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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• Antoinette M Trepanier
a/k/a: Antoinette Ellam
a/k/a: ~,ntoinette Hwescon
a/k/a:
Date of Death: 08/08/2012
File No: ~ ~ ~~ ~- ~ ~ ~~
(Assigned by Register)
Social Security No:
Age at death• 65
Decedent was domiciled at death in Cumberland County, PA (stare) with his/her last
principal residence at 10 White Oak Dr Cazlisle N Dickinson Twa Cumberland
Street address, Post Office aad Zip Code City, Township or Borough Coouty
Decedent died at 10 White Oak Dr Carlisle N Dickinson Twp Cuberland PA
Street address, Post Office and Zip Code City, Township or Borough County State
Real estate in Pennsylvania situated at:
(A ach 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/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~ ~'~, 1 ~ and Codicil(s)
thereto dated
Estimate of value of decedents property at death: (~j /~(~
If doaricilad ~ Pennsylvsnna ............................All personal property $~~
If not doaticiled in Pennsylvania ........................Personal property in Pennsylvania $
Ijnot doririciled i,e Pen-uylvania ........................ Personal Property in County $
Vadae ojreal estate in Penr~sylvonia ......................................................... $ .
TOTAL ESTIMATED VALUE.... $ ,,QQ~
State relevant circumstances (eg. renrnciatwn, deRtli ojexecwtor, etG)
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
divo proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born or
ado • and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
NO EXCEPTIONS O 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, ~~a or db.n.G~t~, 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.
Q NO EXCEPTIONS Q EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following use (if any)d heirs (attach
O ~~
additional sheets, if necessary): ~ +~ ~?
Name Relationshi Address o~ ~ ~ ~'' ' ` ='
L ~ t A ,-; r ,.~
~I~ f r" ..i ry.'7
L__ ~ _ -rn
'-'1 ~
D .. t'T'3
~'
C] ~n 0
Forne RW-Ol rev. 10/11/2011
Page 1 of 2
A..aL _rr__ _ _
i ne reuaoner(s) above-named swear(s) or affirm(s) the statements in goin Peti ' true and correct to the best ofthe knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the e P er(a) 1 well and truly administer the estate riling to law.
Sworn to r affirmed subscribed before r ,.~ ,l
me ~i day of ~~ IDiat~e ~~~.~
sy: ~,,,~
For the Register Date
Date .__.-.._.__._.._.__ .___._..__._ -.
BOND Required: (;~ YES Np
FEES:
Letters ...................... $ ~-~ ~ l/~
( ~ )Short Certificate(s)...... ~,fi~]'
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other - .......
Y41 11 .......
Automation Fee ............... S~ ,L
JCS Fee...... ~
TOTAL ..................... $~ZiR ~--
To the Register of Wills:
Please enter my appearance by my signature hetn~•
Attorney Signature:
C7 n..~
<::~
x-
Printed Name: _
~~ ~ r-ti , ~
Supreme Court r
-'
~ ~
~ _`~~
ID Number: _ rr, ~
Firm Name: 0 ~ 3t: _ - -~ i
-
Address:
--~ -J
' ~ ,
r~ :~
Q ...r,~
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of Antoinette M Treoanier File No: ~ j '- ~~--" C~ S~
a/k/a:
~m .~-
AND NOW, ~ in considera 'on of the f oin Petition
satisfactory proof having been presented fore me, IT IS ECREED th t Letters Q g g '
are hereby granted to ~~ V Pt'1 (l ~ll. r')') G. C' I ~ / o c ;f,
the instrument(s) dated
described in the Petition be
in the abdve estate and (if applicable) that
to probate and filed of record as the last Will (and
of Wills
of
Form Rw 02 rev. 70/17/2011 V ~ f ~ ~J
Page 2 of 2
LOCAI~~ ISTRAR'S CERTIFICATION OF DEATH
s~~~~~~~T i 'illegal to duplicate this co b
tai ~,~ ~,~ ' ,+I I~,~ PY Y photostat or photograph.
,~_.w .. W
Fee for this certificate, X6.00
L~~! SEP ,,,,,,--,<,,;;,
-~ P~ ~~ ~ ,I"a~1NOFp`°~ Th(s )s t( certit~, that tl~e i))fon;~atio(, here given i.
ttlpill~~~'%~.-\~~/ji~_ CnCIt,Cti} (,ppieij ~~-~tpl all Orl~l)]dl ~ert7tll'~lte O~ ~l;Alh
~~'~~ A ~, duly filed with ))te ati Loca? Registrar. The o)ig
.~~ ~~' ,~ Viz; ce(hfica)c will k>° inai
p OHPH,"~J~1~ vv~~~ l'\~-'~ ~ tur~~arded tc) the State Vital
P ~ O ~ ~ ~ a, Records Office t~ir ,
*% permanent fiiinh.
2 ~~~taND CO.r PA ;oF ., ~ ~ ~~;
,~ ~~,~~~
~,I p0
"~'~ ~' " - ~P~ ~r..~lV~ ~~
Certification Number "''--T!~~NT 0~~ I'' Q12
~5~ ,,,,,,,,~Is- __ _AU~ 2 7
TYPe/Print In ~ ~~- Local Rey**istrar T`
Permanent COMMONWEALTH OF PENNSYLV ` `J`(tt 1tiSt)ed
Black Ink ANIA • DEPARTMENT OF HEALTH . VITAL RECORDS
1. Decedent's Legal Name (First, Middle, Last s ffl > CERTIFICATE OF DEATH
' Antoinette zs b
5 Ag L t Blrthd I M Z're Dan 3 5 1 1 5 ity N b II ;
Carlisle
G
] Ves ~] No Q Unknown Illy Marital Sta
~] DI d
F th N (First, Middle, last, Suffix)
James [n7_
a. Informant's Name E 1
Steven J_ H v
eath Occurred In a Hospital: ~ ~ ~ Wf "'"""•-^•~
Q Emergency Room/Out u I^patient
b. Facill spatient Q Dea
ty Name (If not In tltutlon, gly¢ street and
l O Wtli
a. Method of D{sposltion Q Burial
Q Removal from State Q Donation
r1n
~ Ncyer Married
E
s
am
14b. Relatlonsl
__ Son
........................r........ ~
;If Deat
on Arrival
c_ 27, 1946 xosall
r-Include Apt No.) Bc. Dld Decedent LivebinBa TowlnshiP?
Drive Yes, decedent Ilyed In __ D~7~
7 ~ 1 5 []NO, decedent Ilyed wlthln limits of
Married Widowed 11. Survlyln 5
O UnkOwn g pouse's Name (If
twP
~~
L6d. Location of Disposition (City orTOwn
St
t 8 / 1 O / 2 01 2 Ho 11 _,~P~
j-ne3 ~,~r^n lName of cemetery, crematory, or other place)
ar
,
a
e, and Zlp)
Mt_Ho11
y Sprin
s
p
-
' FH
l~a.slg °fF~nerals¢rvl~e ns¢ /Crematory-
g
,
A
t
7 O 6 5
.7c. Name and Complete Add 1
~ s
°" 1n a ergs Intermem 17b. Licen
ress of Funeral Facility
Ho111n e ~ se Number
r FH Cremato
8. Decedent's Education -Check the box that b
I
h a
Mt
Ho 11 imo
- _
AV e
g
est describes the
est degree or level of school completed at the tlm
Q 8th grade or less a of death. _
19- Decedent of Hlspanlc Origin - Checsk
the 1 n
box that b _
8 `~
ZO
Q No diploma, 9th - 12th grade
~Hl
h est describes wh¢ther the decedent
Is Spanish/Hlspanlc/Latino
Ch
k
" . Decedent's Race - eheck ONE OR
the decedent consid
to Indicat
O
)
g
school graduate or GED campl¢fed
Q Some college cr
d .
ec
the
(y0^
box If decedent Is not 5
Panlsh/Hlspanlc/L
ti e what
er d himself or hers
elf to be,
hits
e
it, but no de
Q Associate degree gree
(a.g. AA
AS) a
no.
No,
not Spanish/Hlspanlc/Latino
Q Yes
Mexi Q Black or Afrl<an American Q Korean
~] Vi
O A
,
Q Bachelor's degree (e.g. gq, qB BS)
Q Mast
'
,
can, Mexican American, Chicano
Q Yes, Puerto Rican etnamese
merican Indian or Alaska Native
~ Asian Indian ~ Other Asian
er
s degree (e.g. Mq, M5, MEng, MEd, MSW,
MBA)
Q Doctorate (e.g, phD, Etl D) or P ~ Yes, ouban
[] Yes, ther S
ani
h Q Chinese ~ Natlye Hawaiian
Q FIIl
l
~ Gu
rofessional de
Brae
. MD, DDS DVM LLB, Jp p
s
/His
Panic/Latino
(Specify) p
no
amanian or Cha MOrro
Q Japanese Q Samoan
. Decedent's Single Race Salf-Des!
~j~ White gnatlon -Check ONLY ONE to In
di ~] Other Paclflc Islander
~ Other (Specify)
Q Black or African gmerlcan Q Japanese
Q Korean
Q Am
i cate what the decedent considered himself or herself to be. 22a. Deced
Q Samoan
'
er
can Indian or Alaska Natlye
Q Asian Indian Q Vle[names¢
Q Other Pacific Islander
Q D
' ent
s Usual Occu
done Burin Patton -indicate type of wort
IS most of workin
lif
~ Chinese ~ Other Asian on
t Know/Not Sure
~] Refu
d g
e. DO NOT USE RETIRED.
Q Filipino Q Nature Hawaiian
Q Guamanian or Chamo
MS 23 se
Q Other (Specify)
rro -~-___ _ Realto
22b. Kind of Business/Indus rv
OR
ealestate/Broke
--,
26. Part 1. Enter the chain of ey c
~--diseas or Coroner C
CAUSE OF DEATH er ontacted? ~~VJ ~`~~
Q Ves
es, In)
respirato o
ry arrest, entrlcular flbrillaUOn wi
u rtes, or complications--that dlrectl
Y caused the death
thout showing the
. DO NOT
t O No
IMMEDIATE CAUSE -- _
(Final di
~ '
t
olo
a eY. DO NOT ABBREVIATE. E ter onl vents such as cardiac arrest
enY ausero 1"al e
APproz mate
~~ ~ / Y o^c+ c n a line
Add
Int
~
?
~
sease or condltlon
resulting In death) G s
R
~ s'
// 4 // ~~
D .
erval:
additional lines If necessa
~ ry onset to Dearn
Sequent1a11Y Its[ conditions, b'
If r
ue to (o a sequence of);
~ __~ r ~Y, .--• ~' con r~ S/ ~ ~! ~
` ~'--
any, leading co the cause
listed on Ilne a. Enter the Die to (^
r as a consequence of):
UNDERLYING CAUSE
c -~~_
W
F (dlse r injury that
Initiated the events resulting Due to (o
r as a consequence of):
d
in death) LAST. ) ~__
26. Part 11. Enter other slgnlfl
r as a con
Due to (o sequence of):
g CSOndItl [I t d th but not resultln
gin the underl
i i --~--
y
ng cause given In P
aKl
~ 2T. Was an autopsy performed?
s'
29. If Female: Dues
No
V .w
pJ Not pregnant wlthln past
year
Q Pregnant at ti
30. Dld Tobacco Use Contribute t
D 28. Were a t
toe opsy flntling5oayallable
om
Plete the eau f death?
se
m me of death
Q Not pregnant, but pre P
eathT
(~' Yes Q probably Q yes
O No
31. Manner of Oeath
~ gnant wlthln 42 days of
Q Not pregnant, but
p
regnant 43 days to 1 Beat[ Q NO Q Unknown
b ~ Natural
Q Homicide
a
r
year
Q Unknown If pregn t within the
past year efore death
32. Date of Injury (MO/Da
/Y Q Accident
Q Suicide ~ P¢ntling Inyestlgatfon
34. Place of Inlury Ina i..•.__. __.- Y
r) (Spell Month) ~ Could not be determined
Q yes Q Drlyer/O V J~+rY"specify: 38. Describe How In
~] No Aerator Q Pedestrian Jury Occurred:
Q Passenger 0 Other (Specify)
Certifier (Check only one): ~-----
Certlfying physician - To the best of my knowled
Pronouncing 8< Certtfying physician - To the best of my knowled red due to the cause
Q Medical Examiner/COro o6e, death occur (s) and manner started
net - prr the basis of xamination, and/ Iny¢stigatlon, lid at the time, date, acd place, and du annar
Signature of certifier: /w% /~~1 rnY opinion, death o r e to The cause(s) and m
red at the time, date, and place, and due totthee
b. Name, gddress and Zlp Coda of Perso Title of certifier. ~~ ~ u ause(s) and men rated
- '0 mPletin Cause of Dtttrh (I~/e~~ 26) License Number._ "a^tQ LyZ,Q f /4/
Registrar's District Number f ~ ` ` C) ~~\~~ K~~ ~t~\ ,fit 39c. Date Signed (MO/D
r~~• 44 _ t al. Registrars tyre /!~~ I ' `~+S \"'106 aver)
Amendments \~ ~` t~ 4Z. R(ne~gistrar Fllfe~Date Mo Day
Dlsposl[IOn Permit No. O ~ ~ n r 5~ /
~~c~t ~iII ~n~ ~~~x~in~n r~
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I, Antoinette Ellam-Trepanier, residing and domiciled in Hallwood, Accomack County,
Virginia, declare this to be my last will and testament and revoke all former wills and testamentary
dispositions.
FIRST: I direct that all of my just debts to be paid as soon after my decease as
practicable.
SECOND: I give, devise and bequeath all of my estate, real and personal, tangible and
intangible, or every kind, character and description and wherever situate and however held as
follows: Ninety-five percent (95%) to my son, Steven James Hyvesson, and the remaining Five
percent (5%) to my daughter, Kristin Hyvesson McCrorie, in fee simple and absolute property. It
is my desire that my daughter, Kristin Hyvesson McCrorie, be allowed to live in my residence,
28377 Grotontown Road, Hallwood, Virginia, until it is sold or ownership of the property has
changed with the stipulation that she will pay the utilities.
THIRD: I nominate and appoint my son, Steven James Hyvesson, as Executor of this
my last will and testament and knowing that he cannot qualify as such without the joint qualification
of a resident, then I direct that he obtain the services of my attorney, Thomas B. Dix, Jr., for that
purpose. I further direct that no surety be required of them upon their qualification.
FOURTH: In addition to and not in limitation of all power, authority and discretion
granted under applicable law, every fiduciary serving hereunder for the purpose of carrying out the
terms of this will, shall have all of the powers set forth in Code of Virginia, §64.1-57, as amended,
and in effect as of the execution of this will, which section is hereby incorporated in this will by
reference, specifically including the power to sell all or any part of my estate.
IN WITNESS WHEREOF, I have set my hand and seal, this
~l ~ T
~u~ , 2012, to this my last will, consisting of three (3) typewritten pages.
day of
This document was prepared by:
Thomas B. Dix, Jr., who is a member of
the Virginia State Bar- VSB 23899
Accomac, Virginia 23301-0577
t `~~ ~~
Antoinette Ellam-Trepanier
Signed, sealed, acknowledged and declared by the said Antoinette Ellam-Trepanier,
Testatrix, as and for her last will and testament, in the presence of us, two competent witnesses
present at the same time, who at her request, in her presence and in the presence of each other, have
hereunto subscribed our names this ~l~~day of , L
2012.
-.
Witness
Witness
State of ~~
J ,
City/County of ~ 1.~C-n'tij.~~~yZ~ ~ to-wit:
~~/ r~ ~~ l~i' Lei/
Address />G
~~~ ~ ~ ~ SS ~:_. n
Address
~ ~ ~_c5~_ 1. t ~ j
Before me, the undersigned authority, on this day personally appeared Antoinette Ellam-
Trepanier, Testatrix, 1~~ ~- ~ - .2-~i--~
and ~ i~~~ 1i/a--~ ~,. known
to me to be the Testatrix and Witnesses, respectively, whose names are signed to the attache
d or
foregoing instrument and, all of these persons being by me first duly sworn, Antoinette Ellam-
Trepanier, Testatrix, declared to me and to the Witnesses in my presence that said instrument is her
last will and testament and that she had willingly signed or directed another to sign the same for
her, and executed it in the presence of said witnesses as her free and voluntary act for the pu oses
therein expressed, that said witnesses stated before me that the foregoing will was executed and
acknowledged by the Testatrix as her last will and testament in the presence of said witnesses who,
in her presence and at her request and in the presence of each other did subscribe their names
thereto as attesting witnesses on the day of the date of said will and that the Testatrix, at the time of
the execution of said will, was over the age of eighteen (18) years and of sound and disposing mind
and memory.
This document was prepared by: 2
Thomas B. Dix, Jr., who is a member of
the Virginia State Bar- VSB 23899
Accomac, Virginia 23301-0577
. P~ .
_~ c* ~ J
~~
Antoinette Ellam-Trepanier, Testatrix
~ ~- i
Witness
Witness
Subscribed, sworn and acknowledged before me ~by~Antoinette Ellam-Trepanier, Testatrix,
subscribed and sworn before me by ~~~`- ~ 1~/~%~.~ and ~-n- ~~ ~-%~~~ ,
Witnesses, this ~1'~day of , 2012.
~jcc~1 y7.[.~~d..~.~~1 (SEAL)
Notary Public
c~MMS~~w~a~.~ c~ ~~r~r~~~. ~
Notarial Seai Public
My Commission expires: / U ~ ~ Kathleen Nissley, Notary
Wuth Middleton Twp., Cumtrerlas~d County
{ My Commission Expires Sept. S0, 2013
Mnn'4Y.r. PC'?t15`~ll~r8ifla =15OCi~tl9!'. 0~ ~~,Oiarl4'.~i
This document was prepared by:
Thomas B. Dix, Jr., who is a member of
the Virginia State Bar - VSB 23899
Accomac, Virginia 23301-0577