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HomeMy WebLinkAbout11-20-12I Reset I 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: Richard S. Butler i File No• ~ ~ - ~~ - ~~~ ~' a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Secarity No: ~ S~J .~ -~ ~1 o(Cj Date of Death: 11/4/2012 Age at death: 49 Decedent was domiciled at death in Cumberland County, pennsylvan;a (state) with his/her last principal residence at 320 Mountain Road, Newville, PA 17241 Lower Mifflin Twn Cumberland Street address, Pnst Office and Zip Cude CiTy, Township or Borough County Decedent died at 361 Alexander Snrlna Rd, Carlisle. PA 17015 South Middleton Twn Cumberland PA Street address, Pos[ Office and Zip Code City, Township or Rorough County State Estimate of value of decedent's property at death: /f domiciled in Pennsylvania ............................ All personal property $ 1,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ if not domiciled in Pennsy!vania ........................ Personal property in County $ Value ofreal estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... S 1.000.00 Real estate in Pennsylvania situated at: N/A (Attach additional sheets, ijnecessary.) Street address, Post Office and Zip Code City, Township or Borough County ^ A. Petition for Probate and Grant of Letters Testamentary nom. ~.~ ~~ Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated f; _r "end Cd~i~ 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 divor~e~; was not a pe€Iy to a pen CC divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), anTditj not have'achildibotrt,$r adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. D ~. C~ q Q NO EXCEPTIONS ©EXCEPTIONS ~~` T ® B. Petition for Grant of Letters of Administration (ICapplicable) e.t.a., d. b. n., d.b.n.c.t.a., pendente lite, durance absentia, durance minoritate If Administration, e.t.a. or tLb.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) and was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS O EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (ifany) and heirs (attach additional sheets, if necessary): Name Relationshi Address Roy W. Butler parent 320 Mountain Road, Newville, PA 17241 Reba C. Butler parent 320 Mountain Road, Newville, PA 17241 hbrm RW-02 rev. ID/[!/20/7 P3g0 I Of 2 '~~, Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA ) } SS: COUNTY OF CUMBERLAND } ~Fy`f"-~, ~,F' ~ i'~JC Q~ ~ tl~ r _ ~ _ Petitioner(s) Printed Name Petitioner(s) I~rin ` d r ss Ro W. Butler 320 Mountain Road Newville PA 17241 Reba C. Butler 320 Mountain Road, Newville, PA 17241 ~-~~~{~' ~" `~` fhe 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 Dccc¢cnk~the Petitioner(s~)r/willwel nd truly administer the estate according to law. Sworn to or affirmed and subscribed before _ ~, --~~° ~,, x~~~~ Date ~ /- 6~(~_ met day of y „ l ~-l 1 , 'C '~~i~7t/~ jti ~~ .cr~ Date _ By: ~~~ f ~,~ l ~ ~~ ~ f >~~~~ 1~ ~,~~ .~~ '.~V ~ - / Date F'nr the ReQisfer _ Date BOND Required: Q YES Q NO FEES: Letters ................. ~(~ ..... ( ~ )Short Certificate(s). ..... 1 , ( )Renunciation(s).... .... . ( )Codicil(s) ........ .... . ( )Affidavit(s)....... .... . Bond ................... ..... Commission ............. ..... _ Other ... ..... Automation Fee ............... JCS Fee. ... TOTAL..... ........... $ le~.~-~.tlU To the Register of Widls: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Andrew H. Shaw Supreme Court ID Number: 87371 Firm Namc: Law Office of Andrew H. Shaw, P.C. Address: 200 S. S}~riug Garden St. PA 17013 Phone: Fax: Email: 717-243-7135 717-243-7872 andrew(n~ashawl aw rom DECREE OF THE REGISTER Estate of Richard S. Butler File No: ~~ ' a ~ ~ (~'~ a/k/a: AND NOW, i~~a~nti~ f1/,V ('yCU~ ~ ,inconsideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to Roy W. Butler and Reba C. Butler 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 fast Will (and; Codicil(s)) of Decedent. /Register of Wills ~ :~~~ ~~~~~~ ~~~~~ i~ Form Rw-oz rev. ~oiuizou - Page 2 of 2 .,.e ~~ A.wF b"4 ~.a 35~1F ~ ~~I~S q ~tf' a`"' a. ~ ~ . .. .. ~ , "~'~I~4h4~iAgak t ~ It3 ,~4+Ct(~a• tt.n~i~~t'~ .. - _~.1 _IL~,L _~:~ _I Y. .. ;:~~'?': ~ 20 Pty ~`~ 47 I _ ~ ~,.; ~ ~° /~ r COMMONWEALTH OF rENNSYLVANIA ~ OERARTMENT OG HEALTH ~ VITAL BECOROS rFRTICIr JSTF AF IIFATI-1 _ _.. ll ~d ` ~b/T p[/Prrntl oeB;m nc4t #33-371 1 ~y i ' n l- Oe<leent'2 Legal Na o IFirz[, Mltltlla. Last. SUHia) 2. lea 3. SOCIaI SecUrhy Numb<r d Data nt Dealn IMO/nay/Vr) (Spell Mn) m S Butler Mala 185-54-0120 Novambar 4, 20'12 Richard . Age-Ld5[ Birthday fYrs) Sb. Under 1 Year Sc. VnAlr 1 Da 6. Oat<O[ Birth (MO/Day/V ear) (Spell MontM1) a. Bjrthp-IaSe,Ifl~ed 5t ~e; . Gorpign Lou n[ryl OnthT DAYS NOUrs Mlnu[<s L.LV[-[i(iD M qg October 5, '1963 zb. HirthPlece (county) CUO eh 4n Aa Rrzldence i5tate ar rOTiRn Country) 8b. R IelnC<IStrGG[ and Number - lode apt NO.) Hc. Ord OGCeeent Liy[ in a TOwn3hlpi Pennb .eva.wi-a. 320 Mauwtrun Road ®Yex. der<eent B„Gd In Lowe~e M-L{S {~.P~n ad. Rezmence (counts Comb an He. Rmleen<G 12ip COeGI 4 O Np, dmeaom liyaa whnin Bmha p+ uty/pero. ed Portal? lO. Marital 3titui at Tlme of Dlalh O Marrbe (~ Widnwe[I 11. Surviving Spnusre'a Name (I wr e. give name prior [o feral marriage) 9. leer in V 5 Ar m ~ ~ W QY 6[y_O OVnknorvn ODivorced ~J NGV rMn.rl[tl ~UnknOw 12. FatM1[i s N e (First, Mietll<, Last, 3rairla) 33. MO[h[I' z Nem[ Prior to F nt M m1aR[ IFIrSt, Meddle. Last) ! Roy GVm But~Q.e2 Reb¢ C. Shunk Ida. InrOrmant's ldn. Rala[IOnshlp to OecedGnt Na 1d[. Infprmant'S Melling AetlrGZ515trc[t ins Numb<r. E~tY. Statt, Zip Cotle; Reba C_ Bu,Lee~e Mo~he/% 2 r" eatM1 OCCUrt<O Yn a Mospltal'. ~ Inparent i lr Dnaln Occurred SOmewnerG Ocher Then a Ho>pltal: ~ Hospice GacI11tV 7~ D<tttlent'3 HOm< 5y Em<rg<n m/OUtpnnont Dlatl On Arrival ~ Q Nuraing HOT!/long-Term Car! EaClllty Otner ISppclf d 15b. r Cllity Nam[ i11 n n, glv a ane npmber; t Isc. City or Tnwn, Stela, and 21p Cotle ~ ]$e. Co my O( OGath Madical Canter Carlisle Ra Ional Carlisle PA 170'15 Cumberland 16a. pa or Dnvpxmn.. R...:al uemnion m tsp. Date or Dlspp:aeon SBC. Pence pr Dlsm3alpn Iwme or cemetery, creme Dry, o. Dena. pia«) po.n.~tsp«~ryl O Dpnanpn _ p R~ 1 1 -9-207 2 Cu mbelr..e ccnd Va2.f.e. Memo/t.Ea.e GaJCd¢.n.d Z 16d. Location Of V esposrtion (City ray Town, Sta[s, ane 21pI 1Ta. Signet Funeral Service Licensee or Person In CM1erge or Int[rment 1 ]b. Lic[n>e Number CahX,id X.e_ PA 17073 -- - - 014837-L Name a epmpl[ee Aaa.e55 r wne.al F lute ITE " ~ r' e.~an en-B/c.~clze/c F.H. Znc. 112 W. K n # m 1H. Oecedent'S Education -Cneck [he bon that pe]t e!]c.ipls the 39. DGCte[nt O( HISOin < OreBln - Cn[<k the r 20. Decedent s Race -Check ONE OR M00.E r inCicdt! whit fo M1iRnes[ eegree r level er 5<nool completed at the bend old<atn. bo: tM1et bGVt ee> ribes whether the decedent he QR dent considered bimzelf or nersGll to b<. ~ 9th grade or leas iz Spanish/Hlspanlc/Latino. Cneck the "NO' [~4/nl e ~ R n ~ Na diploma. 9th - 13tH grade bokjVd ced[nt iz not SoanlsM1/Hlspanlc/liHno.' O Black Or Arricen AmGricen O V etnam!>[ []}Rgh icM1001 gradual! Or GEO COmplefee [SaW .not Spanish/Hlspanlc/LafinO Q nm[r can Indian or Alaska Native ~ Ocher 4sian ii r 1S SOmp cnlinge credit. but n0 deHree l~ VCE. Mealcan, M an Am Grlcan, Cnican0 k ~ AElan lndl8n ~ Nally[ H walran A e eegree le_g_ AA, AS) ~ Yes, p erto Rlcan ~ ChlnG]G Q GU m nlan or CM1emorro Q BacM1Glei s d<eree le.g. gn, AB, BS) Q Yes, Cuban ~ nllpln0 Q Samoan Q Mas[e~ s eegree (e.g. MA. M5, M[ng. MEd. M$W. MBA) Q Ye otM1[r Spanish/Hi50an1</LdbnO ~ JE08n15! ~ OtM1lr PGCifI< Islander O Dpctorrte (e.g. Pbo. Eem o. rrose5zional eegree Ispeab) O Dteo (sppc:h/ . MD, Dos DvM, Llg. JD u. DGy5P[eJ 5 single Ra[n seu-De3:g..w inn - rnG[k oNLV oNE.n Inm[are what me e!claent [on5leerltl nimzeR or nlr5ev m b!. t zza. oec[eenr5 Dzuar oanpmpn - mmcate rvpe ne wnrk p[c~+nitG o Japanese O samosa none annnR mnat or working Ina. Do rvoT LJSE RETIRED. p slack o. nrrican nmpri[an p Ko.ean O otner peanc I]lanae - .I1 pp QAmerican Ineiin Or Alaska Na[IUC ~ Vletnamesa Q Oon't K w/Not Sure O ~~ /'(Jt eL,iz~oh (~ ASlan ineian Q O<n!r ASlan ~ RISUSItl 22b. Klntl e1 BUSIncSS/Intlustry Q CM1lnese Q Native H wwlisn Q piper (Specify) oF.Ilpin oGpaman~anerchame..p Gov¢ll.JVnev~t bducwtion ITEME 33a - 23tl MVST gE COMPLE TEO 23a. Da[! Pr n u ttO IJCde IMO/Day/Yr) O O n 23b Slgna[ure Or P!r]On PrOnOUncing OldtN (Only wM1ln apOhcabll~ 23c. LrcenT! Nump<r Hy pER50N WNO pRONOV NCE3 OR CERTEIES OEATN Novambar 4, 2012 23e. Dat! s.gnee IMO/uay/yr) or Deatn 3 1238 A.M. zs wa dental Eaamin . eo r coma adz m O CAUSE OF DEATH mace Sfi part 1- Er, tM1e cha of p --dlse . Inlu alit -that dlrvclly pd Inp dpa[h. 00 NOT pacer fe wl a n[s cn erase n[e ai- r p + r rpSpira[Ory errGS[. Or v[n<rNUlar rlbrlllation wItM1OUt Showln9 tna etiology. 00 NOT ABBREVIATE. Enter Only on! taus! On a IlnlC Atle >eOrtienal nnt5 d n[C[]Sary On>![ [O Oeafn ATE cnusE -------> Hypertensive AtlTarosclarotic Heart Disaasa r N F inal asease o. conmtien Due tO le. aza consequence eq. I resprtmR in eeaeh( b Sequln[Ially lis[ <ondition5. _ OVe [O (Or a5 i con Slq Uln<e 0/): tll l th Ga a e c nB Ba~ea~pn nn En ~n~ r VNnERLYING CAVSE Due fo (O as a consequ¢nca ore: Itliseaze 0 nlurv fna[ r 1 initiated the a ultiny d_ ~ ~ In eeatM1) LAST. "~ DV a [O (Or iE l COn TlgUln<l 00: s ?5. Pert IL Fnter ntn mf:cam c ndiVnns On[rlnutin¢ to dGa[n nut not rezu111ng ir. the untlcrlyeng c u p given In Part I 2J. w eOSY Perfarmttl? n Yea 0 NO E 38. We p5V Rndingx ailable [o mplete the cause eI eea[M1? c °y m Y!E ~ No S' 39. If Gemar!'. 30. Oie Tobeece U><Centrlbute to DeatM1? 31. Manner oI OeatF o ~ Not Pre Rnant wl[nen pas[ Year Q Yei Q f/nnably m Ns[ural ~ N meted! Q Prag^ant a[ O r tleatn Q No [~eV nknOwn ~ Accrtlen[ Q P ntlinR inva5[iRitiOn m ~ N e pre8nant, ben pr<8nan wl nin d2 deVS oI tleaV t Q Sulcltle p Cor.le net pG aetGrmin[O O NOt Or[Rnanl, but preRnan d3 eaV5 t01 Vlar blrere epatr 32. Oats Of InjVry (M0/Oay/Vrl (Spell Month) Q Vnknown If pregnant wi[hln tna pall year 33. Time or Inlury Place or nlury (<. g. Home, cpnstructlon xhe: farm; scM1OOI) 35. Location or In IUry (SVeet ane Number. City. StetG. Zip CodGl aR. Inju a Work ry 3T. 1f Tranzpnrtatlon Inlury, Sp<clly: 3g. OescNbe HOw Injury OcCUrrGO: O s tJ Dri [r/Op[ratOr ~ PeeeS p No O Pa>]pn er O Othe. (sveclNl _ 39a. Ce RiRer (Cneck only Onpj. 0 Certi(yinR pnysiclen - Te the beat of my knowletlee. eeatM1 accurted dV[ t0 [he cause(s) and rnan..er s led [] Pronouncing R GnnlfYl^g pnYZir'ia^ - [he best or my knowledge, eeatM1 O red a the time. es[!, ane place, anO eUG [O tM1! c e(3) and m sts[ee r m Metllcal Eraminer/C pp~~ ry~ basis 01 ekiGmini[ien, I n tl/O~r' (^~ IRitlOnr In my OPlnlon, eGath OCCUr.[e et the time, eatG, ane place, and due [o [hp cause(s) and manner ztateC " ~ ' ~ sienaeurG O+cGrtln<.: 4 tL1A..SC o~~ G~ ~~~~c_ Tlua pr[miRGr: Coroner UcenzC Numbly' 39p. Name, Atlere SS antl Zlp COee or Person COmple[InR Cause OI t>eatn II[em 2G1 39c. Oats Slgnatl IMO/Di V/Yr) Charles E. Hall, Comner 6376 Basahore Roatl, SDite 1, Macha c bu A 17050 Novambar B. 2012 d0. R<R ztra~ s DlstrlR Number d1. RlgisV r Si [urn d2. R RlsVer FII< Oat[ IMO/OaY rl ~~ d3. Amendmantz ~~ pq ~Y H105-1d5 OI5p051[IOn Petml[ o._ `(-J l/C ~ 70 REV O>/20]1