HomeMy WebLinkAbout08-20-12PETITION FOR GRANT OF LETTERS
REGISTER OF WII.,LS 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: RICHARD WILLIAM CORNELL File No: ~~ ~ ~ c~ -U~~
tea; (Assigned by Register)
a/k/a:
tea; Social Security No:
Date of Death: 7/17/2012 Age at death. 85
Decedent was domiciled at death in CUMBERLAND County, PA (State) with his/her last
principal residence at 2100 BENT CREEK BLVD 17050 SILVER SPRINGS CUMBERLAND
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at BRIDGES AT BENT CREEK 17050 MECHANICSBURG CUMBERLAND PA
Street address, Post Office aad Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death:
IjdomiciledinPennsylvania ................................Allpersonalproperty $ 25.000.00
If not domiciled in Pennsylvania .............................Personal property in Pennsylvania $
Ijnot domiciled in Pennsylvania .............................Personal property in County $
Value ojreal estate in Pennsylvania .............................................................. $
TOTAL ESTIMATED VALUE.... $ 25.000.00
Real estate in Pennsylvania situated at:
(Anach additional sheets, ijnecessary.) Street address, Post O[fice 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 9/30/2005 and Codicil(s)
thereto dated
State relevant circumstances (eg. renunciation, death ojexecutor, etc.)
Excep[ as follows: after the execution of the instrument(s) offered for probate Decedent did not many, 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(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.b.n.c.t.a., pendente life, durante absentia, durante minoritate
If Administration, Gta. or db.n.c.>: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.
^ NO EXCEPTIONS ^ EXCEPTIONS
~~
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse ~) and heirs`-Mach
additional sheets, if necessary): V ~7 ,
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Name Relationship Address r_.:-. ~ ~
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Form RW-02 rev. 10/l1/2011
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Page 1 of 2
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Official Use Only
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND }
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Petitioner(s) Printed Name Petitioner(s) Printed Address
PAUL R. CORNELL 36 MURPHY STREET ,~..-.:~~;r
MANCHESTER "~ `` I NH 03103-6025
(~NEiERI.AND CO.. PA
The Petitioner(s) above-Hamad 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 Deceden e e 'oner(s) w' well d y inister the estate according to law.
Sworn. io or affirmed and s bscrib ~efor~, Date ~ ~ Z
me '~ day of ~cLt Date
By: -
For the Register
Date
Date
BOND Required: ^ YES ®NO
FEES:
Letters ................... .... $ ~ v
( ~~ )Short Certificates(s) . ..... G
( )Renunciation(s) ..... .... .
( )Codicil(s) ......... .... .
( )Affidavit(s) ........ .... .
Bond .................... .....
Commission .............. ..... .
Other .... .....
(~1r l~ .... ..... .~
Automation Fee ............ ..... '
JCS Fee .................. ..... ~ . c'CJ
TOTAL .................. ....$ ~'
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name: R. MARK THOMAS. ESQUIRE
Supreme Court
ID Number: 41301
Firm Name: R. MARK THOMAS- ATTORNEY AT LAW
Address: 101 SOUTH MARKET STREET
MECHANICSBURG PA 17055-6328
Phone: 717-796-2100
Fas; 717-796-3600
Email: rmarkthomasl~gmail.com
DECREE OF THE REGISTER
Estate of RICHARD WILLIAM CORNELL File No: ~ ~-I e~,s'~R I ~.
a/k/a:
AND NOW, T, L~~'~)cS -~- ~ , 2012 , in consideration of the foregoing Petition,
satisfactory proof having b~sented before me, IT I EC E that Letters
are hereby granted to i
in the above estate and (if applica le) that
the instrument(s) dated i ~_
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent...
~ ~ ~ n
Register of tlls
Form RW-02 rev. 10/1 //10/ 1 ~ ~ ~~ Ez1-~E.Q~.C.C~~~r y
~ ~ ~~" ~' ...age 2 of 2
H105.805 REV (9/I1)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNI,'~~etgle~~~plicate this copy by photostat or photograph.
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Fee for this certificate, $6.00 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 be forwarded to the Stxte Vital
1~.:.~ ~~), . _, Office fo n nt filing.
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P 1853746? a~woco..~ - ~ ~~
Certification Number cal Registrar Date Issued
Type/PNnt In
Permanent
COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF HEALTH -VITAL RECORDS
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Sex 3. Socisl Secu Nty Number 4. Date Of Death (MO/Day/Yr) (Spell Mo)
2
.
1. Decedent's Legal Name (First, Mlddie, Last, SuMx)
ehand W-i.PP~i.am Conne~2 Mace 039-16- 8
7Li
.
S•. Age-Last Birthday (Yn) Sb. Vnder 1 Year Sc. Under 3 D• 6. Date Birth (MO/Day/Year) (Spell Menth) 7a. Blrr~~hplaee (CI~y d 54SPSr Foreign Country)
l:hQn3.LOn FCL
Menthe Days Hours Minutes
g 5 J n 9 7 7 7b. Birthplace (County) hov.(. ante
Residence (State or Foreign COYretry) 8b. Residence (Street end Number - Includ! Apt No.) 8c. Dld Decedent LIYe In a TOwnship7
Ba
.
PA 2100 SeH.'t C/(.eelz S.evd. vea, deeed@ni nyee In S.c.e.V e>• Sn/(.c.nQ.e twp.
ad. aid ( ntY)
decadent uwd wlehm umlts of ~Ity/bgrq.
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,
nd ae. R.am@n~e (ZIP Cpde)
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Ever In V3 Armed Forces? 10. M•Ntal Sutus •t Time O} Death Marrlad Wldowe 13. Surviving Spouse'a Name (If wih, give name prior to first ma M•ge)
9
.
Yes ~ No ~ Unknown ~ Divorcid j~ Never MarNed ~ Unk n
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13. Mother's Nama PNOr Co First Marriage (First, Middle, Last)
Middle, Laat, SuMx)
Father's Name (First
12
,
.
W.i.~2.i.am Obcwc Co/(.rLeRr2. M.i..naJcva ~.P.i..zab h Ta.nn
enYs Name 14b. Relationship to Decadent 14c. Inferm•nt's Mailing Address (S[rcet and Num er, CRy, State, 21p Cede?
I
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k A. CoJ(.ne.2.2. Son' 115 Town Fahm Ro
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... ........ ........ ....... .....
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• ace eat ... ~c..on,y one ..............................µy ...
_ .........
Rll: ~ Inpatient Elf Death Oclurrcd Somewhere Other Then a Hospkal: ICI Hospice Facility ~] Decedent's Nome
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n a
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If Death Ottum
Ema en ROem/Outpatient Dud On Arrival Nurfin Nom•/Long-Term Gre F•rYllty Other (Specify)
p~ 15b. Facility Name (1T not Institution, give atr@et and number; SSp. Clfy or Town, State, and Zip Code 15d. Gounty f Death
,
$ Sh.i.d ¢.e cwt 8¢.v(z Cn.eek Meeha.-u.aebwc PA 17050 Cumb
a esltlon Burial Cremation
f Dl
th
d SBb. OKe of Dlspositlon 16c. Platt of Olfposltion (Name of cemetery, crcmstory, er other place)
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ap
16a. Me
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st.ce p oen.tlen
lf "
rom
p RemeY.
Other (SP•CI )
16d. LOeation of Dlspoalt)on (City or Town, State, antl 21p) 7-23-201 2 H
h.Za.Yid M2mohfLi.C PeL(-12
17•. Signature o1 F rcl S 1 Llunsu or Person in Charge o1 Interment 17b. License Number
Johnb~on RZ 02979 7='D-012984-L
17 N•ma d ComplKe A i of 1 Ility
Fogfz.~'aan fzlc ~n:~e~eJi ~'(`cnen.a.2. Home Inc. 112 W¢"bZ K" S~i(.ee~ Shi.. en86 PA 77257
~ nt's Education -Check the box that best describes the 19. Decedent of Hispania ONgin -Cheek the 20. Decedent's Rece -Cheek ONE OR MORE races to indicate what
d
16
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t- ece
e
.
highest degru or level of school completed at the time bf death, box that best describes whether the deeedem the decedent conaldercd himself or herself to be.
8th grade Or less If Spanish/Nispanic/latln0. Cheek the "NO" White ~ Korean
0 No diploma, 9th - 12th grade box if decedent la not Spanish/Hlapanic/Latlno. ~ Q Black or African American 0 VlNnamese
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High school graduate or GED completed NO, not Spanish/Hispanic/Latino Q American Indhn or Alaska Native j~
O Asian Indian j~ Native Hawaiian
Chi
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can,
can
mer
ca
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j~ Some collage credit, but no degree O Yea, Mexican, Mex
rto Rlun ~ Chlneae ~ Guamanian or Chamorro
P
O Y
es,
w
p Aaseclate degree (e.g. AA, AS)
[] Bachelor's degree (a.g. BA, AB, BS) 0 Yei, Guban n FIIIPIno Q Samean
j~ Nester's dagrce (e.g. MA. MS, MEng, MEd, NSW, MBA) O Yes. other Spanish/Hispanic/Latino j~ le Penese O Other Pacific Islander
O DoQOrcte (e.g. PhD, Etl D) or Protesslonal degree (Specify) (] Other (Specify)
a. . MD DOS DVM LLB JD
nation -Check ONLY ONE to Indicate whet the decedent considered himself or herself to be. 22a. DlcadenYs Vsual OewpatiOn -Indicate type of work
lf-Desi
Si
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ace
e
s
ng
21. Deudent
~ le Penese j~ Samoan done during mesY of working Ilfe. DO NOT USE RETIRED.
Whit
e
Black or African 4meN<en Q Korean ~ Other Paclfle Islander "
(
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.ee
0 American Indian or Alaska N•Hve Q Vletnameae j~ Don't Know/Not Sure Po.~
p Asian Indian ~ ~ Other Asian ~ Refused 22b. Kintl of Business/Industry
Q Chinese ~ Native H•w•Ilan ~ Other (SPecify)
"
On PO~if-CQ. ~e ~.
0 flllplno ? O Guamanian er Chamerre C1(.QYJ,B -7.
i S -2g M ST [ OMPL 23a. DaOte Pin ~~d ~ d (MO Day Yr) 2 Signature on Pranouneing De=t nlY when app leable) 23c. L / Num
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BY PERSON WNO PRONOUNCES OR ~
~~
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CERTIPIES DEATH
y--(~ G~
z3d. Date slg d ( /o.v/Yr) ze. nme of cn
25. Was M! Examiner or Cerener Contacted? Q Yea No
CAl.fSE OF DEATH Approximate
Enter the chain of events-diseases, Injuries, or compllcaHOna~that dlrccdy caused Che death. DO NOT enter terminal events such as cardiac arrest Interval:
Pert 1
26
~
.
.
O~ t to Death
onjy a Ilne. Add additional Ilnes if necessary
ABBREVIATE. Enter
T
DO N
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win
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rcsplretory •rtesi, or ventricular flbrilleUen wlihout s
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IMMEDIATE CAUSE --,-> ~-'a -~'^'~" - `" ~
!~ !_
a `
~ Due to (or as n quanta of): VV
(Final disease or condition
~~ it ~~1
reaulting In death) ~ _ l' d1 n [~..,. ^ rl r ~ - -f n
~~a
b. L1~~ l~c~ I \1 S.i L..f_J C .(/LJ1-C X JJCC//
Sequenti•IIV I\at conditions, - Due es • consaquene ): )
Many, lading to the cause
)
listed en Ilne a. En[er the
VhIDERLYING CAVSE ~ ~ Due to (or es • consequence of):
(disa•ac or ln)urythat
)
initiated the events resARfng d. 1
'
In death) LAST. Due to (or as • consaq uence of):
4 26. Pert 11. Enter oth@r 1 1 1 ~[Ina~tg /d~e~aih~bR~r-t~nq[ refueling In Ch! underlying cause given in P@rt 1 27. Wa3 an aptopsy pe Aerrne~
~
~
j~
y
•
( [~L-f L,/t r vl ( 28. Wer¢eutopsyflndl
av
allable
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f d
h?
h
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e cause o
eat
~ ~, to c Plate t
eO Vea No
If Femal 30. Dld Tobatto Use Contribute to Duth? 31. Manner of Death
29
.
j~ NoY pregnant wlthln past year Yes O Probably Natural 0 Homicide
~NO 0 Unknown Accident ~ Pending Investigation
.$' j~ Pregnant at time of death
~ Not pregnant, but pregnant within 42 days of dlHt j~ Suicide j~ Could not be determined
0 Not pregnant, but pregnant 43 days to 1 year before dean 32. Detc of Injury (MO/Oay/Yr) (Spell Month)
j~ Vnknown If pregnant wlthln the pest yea, 33. Time of Injury
34. Place of Injury (e.g, home: constrvCtlgn slte~farm; school) 35. Location of Injury (Street and Number, City, State, Zlp Gode)
36. Injury at Work 37. If TranspoRatlon Injury, Speelfy: 38. Deacrlbe How Injury Occurred:
j~ Yes Q D[IVer/Operator ~ Pedestrian
j~ No Q Passenger 0 Other (Speclly)
39•. CertiRer (Check only one):
e rtllying Physician - To the bast of my knowledge, deaih o furred due to the cause(c) antl manner stated
and due to the cause(s) and msnner stated
and
th occurred et the time
dace
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Pronouncing & Certifying physician - To t
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as ~ Ho
( ) d t•ted
~jrtt~DdFiptTand or invertigatlon, In my oPinlon, death occurred at the time, date, and Place. and due io the ce
On th
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~ Medical Examiner/COro
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License Number:
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Tlile of certifier:
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Signahre oT certifler:
39 Neme. Address end Zip Code Of Person Comple[ing Gause of Death (Item 26) 39c. Date 5 n d ( /Day/Yr7
40. Rage s Dlstrltt Number 41. Re IsMr's Ign•[urc 42. Istra tie Date (MO Dey/Yr)
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43. Amentlmen[s
0739478 REV O~/2011
Dlspositlon Permit No ,____.. _.-_
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RICHARD W. CORNELL ~
~
KNOW ALL PERSONS BY THESE PRESENTS that I, Richard W. Co _ ~
rn~l of
Wakefield, Carroll County, New Hampshire, being of sound and disposing mind ands
memory do hereby revoke any and all prior wills and or codicils by me made and do
make, publish and declare my Last Will and Testament to be as follows:
FIRST: I direct my executor or executrix, hereinafter named, to pay all my legal debts
and funeral/cremation expenses, and expenses of administration as Boor. after my death as
practical. I further direct that all such debts and expenses, as well as all estate,
inheritance, transfer, legacy or succession taxes (state and federal), and any interest and/or
penalties thereon which may be assessed or imposed with respect to my estate or my will ,
including the taxable value of all policies of insurance on my life, and all transfers,
powers, rights or interest includable on my estate for the purposes of such taxes and
duties shall be paid out of my residuary estate as an expense of administration and
without apportionment, and shall not be pro-rated or charged against any of the other gifts
in this will or against property not passing under this will.
SECOND: In the event I am survived by my wife, Naomi A. Cornell, I specifically
give, devise and bequeath nothing to her and I give, devise and bequeath all the rest,
residue and remainder of my estate, real, personal or mixed, wherever found and however
situate, including property over which I may have the power of appointment or
disposition to my children that survive me in equal shares per stirpes.
THIRD: In the event I am not survived by my wife, Naomi A. Cornell, I give, devise
and bequeath all of the rest, residue and remainder of my estate, real, personal or mixed,
wherever found and however situate, including property over which I may have the power
of appointment or disposition to my children that survive me in equal shares per stirpes.
LASTLY: I nominate and appoint Paul R. Cornell as executor of this, my Last Will
and Testament. I request that no bond shall be required of any fiduciary named pursuant
to the terms of this my Last Will and Testament, except insofar as may be required by
law.
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PAGE 2
IN WITNESS WHEREOF, I have hereunto set my hand to this, my Last Will and
Testament, consisting of two (2) pages this _~ day of Serf . , 2005.
~~4~ ~
Richard W. Cornell
Witnesses:
Marilynn aughan
Kathleen Zervas`-'`~
State of New Hampshire
Carroll, SS.
Addresses:
Effingham, New Hampshire
West Ossipee, New Hampshire
The foregoing instrument was acknowledged before me this ~(~ ~'~ day of
~~, 2005 by Richard W. Cornell, the testator, Marilynn Maughan and Kathleen
Zervas, the witnesses, who under oath do swear as follows:
1. The testator signed the instrument as his will or expressly directed another to sign
for him.
2. This was the testator's free and voluntary act for the purposes expressed in the
will.
3- Fach witness signed. 2t the newest of the testator, in his presence, and in the
presence of the other witness.
4. To the best of my knowledge, at the time of the signing the testator was at least 18
years of age, or if under 18 years, was a married person, and was of sane mind and
under no constraints or undue influence.
~'
Jay S. Clough Justice of the Peace
My commission expires: May 19, 2009
~~~
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of ~Gf'jQ,y'G~ I/V //~~yYI l~0`~" ~~ // ,Deceased
UNAVAILABLE WITNESS AFFIDAVIT
I, / ~ u / ~ ~~>7~ ~/ being duly sworn according to law, depose and say
that I~t e ^ ttorney~/^f Person 1 Representative in the a o e referenced Estate, declare that
/v/L~~l /1/YI / / /a~G1~G~/I~ and ~a~~~G~-°~ ~~1/~
whose signature(s) appears as subscribing witness(es) to the ~ Will or ^ Codicil of the above
Testator is/are not readily available to prove the signature to the Testator by reason of
C~eo~- ~^~r,D/~ica~ ~ ~cr 7i~Yi l~i~~,~~s'I
Sworn to or affirmed and subscribed
Be ore me this ~~_~ day2of
~U ~ ~~_ , 2010
I~puty for Register of Wills
(Must sign in Register's Office)
Signature'of
~~c a
~~~.. ~
~- ss
OATH OF NON-SUBSCRIBING WITNESS ~~°•
/~GL l ~ ~'YI~°</ and Gt%~?/ L° IG~G~.~i/~i~cr'
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
he is/she is/they are familiar with the signature of the above Testator of the ~ Will or ^ Codicil
presented herewith and that he/she/they believe(s) the signature on the Will or ^ Codicil is in
the handwriting of the above Testator to the best of his/her/their Imo edge belief.
Sworr! to or affirmnd subscribed
Before me this da of Signature f - ubscrib~ g Witness
20~
Signatu of Non- ubscribing Witness
eputy for Register of Wills
(Must sign in Register's Office)
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