Loading...
HomeMy WebLinkAbout07-03-12Reset PETITION FOR GRANT OF LETTERS REGISTER. OF WILLS OF L+ tJ/!'I ~ ,1= ~ L ~ ~~ D 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: _ R o 3 C l2 ?'" F_ ra2L 5~ Lc L L a/kla: a/k/a: a/k/a: Date of Death: ~ ;, to E, ,,~ ~. , ~ U i .~ ~, _ , File No• ~' ~ ;~ ~ ~~ j (Assigned by Register) Social Security No: ~-G9 - ~~ " ~ '~ ~`~ Age at death: Decedent was domiciled at death in ~ UI-16(_r2 L H~~J fi County, ~i;NAFS 'C //~w'r (Srate) with is er last principal residence at / 7C~G~ iI1E1QKET ST,PE~T, C'/~t'-'I ~' i-f t L.G. /~ % ~'/)// C ~rnl~~2L ~v Street address, Post Office and Zip Code City, Township or Borough County Decedent died at ' ~ U ,M ft2 f«T Sr2~~T. Cam /a 1-I' 1 ~L /~A / `70 // C c-`M B ~.2 ~ t?rV D Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death If domiciled in Pennsylvmtia ............................ All personal property $ `J~iC'~, Q If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ ,~ ~; i7 , If not domiciled in Pennsylvania ........................ Personal property in County $ ~ N (~ , I~alue of real estate in Pennsy[vania ......................................................... $ N C M k TOTAL ESTIMATED VALUE.... $ ~ ~ GQ~ ~T Real estate in Pennsylvania situated at: ~It ~ rV (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County ~] A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/sheithey is/are the Executor(s) named in the last Will of the Decedent, dated _~ / ~ ~ ~./~'J /and Codicil(s) thereto dated 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., pendente life, 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) an~i 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 survivedby the following spouse (ifany) and heirs (attach additional sheets, if necessary): Name Relationshi Address C~ CTJ z-; ~ r ~ `.~,. _ ... C r ~, ~G i i Form RW-02 rev. 10/11/10/1 .t? -: .! • ~ ~i D ,_' C~ ft'7 ~`Iiage 1 of ~ , Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF } } ss: } I ih( .~`' ~ci~] [Yse -,~,,~ Petitioner(s) Printed Name Petitioner(s) Printed ,~• ~- --;~ r. 17 ~- ~ ~ ~ ~ . .~ ~ ~' 3 ~- v G ~ 3 ~ 6 q c: ~ l~ o ~~ ~~ ~ ~ MAR CO. %p~o / ~ 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 Dec ent, the Petitioner(sZwill well and truly administer the estate according to law. Sworn to arar affirmed a~td subscribed before ~~~ •UO ~ DateO 7~0 3 ~ ~j ~ me s _~l _ d.ay of,-~ ~ -~ ~ Date By' ~~ 61~ ( ~ l j i ~'~ ~ `; ~~; i ~l ( 1 Date For the Register Date BOND Required: ~ YES ~NO FEES: ____\\\\ Letters .................... .. $ `{ ~~) C-~' ( (~, )Short Certificate(s).... . . ( )Renunciation(s)....... . . ( )Codicil(s) ........... . . ( )Affidavit(s).......... . . Bond .. .................... .. Comm ission ................ . . Other ...... .. (,~l i I ~ ~ ...... .. ~ ~ . ~~ , Automation Fee ............... ~'~ - .' JCS Fee. ,)`~ :. ~ ,~ ................... TOTAL. .................... $ „~' "~(1-66' To the Register of Wills: 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 t~CG~~-~ (--~- ~~,C~~C ~ I 1~~~ File No: s~', -'; ~ - ~ ~- a/k/a: AND NOW, ` ; , ~ ~-~ , in consideration of the foregoin Petition, satisfactory proof having lie n presented before me, IT IS DECREED that Letters ~ - ' ~ ('( ~ ' are hereby granted to "c ' ~ ( T~ i r in the ab ve estate and (if applicable) that the instrument(s) dated ~=~ I ~ (`~~ ~f described in the Petition b d ~ttted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. ,~ ,^ ~ ' `~~ ~ ~ C" C ' ~ " ; Register of ills ~ ~ ~ -~' Form RW-02 rev. ]0/l !/z01 / Page 2 of 2 ~, F ,~"C ~ c ~~::a ' ` ... ~ `~~~ ~ ~~ ,;~JuL -3 ~~tl~ .1 ~ _c.: ORP~At~1'; CCr~~r LAST WILL AND TESTAMENT ~~~~ C0~" ~ OF ROBERT SNELL I, Robert Snell of 116 Robin Road, Hummelstown, Dauphin County, Pennsylvania , being of sound and disposing mind, memory, and understanding, do hereby declare this as and for my bast Will and Testament, hereby revoking all Wills and Codicils previously made by me. 1. I nominate, constitute, and appoint my trusted and loyal friend, David Leroy Delbaugh, presently residing at 34 Gale Road, Camp Hill, Pennsylvania, as the Executor of this, my Last Will and Testament. He shall be authorized to carry out all provisions of this Will and I hereby relieve him from the necessity of posting security in connection with his duties as such in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. 2. I direct that all my debts and funeral expenses be paid as soon after my decease as may be practicable. 3. 1 direct that inheritance tax on property disposed herein shall be paid from my residuary estate. 4. If a named beneficiary predeceases me, the inheritance shall be issued per stirpes. 5. I leave all the rest and residue of my estate, of every nature and description, and wheresoever located, to my friend David L. Delbaugh. 6. If any person, group, or beneficiary files, or has filed in their behalf, any legal proceedings against my personal representative, executor, executrix, or against my estate and possessions for what ever reason, then that person, group, or beneficiary shall not share in any portion of my estate, and appropriate legal action may be taken to suppress the challenge. LAST WILL AND TESTAMENT OF ROBERT SNELL ~~ ~ ~' ° `( Date Executed: ~~ Signature: ' ~ `- Witness~~:~<~~~ E~ E~ :_~~cz ~~~, ~>,~, Witness: ~~ ~~ ~~~, . ~.-.e ,~ f~ ,5 ~__f COMMONWEALTH OF PENNSYL VANIA CO LINTY OF DA UPHIN Witness my hand and official seal on this // ~~ Day of ~~ _2009. NOTARY P17BLIC q~Ct,,-~ ~ ~}- ~ ~.~~ ~~,/~ wwc~i~ rr~acK wwn Mx~ o~ «cow~r !Ai iM~NON x~or~ w r~ww ~ ~~+ tI1NiIDa M11MW0 ~ M~ ~j ~Mt At b0 ~Migi noM~w~ vM ~~ 02/11/2?12 21:2]- 7177373283 DAVID DELBAUGH PAGE 02 -~. ca r~ ~? ~q` ~ G~ r ~ ~ _ _ ; ~, ~ '~` ATI~ Ok' SUBSCRXBING WIxNESS(ES) ~`~ O ~ -`.', , ~ ~~ ~~ REGISTk'R O)~ WILLS n ~ `~ ~, V I-1 ~ E+Q L/~N Q COUNTY, PENNSYLVANIA ~ )~state of _ ~,~~ ~(z`T ~~R ~. i~ N f ~ ~._- _ ,Deceased ~N ~1-i i C ~ ~ © ~f3 tQ~~ ~-a K ~.. , (each) a subscribi ng witness to (Pr(nt Name/s) the ~ Will ~7 Codicil(s) presented herewith, (each being duly qualified according to law, depose( and sa 's that she / he /they was /were present and saw the above Testatoz' /Testatrix sign tl~e same and that she / he / t~ signed the same and that sh.e ! he / t~ signed as a witness at the reduest o~ the Testator /Testatrix irA her /his presence aztd in the presence of each other. ~... • (SiR~'atvr y 3U~ L y.~ct'art d ~r-~~,, ~~~ (City. SlQre, Zrp) ~- Executed in 1Zegister's Office Sworn to or af£-rmed and subscribed before me this of day j$lgnafure) (Street Address, !' (City. $artr, ZiPi C~ Cy!'l27f'1 f.~Y! lc~z ~~~ ~ /mot ~R,4?~yf.~+~ C~ ~,~~ ~ ~," Lr'xecuted aut of 17egister's Office Sworn to or at'~xrned and subscribed A before me this ~~ day o f ~~ .o~ v1c~ _ ,. Deputy for Register of W 11s Nancy n. w~ Notary Pubik o ary l? is Lower Paxton T~ ,, Dauphin County y Commission 1/xpires: !d ~ot(~ 070/ COnIfn~510n Tres OCt 26, 2013 gnature and Seal oCNotary or other official qualifie~o Member, PRnnsvlvanla IlS50Ciatlon of Notarie~dminisier oaths. SNOW data; of expiration of Notary's Commission.) No'r@; To be taken by Offi:er authorized to adm~gist:r oaths. Pleas^.. have pres~'m the original or cUpy of instrument(s) at time Of nOt~rizauon. RormRW-U3 r¢i~. IO.IJ.06 ~C~~ R.~~ TRAR's t:~R'~~~I~I~:~T~~I~ ~J~'ng"I" S4'I~f,~1f~C~.' ICE r li gal to dupfic~x~~ t~aE~ ~ xa~ ~ :~:f ~,[~r~~~~~~to# ;~,"s ~~~~[ ~~z::<~~,~: ,- ~ • I-~cc (In~ thf~ L:ertif~cate tiEA.(it}, ~:~3t2 JUL -3 k~ 11' I f O~SP~~tVr~J ~Ui~+S~ ~ ~; ~ ~,~ ? ~FRI~WD C4., PA --- ---- ('ertifiuitil~n '`,I[n1}~t+ /Prim In `~ ... ,3 °~„Y~ ,) ~ ~(~~;f;v It -~~; }_.Itt~, v 4r. twat I r ,. !r ~r(I; _ ~..Lv f , ~ -'7~ Ya4 N ,r 13° , t. G .l ` ~ ~~~~ ~r ~~ ~ gt~ ~1• ,. ,,,,,~ _.. - .., ..;, ,-. ;,.. I _, c I,x:url. COMMDNWEALTH Of PENNSYLVANIA • DFPggiMF N' OF HEAT TI•' • VIigL RECORDS fCDTI Cg I`nTe n Suffix) • • State File Number'. 1. De[etlent's legal Name (First, Middle Last , , 2. Sea 3. Social Security Number A. Dale of Death IMO/DdY/V!) (Spell Mo obert hell Male 209-12-9788 June 22 2012 T , a AgeLast Blr[M1tlay IYrsI Th. Under 1 Vear Sc. Under 1 Da 6. Date of Birth IMO/Day/Vear11S0e11 MDn[h }a. Birthplace (City and State or Foreign Country) M onths Days Hours Minpt<s HdrrlSbUrtJ, PA 88 May 8, 1929 }b eirth la[ (c . p e p~mY) Dau hin Ba. Resi]enceJ-StJa+te or Foreign Country) qb. Rey[dsnc JT[[eeet aln~tl L~:mber- Include Apt No.) 8c Oltl OPCedent live In a iownshlp? .34 (;al C1 ^Yes, tlecedent lived In .._'wF. 8d atsltltnre lCopntyl (~~~ CYunberland Re. Residence IZIp Cade) ~NO, tlecedent lived within limits of = `Y' Hlll _ <itY/born 9 Ever in US Armed Forces? 10. Marital Status at lime of peach ~ Married Widowed E1. Surviving Spouse's Name IlF wife i Y , g ~ ve name prior o first marriage) e ^ No ^ Unknown ^ Oivo ced ^ Never Marrietl ^ Unknown t 12. fatM1er's Name (First, Midtlle, last, SuXial ' Charles Snell 13. Mother s Name Prior tO First Marriage (First, Middle, Lastl I lAa. Informant's Name lAb R Yklna Eckert . elaTlonship [0 peeedenl David nelbau h 1A[ Intorman['s Mailing gddresi (Street and Number, Clty, State, Zip Code', o Executor `~ 39 Gale Rd. Camp Hill, PA 17011 ' ~~ .... 1T I Dath Ch _Y.n a If De M1O~ ~ ~d ~p I i~ In at ~ ~ ~ ~~ ~~~~ . p ens MMii .. ............ :Ipe [M1O d SO h 0th Th H ~ '~~" ' o ptal' y p p Fac3'ty ..d Decede s Home _ ^ E g V R /0 p t ~ Dead an A I ['¢N rsin H ( g ome/Long-Term Care Fadl ty Otn r Tpecly) 15b. Fac me( t ns[[uton gve street and number IT ~~OT ~~ e , . C. Cityor Town, State, and Zip Code 1Td~re t~ Camp Hill, PA 17011 1 16a MetM1Od of Oisposihon Burial ~ Cremaupn 16b. Date of OisDOSition 16[. Place of Disposition (Name of cemetery, crematory, or other place) ^ Rempval hDm start k1 ^ ponanpn a 6/29/2012 Warner's Cemetery i7 Other lspe[dY) Z Ifid location of Orsposibon )City or Town, State, and Zip t}a. 5ignatute~f u Servr[ is Bison In Charge O(Interment 1?b L Prise Numbe 1 e~, r v Liverpool, PA 17045 ~(/ ~,/ FD 013239 L ~ v[ Narie and complete Address of wneral Facngv Neill Funeral HCme Inc 3401 Market S Cam Hill PA 17011 18 D d ' . ece ent s Education -Check the boo that best tlescribes the 19 Decetlent v(Hlspamc Origin Check tM1e 20 Decedent's Race Check ONE OR MORE races t0 indicate what highest degree or level of s[M1OOI cpmpletee at the time of d th b ea oa that best descr bes whether the decetleni he decedent considered nrmsell or nersell to de (] th gratle or less N is Spanish/Nlspanr[rLatino Check the "NO" Wnrte ~ g rean 0 ]IOIOma. 9tM1- 1}th gratlt boa it decedent is not TDdnlSh/Hlspamc/Latino ~ Black nr Alrican American ^ V %] Nigh school graduate or GED completetl ~N not 6 M1 'H t pan:s , rspamc/Latino American lntllan Or glaska Native ~ O[h e aASeae ^ Sortie college credit, but no degree ~ ves Mexican Mevlc r A . . a merican, CnRano ~ gsran Indian ~ N []ASSOCIate degree e. g. Aq, AS) ^Yes Puerto Rrca+ W a , ~Cnrneze Guaman a Or Cnamor•o ^ Bacnelvr s de8ree le.g. BA, q0. BSI ~ Yes Cuban ^ , Filrprn0 [] Master's degree Ie.g. MA, MS, MEng, MEtl, MSW, MBA) es ~ ^ Samoan ^ Y ,o[M1er Spanish/Hispanic/latine ~ la anese ^ other Pacil~t lslantler ^ Doctorate le p g. vh0, Ee01 pr Professional de8ree (S d pee o) ______ _ ^Otner lSPecrNl__._______ le. Mp, DpS, DVM, LLB,10 - -. -__-.. rp } 1. Decedent's Single Race Set/-Designs n Check ONLY ONE m rndlcate what the decedenr considered nrmselt Or herself to be Z2a Deced t' U l t . en s sua ~wnlte Occupation Indicate type of work ^Kapanese sam0an none corm (]Black or African American ~ o ^Otner Pacili[ISlander 8most pl worklnq llle DO NOT USE RETiREp ^ gmeri[ai, Inalan pr Alaska NatNe ^ viem,mese ^ Don't anew/NDI Tpre Steel Worker ^ Aran Indian ^ omer Arian ^ Remsm ~ }}b. gmd Dl Bpsmts:/mdevrv Cn nese ^ Native Hawaiian ~ Other ITpb.dy __ _ _ ^Filicin° ^Gua nlnprChamrr _ ~-- Steel a ITEMS 23a ~ 2;d MUST 8E COMPLETED 23a. Date Pronounced Dead IMO/Day Vrl }3b Signature of Person Pronouncing Death (Only when applicable, i3c. l'r[ense Number BY PEgSON WHO PRONOUNCES OR /aa ao( ~ ~ ,~~ / 23dT0aEe Ngned /DaV/Vr) 2a. Time [ t ~~ ~ti Rti So3 d d ` OCo l ~ .'T. Was Medical Examiner or Coroner Contacted? ~ yps No CAUSE OF DEATH t ap imate :6. Pan 1. Enter me<h r ns-diseas wreso pt ions--that ereary <amed me Beam Do rvo3 encerterm'na e~nn aucn,5 ca,ea[v - res espratory arrest [ far lib latlon wRhou[ h g h euOlogyr pO NO ABBREV ATE. Enter only one cause onaFnee Add addtonallmes'f necessa ) oDtath ~ MMED Aif CAUSE -- ~' ~.\ ~ a Irnalasease or [prix-bon ~ r ~ - -..-.-_.._-.- ---- or ass p resultn9ndeatnl `~ ~ b , L~ '_-..__.-___ _ _-._-- sepr,en a lv st pnenpna, dot to lo.asa COr~sr1 [ I any, leading to Ihe cause r led air lines Enter the ' UNDERLYING CAUTF Due tO lo•as a.On rtuence ol7 ~ --- ----- Idrse injury that ', .r. ~ ~ea me eyems resplbng a. n deaznl LAST. .-- o -- _._ ue m Tor as a consequence pt) -- --- .`f Part ll. Enter other figni/leant cpntl-t t b [ d Ihbut not resulting in'ht underl in ca ~~ y g use grvrri rn Partl }) Was an au[005 Y Perfor ^ yes No 1B. Were autopsy findings available tv Ompl<te the cause of dea[h+ [ 29 II Female 30 i es ~ v ~ NO Nol pregnant wlMin past year . D d ioba[co Use Conlribu[e to Death? ~ V ^ Probably 31. Manner of Death l p Pregnant atume Ol death ~ No ~ own ora ~ H micide A N regnant, but pregna within AZ days of tleath ^ No' pre nant b t ^ ccldem ~ Pending Invesfigatron ^ Suicitle ~ Could not be d l • , g , u pregnant A3 days to 1 year bel0re death ^ UnmOW pregnant wenin the pas[year 3}. Date of In ury IMO/D I aV/Yrl lTpeP MOnthl e e mrnetl laced 33. Time OI lniury Iu v leg. soma. cvnsuucuon z se, la , school) 36 injur t W N > Locauvn o I v ISUeet and Number, tv. State, ZiP Cvtlel y a or 3 Il iranspor[ahOr Injury. SOecrfv Describe HO nlury Occurred r) v ^ D ver/Operator ~ Pedeslrlan No ~ Pas en8er ~ Other lSVe<rrvl ~~~_~-- -- 39a iier )Check Only oriel: ~ a ulying physician io me best of my knowledge, death Occurred due sel=l and m arine !ed ^ Pronouncing S Certifying pnYSician tM1e e t of my kno e, death occurred at the ume, date Sand plate. and due t0 the causels antl mann r ^M di l e s e ca am Examiner/Coroner On b n, and/pr rnvestlgatron. in yvp .vn, tleath v<cur~ed at iM1e ume. date, and place. and due tv sels)and ma to n n er stateu SrRnature of certifier _ _ lltle Di cerulrer___~ _ -. __ License Number 39b ame Add tl ~~~ . ress an Zip de on Cvm )Bring Cause of Death Item 61 ~QIE /S r~} ,,yy 39[. Date si d o/ aylVr) 7 Z/ C l~ R ' , F U ~Y1 )/O P~i/IFi~E (Vt r o Gr~?F Fllt.~ Ff,. /)~i! (} ,2i 1 q - 0 Registrars DisN mber al Reg tr ignature a ~' ~~ ~ d2 Regist rFile a~ (M O/Day r) ~ ~ ~ ` 1 A3 gmendments ~ ~ ~~ • , D~5Pn5itlpnPe~,I,NP U17~/~!f~ RH1pT-3x3 -. Ev m/zo u