HomeMy WebLinkAbout10-16-12PETITION 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 1 \ ~ ~ ~ ~ ~ ~.
Name: DONALD W. COMP File No:
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 186-24-8186
Date of Death: SEPTEMBER 24.2012 Age at death: 84
Decedent was domiciled at death in CUMBERLAND County, PFTTNCYI.VANIA (stare) with his/her last
principal residence at 297 OAK FLAT ROAD NEWVILLE 17241 WEST PENNSBORO CUMBERLAND
Street address, Post Orrice and Zip Code City, Township or Borough County
Decedent died at THORNWALD HOME CARLISLE 17013 CARLISLE CUMBERLAND P
Street address, Poat Office and Zip Code City, Township or Borough Cooaty State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ............................ All personal property $ 28,000.00
If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $
/jnot domicl/ed in Pennsylvania ........................ Personal property in County $
Value of real estate in Pennsylvania ......................................................... $
TOTAL ESTIMATED VALUE.... $ 28.000.00
Real estate in Pennsylvania situated at:
(Attach additional sheets, if necessary.) Street address, Poat Ofice 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
thereto dated
State relevant circuuntaoces (eg. renunciation, dtarN of execatoq 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.
Q NO EXCEPTIONS Q 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 db.n.c.ta, enter date of Will in Section A above and complete list of heirs.
STEPHEN W.COMP SON 29 ,
t: "..
~ ~ ~
_
p
Form RW-02 rev. /0/11/2011 Page
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.
Q NO EXCEPTIONS Q EXCEPTIONS
fV
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following sp~ (if any) an~irs (attack.,.,
additional sheets, if necessary): p ~ ' ' Si
r^
Name Relationahi Address : c.'?
7 OAK FLAT NEWVILLE PA 1 Q- '-x~
and Codicil(s)
2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND }
offioial use only
F~f CGR~=G' ''FFi(;~ OF
RE~;IS ~!~ '~ - w~~ I c
..,.,
ti~i2
Petitioner(s) Printed Name Petitioner(s) Printed Address .
STEPHEN W. COMP ~~.~:
297 OAK FLAT NEWVILLE PA 17241 Q "' `
LEWD CO., ~Pq
The Petitioner(s) above-named swear(s) or affirm(s) the statements in a 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 Pe ' oner(s) will w and truly administer the estate according to law.
Sworn to r affirmed and subscribed before ~ Date ~ p~/~~/~=
me this day o _L`y Date
By' Date
Fo he egister Date
BOND Required: Q YES Q NO
FEES:
Letters ...................... $ 90.00
( 1) Short Certificate(s)...... 4.00
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other
Automation Fee ............... 5.00
JCS Fee ..................... 23.50
TOTAL ..................... $ 122.50
To the Register ojWills:
Please eater my sppearaace by my signature below:
Attorney Signature:
~. ~ .
Prieted Name: R ER .IRWIN, ESQUIRE
Supreme Court
ID Number: 6282
Firm Name: IRWIN & McKNIGHT, P.C.
Address: 6O WFST Pt7MFRF_.T STRF.F.T
CARi.iST.F„ PA 1701
Phone: (717) 249-2353
Fax: (717)249-6354
Email:
DECREE OF THE REGISTER
Estate of DONALD WCOMP File No: ~2~- ~(~~ ~~~ - /
a/k/a: ry
AND NOW, ~ E d ~~~ , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, YT IS DECREED that Letters OF ADMINISTRATION
are hereby granted to STEPHEN W. COMP
in the above estate and (if applicable) that
the instrument(s) dated
described iii the Petition be admttted to probate and filed of rec r the last Wil and Cod' s)) of ecede
gister of Wills
Form RW-01 rev. 10/11/20// Page 2 of 2
H 105,805 RF:V f9/I I1
LO EGISTRAR'S CERTIFICATION OF DEATH
~nt~~~ ~!N~It is illegal to duplicate this copy by photostat or photograph.
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R~`4Jltr. ,ti,. .t,1..1-V
Fee for this certificate, $6.00 Ph 2~ OJ This is to certify that the information here given is
~0`2 OCj ~ (~ correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
i~~_:,'~r.'_~
5 ~OURr
P 18 $~~g'~o co.l ~
Certification Number
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TYPe/Print m
vermenene
3
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certificate will be forwarded to the State Vital
Records Office for permanent filing.
~(~~~(f~,r, SEp 2 52012
Local Registrar Date Issued
COMMONWEALTH OF PENNSYLVANIA> DEPARTMENT OF HEALTH • VITAL RECORDS
~`C ggTi Ctf`ATC AC AFATLE _ -_ _. _
~n i. Decedent'f Leg•1 Na (Firs<. Mltltlle, last, Mx) 2. Sex 3. S/oc~ial/¢ecurlN Number 4.zfDRN of DaetLh (~MO/Daay~J (Spell Mo~)1
/!/V ~~ ~~ ~~ J~ ~1W~ /J ~~M1
i~
='ll Sa. Ats-last Blrthtlay (Yes) Sb. Un er 1 Year Sc. Under 1 • 6. OK• of BIKh IMO/Day/Year) (Spell Monthl 2a.CBsirthr~pP~ < P$rrK/ 3[aNPOrAR[sr¢I{n Country
Mon<hf Deys HOVrf MInVN3 K
84 Mart^.tl 22 7 928 ~b. BiKhplae. (coDnN) ~r
8•. Reile•nce (gtat¢ er FONign Country) 8 R¢fltlenc¢ (Str¢aC antl Number - Inclutle Ap[ NO.) Bc. Dltl O•ceeDM lNe In a TOWnshlpi
PA 297 Oak Flat Rd. E9 Ye:, d«ea•nt oyes m West Pennshoro twp.
ea. R•iltl•nce (cagn<vl
CLaNx>rland ge. Resltlence (zip Cods) Q No, Decedent Ilvstl within IImIN of dN/boro.
9. Ever In U3 Armetl FOrr.¢fT 30. Marital Status at Time o1 Desth Married owe 11. 3Vrvlving 3pouae•s Name (M wlh, gNe name prior t0 fleet merrls{e)
~Yfi Q NO QUnknOwn Q DivOKad Q Never Marrl¢d OUnknew _
13. Father's Nama (First, Mldd e, Oft, 6u x)
Clatan Elwood 13, Me<heYS Name Prior to First Marrlap (Firs[, Mitltlle, Las[)
Ma Susan Wa11acE3
m rm
14a. In r an<'z Nam¢ 14b. RelatlOnshlp to Dac¢d¢nt 14c. In o ant z Mallln{ Adtlraza (Stroat end Number, CIN. Sta<e, 21p Gedal
St W. Son O F
............ ............ ec eat ..!F..°^.Y. ana ....
If Desth Owurred In a Hospital: t~ Inpatient ilf Oa [h Occurretl Somewhero Other Than • Hefpttal: ~ Hosplea Feclllry ~ DeNtlan['s Moma
8 Eme envy ROOM/Out atl•nt Dead on AKlval Nursin Home/Len -Term GN F•NIIN O[har (6 CI )
'
i6c. Ity Or Tewn, state, d zip Coda igtl. GounN Ot Death '
S6b. Facility Neme It no< InstltutlOn, give street and number,
Thorr2wlood I3c[[ve Carlisle, PA 17013 CLanberland
~, 16a. Met o Dispeaitlon Burlol Cremation 1Bb. De[e o1 Disposition
Q Remevol from Stele Q Done<lon
ahe. (s FI ) 9 28 2012 lgc. Plats o Disposition Name of cemetery, cromotory, or oHi•r place)
I3a s Gxnve United Nl~r*~ai at Church Csnete
16tl. LOCanOn Of OISpOFItIOn (CIN or Town, 3[a<¢, and 21p 12a. Signature eI u 1 Sarvlca Licensee Ra Interment 12b. LlGenif NV/nber
NE.wville, PA 17241 FD 012633 L
12c. Name antl Complete gddresf of Funeral Fec111N
77win B r Fltrt =
~t
r Sg. Decedent's Edutatlon -Check the box chat beef tleurlbes the 19. Decedent of Hispanic Orl{In -Check the 20. Dewdent's Race -Check ONE OR MORC races to intlica[s wMt
hlthast degree er level of school tomple<ed at the time of tlea<h. box that best tlescrlbaa whether <he Decedent She decetlenf wnalderod hlmaNf er herzNT to be.
Q B[h {reds er lass Is 3Panizh/HlsPenlc/LetinO. GhlCk tfle "NO" bite Q Koraen
Q No dlplOma, 9th - 12th {ratle boxJJf tlacetlan<IS not Spanish/Hlspanic/tatlno. Q Black or African AmeHUn Q Vletnam•N
„•~High uhool {ratluate or GED cgmplehd j~klo, no[ SponisM1/Hispanic/Leone Q American I.ntll•n or Alaska Native Q Other Allen
0 Some college croDl[, but nb tle{rce Q Yes, Mexlcen. Mexican AmeNCan, Chicano Q gslen Intllan Q Native Hawaiian
Q Assoclote tle{ree (e.g. AA. A3) Q Yes, Puerto Rican Q Chinese Q Gusmonlen er ChomeKe
Q Bachelor's tlegraa (a.g. BA, qg, g3) Q Y•s, Gubsn Q FIIIpInO Q SemOan
Q Masbr'f degree (e.g. MA, M5, MEng, MEd, NSW. MBA1 Q VIF, other Spanish/Hlspanlc/Le[In0 Q laPanefa Q O<h.r paclnc lalander
Doctorate (e.t. PAD, EtlD) or pro/esalonal da{Na (3peclN) Q Doter (9peclN)
e. . MD DDS DVM LLB JO '
21. Dec sot's Slntle Rece Self-Designaflon -Check ONLY ONE [o Indlcah wM1at the ece ant considered himself or M1erssl(<O be. 32e. Decetlen!'z Uausl Occupatlen - Intllca[e type of week
hIN Q Japanese Q Sameen BOne dVNn{ mOSt 01 werking IIh. 00 NOT USE RETIRED.
0 gleck or African American Q Kereen Q Other Paclflc Islander
Q Amerlun Intllan Or Alaska NatNe Q Vle<namese Q Don [Know/NO< Suro ~~~~-An 1 C'
Q Asian Intllan Q Other Asian Q Refused 22b. Klntl of Business Intlurtry
Q Cl+lneae Q Netlve Hawaiian Q Other (6peclN)
Q Filipino Q Guamanian Or Chomorro Farm 1 ~ 8
O 2 a. Date ronD c• Ds Mo aY r 3 . Slgnatu onounc t en app Ica 9c. tense NVm er _
.rsDn
A~~i7~
~
gY HRSON WNO PRONOUNCES OR
GtRTPI D{JLTN aP0/
s
P
33d. D ee nee O wy r/ za. nme o ¢a<h n/'S /
Or 33. Wes M•dlcef Examin er centacKedT Q Vas ~~ rve
er n
CAUSE OF DEATH
~ gpproximna
38. PaK 1. EnNr <he chain of events--dlaeazes, InJurles, or compllce[lOns--that directly causetl the tlea[h. DO NOT enter terminal evenN sucM1 as cardiac arrest, 33 Interval:
{ the ¢tlolo{Y. DO NOT ABBREVIATE. EnNr only one cause on a line. Add atltll[lOnal Ilnef N necessary f O et to Death
respiratory smear, or ventricular flbrlllatlon wlthou ~
o^
j
/
~
~'~ ~ (.CSC/J/Le-At~S
IMMEDIATE GUSE -> a.
~E TT
(Final disease or contlitlOn Oue to (or az a/cles n/a¢~que e0..:.,ss~ r/~~~ ~
roaulting In death) ~~~/~'jrg~ G C./(Q~/~LG/rf-~.~ ~ sfJE.Yia~IS+~W~J ~ ~~/~~~ttt ~~'~.
b. - ~Li~
3•gVentl•IIY Ilst wnditlons, Duero (or as • wnsequence Of): ~ /
II enY. Netllnt t0 the c•uLe )
listed on Ilns a. Enter the !
t1NDERLYING GOSE Due t0 (Or as a consequence of): {
(tllsease Or Injury that
Inltla[ed [he events rosul<Ine tl. )
as a con
In tlesth) LAST. Due to (or sequence of):
26. I•K 11. E//nttter~~ other _ but not re[ult In t ode lying cause given In P¢K/1 2T. Wes on europry pe o mee 2
(/cr(/Ct~ ~~ ~% ~L ' - - -- " ~' ~• - - ~ 3g. Were wtopry findings rvellable
~. to complNe Ms cause o1 tlea[h2
Yes NO
' 29. If Female:
Q Npt Pregnant within Pas[ V¢ar
Q Protnant a«Ime Of tlee<h
Q No[ Prs{nont, but Pregnonf within 62 tlari of desth 30. Did Tobacco Use Contribute to Death2
Q Yea Q PrObablY
Q No Unknown 31. Manner of Death
($'rNetpral Q HOmlcltle
Q Accident Q Pending InwsHgstlon
Q 6ulcltle Q Could not be tle<erminetl
Q NO< pretnont, but pregnant 43 tlaVf <0 1 year before tlea[h 33. OaN of Injury Mo Day r) Spell Month)
Q Unknown R pregnant within the poft year 33. Tlm• of InJury
34. Place Of InjVN (e.g. home; construcnOn site; arm, school) 35. LOCetIOn of Injury (Street antl Number. CRy, StNe, Zlp COd•)
36. In)ury a< Work 3J. If TranspoKallOn Injury, EDICIN: 3B. Describe Now Injury Occurred:
0 Yea Q DHVer/Operator Q Pad¢f<Han
Q NO Q Pafsenter Q Other (50•clNl
39e. GKlTlar (Check only one):
CaKlNing physician - To the best of my knowl¢d{e, tlao<h owurrotl due to the cauae(a) antl manner metetl
Pronouncln{ 6 CeKINIn{ phYaiclen - To <M best O/ mY knowletl{e, tleath occurred at the time, date, and pieta, and due to the couze(s) and manner stated
Q Medical Examiner/<orone~ ~tM1- ggsis O(eaaminetlon, and/or Invests{orlon, In my epinlon, ae th retl at the [Ime, tls[e, antl place, antl tlu• [otPhe~e!e~usels) a/ntl~mennar s[e[!tl
signature of ceKl(Ier: (/ ~CJ~Qyw~a_~/_.~ Tttfe of c¢KM¢r: ~~ License MVmb•INLY ~~{ c~ ~>~ s~+
39b. Name..]tltl~rea tl Zip <otle et Pervon Compls[Ing Gu e o h (Ice 36)
/yt ~J2 /e t/1 3a3 /-~ ~ /~iriL /rsf•l~sf ~ ~/~` 39c. D•N Slgn O ay tl
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4 Rfglz[ra s D strict Num er - ag scree f IjwaYrre ~ ^
7! ~(ll~jltl'_ C 4 Re{ rtrar 1~ O ey r
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43. Amentlmen[s ---
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Dlfpefltlen Perml[ Np.~f~~,~~ REV 07/2033