Loading...
HomeMy WebLinkAbout01-09-13PETITION 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 requests the grant of Letters in the appropriate form: Barry Simmons Decedent's Information Name: Walter J. Brashear File No: _ 21-1~ ~- (,x„_~~ 7 a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 198-30-1343 Date of Death: 10/11/2012 Age at Death: 81 Decedent was domiciled at death in Cumberland County, pA (State) with his/her last principal residence at 295 South Pine Hill Ex., Enola 17025 East Pennsboro Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 295 South Pine Hill Ex., Enola 17025 East Pennsboro Cumberland PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: /f domiciled in Pennsylvania ...................... All personal property $ 16 000.00 If not domiciled in Pennsylvania ................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ................ Personal property in County $ Value of real estate in Pennsylvania ................................................................... $ 100,000.00 TOTAL ESTIMATED VALUE $ 116,000.00 Real estate in Pennsylvania situated at Vally Road, EnOla, PA East Pennsboro Twp Cumberland (Attach additions/sheets, it necessary.) pine Hill Road Ext., Enola, PA Hampden Twp Cumberland 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) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated and Codicil(s) 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 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 born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ^ NO EXCEPTIONS ^ EXCEPTIONS ^X B. Petition for Grant of Letters of Administration (If applicable) c. t. a., d. b. n., d. b. n. c. t. a., pedente lite, 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 complete list of heirs. Except as follows: Decedent was not a party to pending divorce proceedin 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 adgudicated an incapacitated person. ~ - 0 NO EXCEPTIONS ^ EXCEPTIONS ~ ~-A-? "~ ~ ~`~ Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived b the folio ~`~~ ~ ~~ additional sheets, if necessa Y ~~~pouse (If:axty) and;fie~f=s (attach ry): ~J ~~. f,..... a ~, , , Name Relationship s- ~ i t ::~ h Address ~ .r~ ~ ~_;,; :: r } d` l y ~.nm~ ~..,. - _. . ,,.. ....,,.1 See attached schedule ~ ~~ __ __ ~~ t;W~ r~ , Form RIN-U2 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2 l' ~~ ,`~ PETITION FOR GRANT OF LETTERS (Continued) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Decedent: Walter J. Brashear a/k/a: File No: 21-12 Social Security Number: 198-30-1343 Date of Death: 10/11 /2012 Age at Death: 81 Jy,ame Relationship Address Marian Shoemaker Sister Manor Care Nursing Home Lebanon, PA 17042 Orian Brashear Brother 1105 Valley Road Enola, PA 17025 Donald Brashear Brother 42 Sherwood Drive Carlisle, PA 17015 Ross Brashear Brother 1090 Valley Road Enola, PA 17025 Barry R. Simmons Brother 295 South PinE mill Rd. Ext. Enola, PA 17025 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland Official Use Only } } SS: } Petitioner(s) Printed Name Petitioner(s) Printed Address Barry Simmons 295 South Pine Hill Rd. Ext. Enola, PA 17025 ~ a ~ : - ..t. ,. . ~~s c ~ .~ ~__ µ ~:x - ..._. ~:~ ~ ~ ~~~ _ `~ . _ w ~.. . y,,.,4r .. ~..... d,.,.. ,._, e, a ,. ~,+ S ..._ . _.........,.~,,, w,,.,.,, ~IGI~Ili4 ,..~a~~~, ~, Q,,,,,,,~,~ ~,.C s~a~ernen[s In the roregomg retltlon arm true and correct to the best ot"fh~ knowledge and , belief of Petitioner(s) and that, as Personal Representative(s) o e Decedent, Petition r(s) will well ~rrd truly administer the estate according to law._~~ Sworn to or affirmed and ~b d fore '~ ~ '.~~ ~. Date ~~ ~ ~ ,~~/ Z me t i ~~' day of ~ p ' Date By: ~ Date r he Register Date BOND Required? ~ YES ^X NO FEES: Letters .......................................... ( 5 )Short Certificate(s)......... ( ~ )Renunciation(s) .............. ( )Codicil(s) ........................ ( )Affidavit(s) ...................... Bond ............................................. Commission .................................. Other JCP Automation Fee s /~ /CA . C;~r Automation Fee JCS Fee..........., TOTAL ............. To the Register of Wills: riease enter my appea~ce by my signature below: Attorney Signatu -' _ ~ Printe e: Jason E. Kelso Esq. Su eme Court ID Number: 209107 Firm Name: Salzmann Hughes, P.C. Address: 354 Alexander Spring Road, Suite 1 Carlisle, PA 17015 Phone: 717-249-6333 Fax: E-mail: jkelso@salzmannhughes.com DECREE OF THE REGISTER $ 260.00 2A:@O- ~ !- ~ T ,, ' "( t'` 23.50 5.00 ~~ c7t` ~~) ~h'• ~ ~~ $ --3D8.50- _, (~ ~. Date of Death: 10/11 /2012 Social Security No: 198-30-1343 Estate of Walter J. Brashear File No: 2~_j7~~, .7 a/k/a: AND NOW, ~ lh1n~/~trwr ~, ~ , in consideration of the foregoing Petition, satisfactory proof having been p sented before me, IT IS DECREED that Letters: of Administration are hereby granted to Barry Simmons 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 th I s ill (and Cod' il(s)) of Decedent. ~ ,/ Register of Wills Copyright (c) 2011 form software only The Lackner Group, Inc. CLL( of mil- J3_r1~~ 7 ~~~~~~ . b• ~ ~~ :S ^+~ ~;,,~ ~~> ~,r / ,_ GL.~1== . )~ .~ ~~ ~~ ~.,..: Qn1zy1 °a~^'~:~''`-R ocr ~ c zo~z Type/Print In COMMONWEALTH OF PEN NSV LVANIA DEPARTMENT OF HEALTH • VITAL RECORDS Permanent Black Ink CERTIFICATE OF DEATH 1. Decedent's legal Name (First, Middle, Last, Suffix) State File Number: 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) Walter J Brashear Male 198-30-1343 sa. Age-Last Birthda October 1 1 , 2012 y (Yrs) sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (Mo/Day/Near) (Spell Month) 7a. Birthplace (City and State or Foreign Country) 1 Months Days Hours Minutes HarrlSbilr , PA August 11, 1931 7b. Birthplace (County) Dallph In 8a. Residence (State or Foreign Country) Sb. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Live in a Township? Pennsylvania Sd. Residence Scounty) 95 South Pine Hill Road Extended Yes, decedent lived in East Pennsboro rwp Ctmtberland Se. Residence Zi Code ( P ) 17025 ~ No, decedent lived within limits of city/born 9. Ever in US Armed Forces? 10. Marital Status at Time of Death ~ Married Widowed Q Ves g] No ~ Unknown (] 11. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Divorced (~ Never Married (] Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Walter F. Brashear Anna Gertrude Jones 14a. Informant's Name 146. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, Ci Barry R. S~nTtY+ns Brother tv, State, Zip Code) ~ 295 South Pine Hill Rd_ Ext. Enola, PA 17025 ................................. lsa. Place of Death (Check only one ~ If Death Occurred in a Hos ital: ---'•'--'='--'•---0 •-••••--•• g---•-----•/ -----. -..... _ ____ _ _ __ p- ~ In anent ...--.... ............................. P ,If Death Occurred Somewhere Other Than a Hos ~tal: - -~ - ~~ ~~~••--"'---•"•-"-'----'•- - - ~ P (] Hospice Facility ~.Decede Wt's Home ~ Emergency Room/Outpatient ~ Dead on Arrival Nursin Home Long-Term Care Facilit w lsb_ Facility Name (If not institution, give street and number; Y Q Other (Specify) 295 South Pine. Hill Read Extended lsc. City or Town, State, and Zip Code 1sd. County of Death Z Enola, PA 17025 CL~berland m 16a. Method of Disposition [$ Burial ~ Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemete -o ~ Removal from State 0 Donation ry, crematory, or other place) p Other (Specify) October 1 7 , 2012 Stone Church Cemetery ~ 16d. Location of Dispositlon (City or Town, State, and Zip) 17a. Signature of Funeral Service Licensee or Person in Charge of Interment 17b. License Number Enola, PA 17025 ~ ~_Sg_ - FD 012774-L E 17c. Name and Complete Address of Funeral Facility 8 Richardson Funeral Hcr~ae 29 South Enola Drive Enola, PA 17025 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the ZO. Decedent's Race -Check ONE OR MORE races to indicate what r-° highest degree or level of school completed at the time of death- box that best describes whether the decedent the decedent considered himself or herself to be. 8th grade or less is Spanish/Hispanic/Latino- Check the "IV O" White O No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. ~ Black or African American Korean High school graduate or GED completed ~( No, not Spanish/Hispanic/Latino ~ Vietnamese [~ Some college credit, but no degree ~ American Indian or Alaska Native ~ Other Asian Yes, Mexican, Mexican American, Chicano 0 Asian Indian ~ Native Hawaiian ~ Associate degree (e.g. AA, AS) Q Ves, Puerto Rican (] Bachelor's degree (e.g. BA, AB, BS) ~ Chinese ~ Guamanian or Chamorro ~ Ves, Cuban ~ Filipino ~ Samoan Q Master's degree (e.g. MA, Ms, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino Japanese Q Other Pacific Islander Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other (Specify) e. MD, DDS, DVM, LLB, JD 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work White 0 Japanese ~ Samoan done during most of working life. DO NOT USE RETIRED. ~ Black or African American ~ Korean Q Other Pacific Islander W l] American Indian or Alaska Native ~ Vietnamese ~ Don't Know/Not Sure Fazmer j ~ Asian Indian Chinese 0 Other Asian Q Refused 22 b. Kind of Business Indust Fill ~ Native Hawaiian ~ Other (Specify) / n' pino Q Guamanian or Chamorro Brashear Farm ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO/Day/Yr) 23 b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number CERTIF EOS DEATH PRONOUNCES OR October 1 l , 20 ] 2 23d. Date Signed (MO/Day/Yr) 24. Time of Death Approx. 3 .00 PM 25. Was Medical Examiner or Coroner Contacted? Yes No t 26. Part 1. Enter the chain of events--diseases, injuries, or complicati i CAUSE OF DEATH ons--that directly caused the death DO NOT Approximate resp ratory arrest, or ventricular fibrillation without showin the g . enter ter etiolo gy. DO N OT ABBREVIATE Enter onl minal events such as cardiac arrest Interval: . y one cause on a line. Add additional lines if necessary Onset to Death IMMEDIATE CAUSE ---------------> a. / ~' C Vt ~~ .!} /~, ~_ (Final disease or condition resulting in death) ~ Due to (or as a consequence of): b. Sequentially list conditions C C rc~ir vc "C- r~ ~'.~- ~ ~ , if any, leading to the cause Due to (or as a consequence of): listed on line a. Enter the c. i UNDERLYING CAUSE (disease or injury that ~ Due to (or as a consequence of): Initiated the events resulting d. ~ V_ in death) LAST. Due to (or as a consequence of): 0 26. Part 11. Enter other significant conditions contributin to death but not resulting in the underlying cause given in Part I 27. Was an autopsy performed? Q Yes ~1~ No m ~ 28. Were autopsy Endings available °...{ -°' 29 If Female: to complete the cause of death? E . ~ Not pregnant within past year 30. Did Tobacco Use Contribute to Death? Q Yes ~ No 31. Manner of Death ~ Q Pregnant at time of death 0 Yes ~ Probably atural l~ ~ Homicide m ° ~ Not pregnant, but pregnant within 42 days of dean (] No known Q Accident ~ Pending Investigation ~ - Not re Want, but re Want 43 da s to 1 P g P g y year before death 32 Date of Inju (M ~ Suicide ~ Could not be determined Q Unknown if pregnant within the past year . ry o/Day/Yr) (Spell Month) 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of In'u J ry (Street and Number, City, State, Zip Code) O •V•• o_ z 36. Injury at Work 37. If Transportation Injury, Specify: 3S. Describe How In'u ry Occurred: 0 Yes (] Driver/Operator ~ Pedestrian ~ No ~ Passenger 0 Other (Specify) 39a. C iffier (Check only one): Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated ~ Pronouncing 8~ Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated ~ Medical Examiner/Coroner - On the basis of examinatio nd/o7r investigation, in my opinion, death occ~u[rred at the time, date, and place, and due to the cause(s) and manner stated Signature of certifier: t~~':_5~- :s~fj) Title of ce rtifier:_ P"` Jl G. ~.-. ,,., dJ ~ z 7?~ ! 7 License Number: 39b. Narr~, AdSlress/and 2i Code of Person Completing Cause of Death (Item 26) _ • G+[e~y~ L ~ 39c. Date Signed (Mo/Day/ r) .-N. /~7 O bit 7> (i'~ ! fZr/ ~ -~ . ! • /?/~ 1 ? ~ [ .- /o// ~ ~/ Z 40. Registrar's District Number 41. Registrar's ' ture _ 7/y) 42. Registrar File gate (MO/Day/Yr) 43. Amendments ~~ S ~ ~ 3 ~ H105-143 Disposition Permit No. REV 07/2011 RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Walter J. Brashear ,Deceased ~~ Marian Shoemaker in my capacity/relationship as n,^, r ame Sister of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Barry Simmons ~.. { _, (ate) ~4,~;:;, ? , ~~~.,, .. _. ;. _.__ ,: ~~'g 1..~„t ~~ c-"-a n:.,.. T _.._., fJ &;~~_: ~> rted in Register's Office to or affirmed and subscribed before m his day of . Deputy for Register of Wills Form RW-06 Rey. ~o-~s-loos r ~ ._ PO (Signatur Marian Sho aker 900 Tuck Street (Street Address) Lebanon, PA 17042 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this day of ~i ~ ~u~3 Ndtary Public My Commission Expires:~~,/~~i3 (Signature and seal of Notary or other official qualified to administer oaths Show date of expiration of Notary's commission.) M~1r4~,g`q~R„s`l to l';~ fir,.. ~ti`fe ~, `a;,:,. !~ I . .. v~,.+. .~ r, .t ..1 Nny.~,yy`iu~1l..PY1rL ~`1: i~t»! 1 3 ~w...,""1 C. ~'~',r~: ~y `f i~:Sy~::e ~y5.i~.+~lf`~ Copyright (c) 2006 form software only The Lackner Group, Inc. RENUNCIATION REGISTER OF WILLS OF Estate of Walter J. Brashear CUMBERLAND COUNTY, PENNSYLVANIA Deceased Orian Brashear in my capacity/relationship as nn ame Brother of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Barry Simmons (Date) ~..~._ ~ e°'ti u r ~.. ,.: .~ ' .. ~~ w Je ,~~ ~.~ -~ t ~:c ~ ~ ~ ~~ Executec~ri~'i?egs~er's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this ~ s~ day ~~~~ ~~~ ~ f~'otary Public _ My Commission Expires: ~'V'~~~' ~~ ~r'_ ~S ~~~ S (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) Form RW-OB Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. j,,. ~. (Signature) Orian Brashear 1105 Valley Road (Street Address) Enola, PA 17025 (City, State, Zip) C~h~MC?I~~~~~A~"t f-i ~3F PENNSYLVANyA ~iut~rlal Seal ~"itla ~u?, ~?ra~>"C',~~:fn, NL~~~ PUb~tC Easl: Penrt~ts~r~; .rwp., ~umbetiand County NOy Corrasnlr~~l7rr ~xplres hlov. 15, 2015 MEM6FR; wFra?V!:Yt'dAf4f~ +>S50CIATION ®F NOTARIES ~ l - l~ t±~~~ 7 REGISTER OF WILLS OF Estate of Walter J. Brashear RENUNCIATION CUMBERLAND COUNTY, PENNSYLVANIA Deceased ~~ Donald Brashear in my capacity/relationship as (Yili7; ,~ alrCj Brother of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Barry Simmons 1~~J~ ~~~~~ (Z ~ Z~ f Z (Date) <~ n ~ ~.... :'~J .. -.?, ti " ,._., ~, . ....._.. ,. .. y,~ 1 M 'y' 'ti:..~ ~ ,. ~_.._ uteri ~n Reg~i~ster's Offi e i to or affirmed and subscribed before this day of Deputy for Register of ills Form RW-06 Rev. ~0-13-2006 (s; nature) Donald Brashear 42 Sherwood Drive (Street Address) Carlisle, PA 17015 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the ren~~rr~~c~ation for the purposes stated within on tku;;.s:.Z~day L Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission. ) -~._._..__.. ~ ~,~ ri ~ j ~r .. ~..__ --_ fa„ ~ ~t ~~~,~ s ~'r ~,. 37 uc; 'l~~ ~ '" '~~1. Copyright (c) 2006 form software only The Lackner Group, Inc. -,.~f d~ ~''~; fi ` SS-b rt wY:~i('f3:'v ~?~:G:. ~~ ~~ ~ •~ ~ ~- ~3 ~c~cr~7 REGISTER OF WILLS OF RENUNCIATION CUMBERLAND Estate of Walter J. Brashear COUNTY, PENNSYLVANIA Deceased ~' Ross Brashear in my capacity/relationship as nn ame Brother of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Barry Simmons r ~ -~ ---~_ (Date) ~ (Signature) Ross Brashear 1090 Valley Road /"~ (Street Address) a . ~. `wA ~_... n. • ` ° Enola, PA 17025 b,, ,..;_ .. ~~,~ ~• •., ,. ~, r ,~,;.; _ ~~ (City, State, Zip) ~~ ... ;.:+ ~.:w.,. r ~~~ Executed i~gist~--'s O~~e~' Executed out of Register's Office Sworn to or acrd and subsc +~ Before the undersigned personally appeared the before me thi`S" ~-, day party executing this renunciation and certified that he or she executed the renur~ciation for the of purposes stated within on this~5' day of ~~ ~ ~-~ •- z.t~ 4 Deputy for Register of Wills No ry Public My Commission Expires: i t~~~ ~5 avr 5~ (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission. ) ;- G©MP~R~3~A~~'N ~~ ~ElV.NSYLVANIA Nclt~rii91 Seal ~'it~a Vii. ic+~~t~ra; ~~~rl,' ~t~~lic East F'enol~bbro ., Curn~7~r~Gi~y aunty COtnml55idi1 Expires ~G~v: ~5; :?015 Mt<MEtP .+ ~f~NhlrvVF~vAN~A ,a.~Sb-'~E?~d G?~ NQ RIES Form RW-OC Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc.