HomeMy WebLinkAbout07-24-12PETITION 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: FRED MCGILLVRAY File No: 21 - ~ c~ - ~)~ ~~
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: 7/10/12 Age at death: 56
Decedent was domiciled at death in CUMBERLAND Coun PA
ty, (State) with his/her last
principal residence at 122 Buttermild_Road 17241 Upper Frankford Twp Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Hershey Medical Center 17033 Derry Twp Cumberland PA
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 Pennsylvania ................................All personal property $ 10,000.00
If not domiciled in Pennsylvania .............................Personal property in Pennsylvania $
Ijnot domiciled in Pennsylvania .............................Personal property in County $
Value of real estate in Pennsylvania .............................................................. $ _ 400,000.00
TOTAL ESTIMATED VALUE.... $ 410,000.00
Real estate in Pennsylvania situated at: 122 Buttermilk Road 17241 Upper Frankford Twp Cumberland
(Attach additional sheets, ifnecessary.) 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/she/they is/aze the Executor(s) named in the last Will of the Decedent, dated 6/19/12 and Codicil(s)
thereto dated None
State relevant circumstances (e.g. renunciation, death ojexecutor, 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 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. 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 comalete 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) 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, if necessary):
-Name Relationship Address ='
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Form RW-01 rev. 10/IIi10ll Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND }
Official Use Only
~F~;~l~_,,h;,, , =~~CE OF
-:. ~: - t,~l, c
~, ,
Petitioner(s) Printed Name Petitioner(s) Printed Address -
Jessica L. Nailor 122 Buttermilk Road ' ~-
Newville ~~~~ ~ ~ ~~ ~U~~ 41
The Petitioner(s) above-named svve~ar(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 Persona! Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law.
Sworn to er ffumed and subscrib?d before ~"„~ a_ t~~ Date 7 -~S/-/2
( S'-`'
me 's da of Dace
By::_ ..i L1.Q t ~ ~~F,,srr~ _
Date
For the Register Date
BOND Required: ^ YES ~ NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters .................... .. $
(5) Short Certificates(s) ...... 20 • CCU
( )Renunciation(s) ......... .
( )Codicil(s) ............. .
( )Affidavit(s) ............ .
Bond .........................
Commission ................... .
Other
Attorney Signature:
Printed Name: Hubert X. Gilro
Supreme Court
ID Number: 29943
Firm Name: Manson Law Offices
Automation Fee ...... ........... ~~•~
JCS Fee ............. .......... . r
TOTAL ............. .........$
Address: 10 East High Street
Carlisle PA 17013
Phone: (7171243-3341
Fax: (717) 243-1850
Email: h~ilroY~u,martsonlaw com
DECREE OF THE REGISTER
Estate of FRED MCGILLVRAY File No: 21 - ~ ~ _ y g
a/k/a:
AND NOW, , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters
are hereby granted to
in the above estate and (if applicable) that
the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
Register of Wills
Form RW-02 rev. l0/11/2011
Page 2 of 2
H105.805 REV (9/I I)
LO~~t~~~AR'S CERTIFICATION OF DEATH
~~ "1t IS t to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 ~~}~ ,}u~ 24 ~~ 3: 3~ This is to certil;v ~h~_t the information h(rre given is
.:orrectly copie(i tir,n~ an original Cerlifia(te of Death
duly filed wit} n):~ as Local Registrar. 7'he original
..~. ,
~~~JS~~~I~T . e(r)ficalc will (-,:, t~)rw'arded to the Mate Vital
~~~ ~rf ~ I~Zecords C)fi~ice to {)'_rmanent filing.
P 18 6 >~ 6~~ 9 L Sl~~. r~
Certification Number
TYPe/Print In
Permanent
red
5 6 I Months
Sa. Residence (Star rFOreign County
Pennsylvania
Sd. Residence (County)
Cumberland
9. Ever In U,S~aa.rAsrmed Forces? 10
[] Ves Ip No [] Unknow-r
12. Father s Name (First, Middle, Last, 5
Fredrick
14a. Informant 5 Nam
J
Lora) Registrar Date (slued
COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH ~ VITAL RECORDS
CERTIFICATE OF DEATH
uffrx) 2. Sax 3. Social Security Num ber5tate File Number:
Me G i 1 1 v r a y m a l e 1 6 8- 4 8- 4. Dat¢ of Death (MO/Day/Yr) (Spell Mo)
sc. under 1 Da 6. Date of Blrtn (MO/Da 3 2 2 5 J u l y 1 0, 2 0 1 2
Hours Minutes y/Year) (Spell Month) 7a. Blrthplac¢ fCiry antl State or FN ~n Country)
October 8, 1955 Fiemin ton
~. Residence (Street and Numb¢r -Include Apt No.) 8,yc. Did Decedent Livebin ai Towl nship? unry) u n J= r O n
122 Buttermilk Road llyes,decedentlivedin Upper Frank£ord
~. Resitlence (Zip Code) 1 7 4 -LwP-
~NO decedent ll d
Days
..al Status at Time of Death ve within limits of
Divorced Q Never MarrledO Married ~ Widowed 11. Surviving Spouse's Name (if wife, give nam i r city/boro.
[] Unknow a pr o to first marriage)
~) Mc G i 1 1 yr a y 13. Mother's Name Pr [o F [ ge (F t e, Lasi)
~ a r`f~ ~"~`~ I~ i^~gl
14b R 1
o
G e s s i e a Na i 1 o r -~ a I hi to Decedent
Y~iancee 14P ytaj
~ rmarJ L]
55tt yyrr~ldd mt~
1
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Occurrod in a Hospital: .,.~~
----• .....................
1]I Irrpatlent 15a. P ace °_ Dea_ t__
......r..............
f C e
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1
7 2 4 1
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~ ~ Emergency Room/OUtpaitent Q Dead on Arrival
15b
__ ___
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Death Occurred So
..we .............. C......
mewhere Other Than a Hospital:
. _
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H
=
•••~
. Facility Na
e (If not Institution, give street antl number; _
S
OS~'e Fa Iliry
•-~
Q Nursing Home/Long-Term Care Facility Oth
LEI Decedent's Home -
M.S. Hershe M
edical Center e
SSC. City or Town, State, and Zip Code ( P"r
16a. Method of Disposition ~ Burial _
Hershe Pa. 17033 lsd. c°„nry of Death
Cremation
Q Removal from State ~ Donation
16b. Date of Disposition Dail
ph in
16c. Place of Dis
o
i
i
'~ Other (Specify)
16d
L 7/11/2012 p
s
t
on (Name of cemetery, c Mato
ry, or other place)
Hollinger C
.
ocation of Disposition (City or Town, State, and Zip) rematory
~ Mt . H o 11 y Springs PA 1 7 O 6 5 na. signac„n..gf n`ral
u ` r"i`¢ "`^sa¢ °r P¢rs°^ In char
e of I
t
E
8
1]c. Name and Complete Address of Funeral Facility g
n
erment 1]b. License Number
F L? 1 3 8 9 5 L
~ E er Funeral Home Snc 15
18
De
d
' Bi S
1 g A V N
~ .
ce
ent
s Etl ucation -Check the box [hat best describes th
h D
E W V 1 1 1 E' PA 1 7 2 4 1
P
s
e
ighest degree or level of school completed at the time of death 19.
cede
of Hi
b
i
O 20
Dec
d
'
.
Q 8th grade or less
N° dl I
p oma
9th ox that best describes
w
ther the dece^ent
is Spa nfsh/His
i .
e
ent
s Race -Check ONE OR MORE races to Indicate what
the decedent considered hi
,
- 12th grade
High school
r
d pan
c/Latino. Check the "NO"
box (f decedent i mself or herself to be.
g
a
uate or GED completed
~ Some college credit
b s not Spa nlsh/Hispanic/Latino.
No, not Spanish/Hi Q Korean
~ Black or gfrican America
,
ut no degree
Q Associate degree (e
g
Aq
q5)
spanic/Latino
~ Yes, Mexican, Mexican Am
i n
~ gmerican Indian or Alaska Native ~ Vietnamese
.
.
,
~ Bachelor's degree (e.g. BA
AB
BS) er
can, Chicano
~ Ves, Puerto Rican ~ gslan Intltan ~ Other Allan
~ Nati
,
,
Q Master's tlegree (e.g. MA, MS, MEng, MEd, MS W
MBA)
0 Ves, Cuban ve Hawaiian
~ Chinese
~ Guamanian or Chamo
~ Fili
i
,
Doc[orat¢
(e.g. PhD, EdD) or Professional degree
~ Vas, other Spanish/Hispanic/Latino rro
p
no Q Samoan
~ Japanes
. MD DDS OVM, LLB JD
21
Dec
d
'
(Specify) e ~ Other Pacific Islander
~ Other (S
e
if
.
e
ent
s Single Race Self-Designation -Check ONLY ONE t° in
~] White
dicate what the d p
c
y) _
~ Japanese
Q Black or African American ecedent consideretl himself or her
~ Samoan self [o be. 22a. Decedent's Vsual Oc
~ Korean
American Indian or Alaska Na<IVe
QVietnamese
~ Other Pacific Islander cu
tlone Burin Patton -Indicate type of wort
g most of working Itfe. DO NOT USE RETIRED
)~ASlan Indian
~ Other Allan
Don't Know/NOL SUre .
Farmer
Q Chinese
Fill plno (] Native Hawaiian 0 Refusetl
Q Other (Specify)
22 b. Kintl of Business/Indu
t
I
TEMS 23a - 23 MUST BE COMPL
O Guamanian or cnamgrrq s
ry
A g r i c u l t u r e
ETED
BY PERSON WHO PRONOUNCES Oq 23a. Date Pronounced Dead (MO Day 23b
Si
C
2 ERTIFIES DEATH O .
gnature of Person Pronouncing pea th (Only when applicable) 23
3d. Date Signed (MO/Day/Yr)
24. Time of De
th c. License Number
a
26. Psrt 1. Enter the
h
i
CAUSE 25. Was Medical Examiner or Coroner Contactetl?
OF DEATH ~ Ves
O NP
C
a
n of --diseases, Injuries, or compli
respiratory arrest, or ventricular fib ill to with
r d
t n cations--that direct)
Y caused the death
DO NOT
<
out showing
IMMEDIATE CAUSE ------
~-Q b1
~ .
`PProximate
the tl to
enter terminal events such as ca rdlac arrest
e ° gy. p0 NOT ABBREVIATE. Enter onl
~ V on¢ cause on a line. Add adtliti
l
---------~ a.
~,. 1.~
(Final disease or condition S
ona
lines If necessary ~ Onset <o Dr~ath
r Mat~i-1 C
~
~\1
resulting in death) ..
,,, ~YY~,O~ r"CYl Ol
D t ( q f)
b.
Sequentially list contlitions,
if any, leading to the cause Due to (or as a consequence of):
listed on line a. Enter the
c
UNDERLYING CAUSE
(disease or injury
tha[ Due to (or as a consequence of):
- l
Initiated the e e is resulting d
in death)LgST.
s
26. Part IL Enter other s~n'fica t di[lo Due to (or as a consequence of):
~ ns contrib tit d4 th but not resulting In the under) in
Y g cause given in Part I
2]. Was an auto
ply pertormetl?
Ves
~ No
_
°'
29. If Female: 2H. Were auto
ply findings available
>_
~
~ Not pregnant within past year
30. Did Tobacco Use Contribut¢ to Death] plete the cause of death?
to coO Yes Q
m
~ Pregnant at time of tleafh
V
Mra nner of Deat
es ~ Probably 3~1. Nq
h
ti ~ Not pregnant, but pregnant within 42 da
Ys of death
Q Nat ~
t,,~~
~~r
r~•'o ~ Unknown Jo~Natu ral ~ Homicitle
pregnant, but pre
~ Unknown "f Hnant 43 days to 1 year before death
I
re 0 Accident
O Pending Invest)
32
Suicid
Dat
f
~
i
p
gnant within the pas[ year- .
e o
e
Injury (MO/Day/Yr) (Spell Month)
Q Could not be deter
mined
O -- .. rmury, Specify:
Yes 0 prlver/Operator ~ Pedestrian 38. pescribe How Injury Occurred:
O No ~ Passenger
~ Other (Specs Ty)
a Certifier (Check only one):
Certifying physician - To the best of my knowled
~ Pronouncing g. Certifying ph Be, death occurred due to the cause(s) and m r stated
~ Medical Examiner/Coroner ysiclan - To the best of my knowledge, death occurred at the time, date, and place, antl due to the cause
- On th of a (nation, and/or Invests (s) and manner sta[etl
xam gallon, in my opinion, death red at the time, date, and place, and due [o the cause
sgnat°re of certlnar~ /t -~ fs) and m tated
'. Na Address and zip code of Per Title of certiFl¢r:.__~\Jt -~ ~TI q a ~
,, ~ ` n Completing Car~plgJe>~I~~y~)y _ F- Llcensa Number:
_ / V ~!Ce l.a p-}~l y~ r -- - 7 Medical Center, Hershey, Pa.17033 39c Date SjgnGd /Mn/nom../v.r
R gl t DI
Disposition Permit No.___~ r) ~ Qb~ ~ H106-143
_. _. - - _. - - - - _ REV 0]/201.1
5" Jv F ~ J~ ~ L Cl~
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41 `n
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
CUMBERLAND C~O/UNTY, PENNSYLVANIA
~~~- ~~ ~~ p~~
Estate of Fred McGillvray ,Deceased
Jessica L. Nailor and
(each) being duly qualified according to law, depose(s) and says(s) that she / he /they was /were well-
acquainted with Fred McGillvrav and am/are familiar
with the handwriting and signature of the decedent, and that the signature of Fred McGillvra
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of rune 19.2012
Fred McGillvrav is in his/her own proper handwriting.
(Jagna ~~
122 Buttermilk Road
(Street Address)
Newville PA 17241
(City, State, Zip)
(J'ignature)
(J'treet Address)
(c.'ity, J'tate, "Lip)
Executed in Register's Office
worn to or affirmed and subscribed
Q ~w:a
~: ~'
before me this : a ~ ~ day
~o
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Deputy for Register of Wills D c.~ ~~
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Form RW-04 rev. 10.13.06