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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: H. Robert Cowles File No: Y l~ l
a/k/a: Harry Robert Cowles (Assigned by Register)
a/k/a:
&Wa: Social Security No: 189-84-8696
Date of Death: January 9, 2013 Age at death: 90
Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last
principal residence at 770 South Hanover Street, Carlisle. Carlisle Borough. Cumberland County PA 17013
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Chapel Pointe, 770 South Hanover Street, Carlisle. Carlisle Borough Cumberland County PA 17013
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania All personal property $ , er
If not domiciled in Pennsylvania Personal property in Pennsylvania $ '
If not domiciled in Pennsylvania Personal property in County $
Value of real estate in Pennsylvania $
TOTAL ESTIMATED VALUE.... $ 1000.00
Real estate in Pennsylvania situated at:
(Attach additional sheets, ifnecessary.) Street address, Post Office and Zip Code City, Township or Borough County
21 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 April 20, 2009 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 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(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 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 a pending divorce proceeding wherein the grounds fo>jvorce had be;establishyd as defined
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated pecEDn
~ 'r t! M
0 NO EXCEPTIONS Q EXCEPTIONS M 0 n C3 p
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the ~dlcin'pouseje of any) d1nMeirs (attach
additional sheets, if necessary): f-N rat Q~
Name Relationship t~dd?ess, i
O
Form RW-02 rev. 10111/2011 Page I of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Petitioner(s) Printed Name Petitioner(s) Printed Address
Daniel Harrison Cowles 23 East Tenth Street #903 New York NY 10003-6119
The 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 Decedent, the Petitioner(s) will well and truly administer the estate according to law.
- 01/ Date 4- 16 - 13
Swom to or affirmed a subscribed In
Date
B 1`~~ I day of Date
For the Register Date
BOND Required: Q YES Q,,NO To the Register of Wills:
FEES: r Please enter my appearance by my signature below:
Letters $ 4,-), L Attorney Signature:
( ) Short Certificate(s)...... „7C,.
( ) Renunciation(s)........ .
( ) Codicil(s)
( ) Affidavit(s)........... .
Bond P inted Name: Ro d E. Johnson, Esq
Commission upreme Court
'O`ther D Number: 16453
l CC ! T1. C
l'1~ [ yl L_' L~ • • • • • t Firm Name: Andrews & Johnson
T' Address: 79 Wacr Pomfret Street
Carlisle, PA 17013
Phone: 717-243-0123
Automation Fee 5 Fax: 717-243-0061
JCS Fee S ` Email: rqjohnsonlpa net
TOTAL $ ~-$8A
DECREE OF THE REGISTER
Estate of H. Robert Cowles File No: L. ~2_
a/k/a: Harry Robert Cowles /
AND NOW in consideration of the foregoing Petition,
satisfactory proof having bee re nted befor e, IT IS DECREED that Letters Testamentary
are hereby granted to Daniel Harrison Cowles
in the above estate and (if applicable) that
the instrument(s) dated April 20, 2009
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedept.
i
Register of Wills J
Form RW-02 rev. 10/1112011 Page 2 Of 2
11101 80S krA' 19/11
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Th)s is to certify that the information here given is
Fee for this certificate, $64C E- N
; i\r
3 t1H OF PFy coucctly copied from an original Certificate of Death
REGST "-R OF '-11'
duk, filed with me as Local Registrar. The original
z' ►
certificate will be forwarded to the State Vital
X111 uiV ) 1 t' a l a Records Office for permanent filing.
\OF- ;
4
b CLERK C".-
F~g9T C AA 1/2013
Certification Number AN S' C "D U I
> Local Re<,istrar Date Issued
Type/Print In C.U B ~t y:CY~Ty1JiA /EALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH • VITAL RECORDS
Perman¢^` CERTIFICATE OF DEATH
Black Ink State File Number:
1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sez 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell M.)
Harry Robert Cowles Male 189-84-8696 January 9, 2013
Sa. Age-Last Birthday (Yrs) 1Sb. Under 1 Year 5c. Under I Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country)
l 90 Months Days - Hours Minptes Dec 13 , 1922 P
7b. Birthplace (County)
8a. Residence (State or Foreign Country) Bb. Residence (Street and Number -Include Apt No.) 1L.,DYe) Dec edent Live In a Township?
770 South Hanover St _ , decedent lived In
8d. twP.
d Be. Residence (Zip Code) 1713 g No, decedent lived within limits of 7 1 7 city/bor..
9. Ever In US Armed Forces? 10. Marital Status at Time of Death E3 Married Widowed 11. Surviving Spouse's Name (If wife, given me prior to first marrlage)
M Yes m No m Unknown Divorced Never Married m Unknow
12. Father's Name (F
H irst, d le, Last, S ffix) 13. MotM1er,'s Name Prior to First Marriage (First, Middle, Last)
arry Russe~ Cowes Bessie Yarnell
14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) 10003
o Daniel Cowles son 23 E_ 10th St_, A t_ 903, New York Cit , NY
ri 15a. P ace o D¢at
If Death Occurred In a Hos (tai: ec on y one
p Inpatl :If Death Occurred Somewhere Other Than a Hospital: ' Hospice Facility ' ` Decedent's Home
CS Emergency Room/OUtpatlent Dead on Arrival [YNUrsing Nome/Long-Term Care Facility E-1 Other (Specify)
15b. Facility Name (If not institution, give street and number; •151. Ci or Ton, State, and Zip Code 15d. County of Death
Chapel Pointe @ Carlisle `GYarlwisle, PA 17013 Cumberland
16a. Method of Disposition Burial Cremation 16b. Date of Disposftlon 11 Place of Disposition (Name of cemetery, crematory, or other place)
m Removal from state p D.natl.n Jan 12 , 2013 Leto=t_- Cemetery
Other (Specify)
16tl. Location of Disposftlon (City or Town, State, and Zip) 17..S. gnat Servl Li see or Person in Char
Carlisle, PA 17013 138504
E 17 d Com let tldr f Funer Fa Ity
fo'man-~2okluneraome & Crematory, 219 North Hanover Street, Carlisle, PA 17013
m 18. Decedent's Education - Check the box that best describes the 19. Decedent of Hispanic Origin - Check the 20. Decedent's Race - Check ONE OR MORE races to Indicate what
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.
E3 Hth grademor less Is Spanish/Hispanic/Latino. Check the "No" White m Korean
C3 No diploa, 9th - 12th grade box If decedent Is not Spanish/Hispanlc/Latino. Black or African American m Vietnamese
E] Hlgh school graduate or GED completed ® No, not Spanish/Hispanic/Latino m American Indian or Alaska Native E3 Other Asian
m Some college credit, but no degree E3 Yes, Mexican, Mexican American, Chicano m Asia^ Indian m Native Hawa Ilan
m Associate degree (e.g. AA, AS) 0 Yes, Puerto Rican
Chinese Guamanian or Ch-r-
m Bachelor's degree (e.g. BA, AB, B5) m Yes, Cuban
Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Yes, other Spanish/Hispanlc/Latino m Finales Samoan
C3 Japanese Q Other Pacific Islander
Doctorate (e.g. PhD, EdD) or Professional degree (Specify) ~ Other (Specify)
. MD, ODS 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 E3 Japanese [j Samoan done during most of working life. DO NOT USE RETIRED.
Black or African American m Korean m Other Pacific Islander
C3 American Indian or Alaska Native E3 Vietnamese m Don't Know/Not Sure Clergy
E3 Asian Indian m Other Asian E3 Refused 226. Kind of Business/Industry
v=j Q Chinese Q Native Hawaiian 0 Other (Specify)
C m Filipino E3 Guamanian or Chamorr. Church
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day Vr) '3b- Signature of Person Pronouncing PERSON WHO PRONOVNCES Death (Only when applicable) 23c. License Number
CE OR ~v t
CERTIFIES DEATH o-4 ~
23d. Date Slg ed (MO/Day/Vr) 24. Time of Death
2S. Was Medical Examiner or Coroner Contacted? Yes ry.
CAUSE OF DEATH
26. Par[ 1. Enter the chain of events--diseases, [,juries, or com pllcatlons--that Approximate
directly caused the death. DO NOT enter terminal events such as cardiac ast Interv al:
respiratory arrest, or ventricular fibrillation without showing the etiology. D(ONOT ABBREVIATE. Enter only one cause on aline. Add additional Tinerre
s if necessary Onset to Death
IMMEDIATE CAUSE a_
r~1 (F~ O`'~V tis ~'C C.~t- `V = 1y
(Final disease or contlltl.n Du to (or as a cons of):
ra s.lting In death) goenc¢
b.
Sequentially list conditions, Due to (o as a consequence of):
If any, leading to the cause
listed on line a. Enter the
UNDERLYING CAUSE Due to (or as a copse
(disease or Injury that consequence of):
F initiated the events resulting d.
I. death) LAST. Due to (o as a consequence
of):
S 26. Part If. Enter other significant conditions contributing t death but not resulting In the underlying cause given In Part 1 27. Was m autopsy performed?
Yes M No
128. Were autopsy flntlings available
m mplete the cause .No
f death?
°w
29. If Female: 30. Did Tobacco Vse Contribute to to co
Death? M Yes
3
o m Not pregnant within past year 1. Manner of Death
C3 Yes 0 Probably CM.N.t.ral m Homicide
E3 Pregnant at time of death
m Not pregnant, but pregnant within 42 days of death m No Unknown m Suicide m Accident m Pending t be determined
19 m Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Da m Could not be determned
0 Unknown If pregnant within the past yea? Y/Vr) (Spell Month)
33. Time of Injury
34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code)
36. Injury at Work 37. If Transpo rtatlon Injury, Specify: 38. Describe How Injury Occurred:
m Yes 1
E3 Driver/Operator F3 Pedestrian
0 No C] Passenger E3 Other(Specify)
39a. Certifier (Check only one):
QrCertifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated
m Pronouncing 1L Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the c se(s) and manner stated
m Medical Examiner/CoroA-110 ner - On the basis of examination, and/or investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner stated
Signature of certifier: Title of certifier: License Number: r~14_D CZ1 «t Z t{ ( C
_T 39b. Name, Address and Zip Code of Person Completing Cause of Death (Item
e 26) 39c. Date Signed (MO/Day/Yr)
1 Gm o p _ gc~ i rN V_
Dc~ 9 2tii
40. Registrar's District Number 41. Registrar's 5 C 42. Registrar File Date (M./Day/V,)
a - ata pE _
43. Amendments
O
11105-143
Disposition Permit No._1~ REV 07/2011
r P k" Y
R E' LAST WILL AND TESTAMENT
3 12
~6 OF
p_ H. ROBERT COWLES
-H 4N, 00,
CUSE..
I, H. ROBERT COWLES, of Carlisle Borough, Cumberland County, Pennsylvania, being
of sound and disposing mind, memory and understanding, do hereby make, publish and declare this
as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made
by me.
FIRST: I direct that all my just debts and funeral expenses, including my grave
marker, shall be paid from the assets of my estate as soon as practicable after my decease.
SECOND: I give, devise and bequeath the residue of my estate, of every nature
and wherever situate, to my Wife, MARJORIE D. COWLES, providing she shall survive me by
thirty (30) days.
THIRD: Should my Wife, MARJORIE D. COWLES, predecease me or die
on or before the thirtieth day following my death, I give, devise and bequeath 60% of the residue of
my estate, of every nature and wherever situate, to my children, namely, Rebecca Cowles Swanson,
Deborah Jane Cowles, Daniel Harrison Cowles and Esther Cowles Schaeffer, equally, provided that
the share of any child who predeceases me or dies on or before the thirtieth day following my death,
shall be distributed to his or her issue, per stirpes, living on the thirty-first day following my death,
and in default of such then living issue, such share shall be added to the share or shares for my other
children and/or their issue.
FOURTH: Should my Wife, MARJORIE D. COWLES, predecease me or die
on or before the thirtieth day following my death, I give, devise and bequeath 25% of the residue of
my estate, of every nature and wherever situate, to my grandchildren, namely, Sarah Swanson
Weisenburn, Robert Paul Schaeffer, Henry David Schaeffer, Stephen Andrew Schaeffer, Mark
Daniel Schaeffer and Rebekah Lynn Schaeffer, equally, provided that the share of any my
grandchildren who predeceases me or dies on or before the thirtieth day following my death, shall be
distributed to his or her issue, per stirpes, living on the thirty-first day following my death, and in
default of such then living issue, such share shall be added to the share or shares for my other
grandchildren.
FIFTH: Should my Wife, MARJORIE D. COWLES, predecease me or die
on or before the thirtieth day following my death, I give, devise and bequeath 10% of the residue of
my estate, of every nature and wherever situate, to the Great Commission Fund of the Christian and
Missionary Alliance located in Colorado Springs, Colorado.
SIXTH: Should my wife, MARJORIE D. COWLES, predecease me or die
on or before the thirtieth day following my death, I give, devise and bequeath 5% of the residue of
my estate, of every nature and wherever situate, to the Chapel Pointe located in Carlisle,
Pennsylvania.
SEVENTH: I direct that all taxes that may be assessed in consequence of my death,
of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a
part of the expense of the administration of my estate.
EIGHTH: I nominate, constitute and appoint my Wife, MARJORIE D.
COWLES, Executrix of this my Last Will and Testament. Should my Wife, MARJORIE D.
COWLES, fail to qualify or cease to act as Executrix, I appoint my son, DANIEL HARRISON
COWLES, Executor of this my Last Will and Testament. Should my son, DANIEL HARRISON
COWLES, fail to qualify or cease to act as Executor, I appoint, REBECCA COWLES
SWANSON, Executrix of this my Last Will and Testament.
NINTH: I direct my Executrix and her successors shall not be required to give
bond for the faithful performance of their duties in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Willa d
Testament, consisting of two (2) typewritten pages, each identified by my signature, this
day of April 2009.
cow (SEAL)
H. ROBERT COWLES
Signed, sealed, published and declared by the above-named Testator, H. ROBERT COWLES, as
and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and
presence, and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
I, H. ROBERT COWLES, Testator, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it
as my free and voluntary act for the purposes therein expressed.
Sworn or affirmed to and acknowledged before me by H. ROBERT COWLES, the Testator,
this Z,O day of April 2009.
FCarlisle MMONWEALTH OF PENNSYLVANIA ~Q y C.o E✓~eo (SEAL)
NOTARIAL SEAL H. ERT CO S, Testator
SHELLY SEXTON, Notary Public
Boro, Cumberland County
COI71rniSSiOn Expires April 26, . o Publics
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
We, RONALD E. JOHNSON and L~- , the witnesses
whose names are signed to the attached or foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw Testator sign and execute the instrument as his
Last Will and Testament; that H. ROBERT COWLES, signed willingly and that he executed it as
his free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight
of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at
that time 18 or more years of age, of sound mind and under no constraint or undue influence.
Sworn or affi %e(
to and subscribed to before me by RONALD E. JOHNSON
and witnesse is Z--b day o ril 2009.
(SEAL)
R nald E. Johnson ness
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
SHELLY SEXTON, Notary Public (SEAL)
141g , tness
Carlisle Boro, Cumberland County
My Commission Expires April 26, 2011
Notary Pu i