaclllry Oeutlent'e ita. :If D..<b'o< nm.wn.r. om. ........... Hnm. H a I v m o P a na P s «~rro D.. 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OO NOTe ale uchv artlla< rval r ~ i/necessary nse<to OCit 4aa aatlltlenal llnea reapbatary arros[. ar uantrl tiler nb6alaelan wlMOU<showlnH Meetlo ogy. ONOT ABBREVIATE. Enter only one cause onaline I D O IMMEDIATE OUSE ---- ---. a. Hanging IHna al: Imo D.,e [n Inr a.. <enae.P•ena nn: n an m a ~ ruwnn{ e b. Dually Ilse =onNCrnna, owe m Inr ar a <pnzeapen=e on: '- v ov. IeamnH <e M. <au:e a <.a nn lme .. E e <. t D,.e m Inru. <enrewen<e one i DggkvlNO EJkuze w (tlisease nr INury Mat [ tatl <M1e events rcxulting tl. i ~ b. aeaml usT. Due to for .x a =on..RUen=. otl: j lg. Part II. En<e. o<M1e but not resulting In Ma untlerlyln[ [sure gluon In Part I 2>. Wes a topxy ri rmaal O r no 38. Were a tillable ~. [o complete <M1e cause of aeatni O Na 39. If semale: eccn V e cantebu[e [a DeathT O. Oltl Tob s 31. 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(spaclM rtlnar (CM1eck only noel: 39 C C nlMn PM1Yrlclan-TO <M1e nes[ni my knowlltlge, aeatM1 nMecausalzl anam 0 Q P rtlNinB P tM1a bas of my kna leagetl retl a the nme, tlat na pia tl au ela) anam tea a one o m n o e tim w ~ .ns• =I e <aPSetxj one manna. x<ae e Imo, sate, ana pl.<e..n c t on, m m n ml.n. aeo c rro ,m/pr m e Mewl Eumm.~/co - ~ne signs ar= nine rcl. pt< mne ~ Acrin9: Coroner mbar T Aaero.r ana zlv tneeerPerren Cemvlaen{c.u,e of Deem lle.m 2s1 5 Base ore Ro Suite 9 x eslsnea (Me/D. q 3s< Matthew S. Sfon¢re Acting Coroner Mecbanicabur PA 170'50 Sul 2 2012 90. Peglsner a Ola[ec<NUm a 1. Re[Ntrar'r tits ~ a1 Regizerar FI a Date ay n ZD i d/-~/ - 7~-9~do B . Amenamanex Dlspozitlan Permlc Na. O7~F O J Os ~ H1O5-193 _-. _ REV D]/2011