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Home My WebLink About02-01-13 Reset 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: JONATHAN DEAN FAIRCLOTH File No: ~ ~ " ~~ - ~~~1 a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: March 29, 2011 Age at death: 22 Decedent was domiciled at death in Cumberland County, pennsylvania (stare) with his/her last principal residence at 11 Greenway Drive, Mechanicsbure. Unner Allen Townshiv. Cumberland County, Pennsylvania Street address, Post Office and Zip Code City, Township or Borough County Decedent died at MCBH Kaneohe Bav, Honolulu, Oahu, Hawaii Street address, Post Office and Zip Code City, Township nr Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ 0.00 /f not domiciled in Pennsylvania . ....................... Personal property in Pennsylvania $ If not domiciled in Pennsy!vania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ 0.00 Real estate in Pennsylvania situated at: (Attnch additional sheets, tjnecessary.) 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) 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 deftned 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 B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d. b. n., d.b.n.c.t.a., pendente lice, dterante absentia, durance minoritcrte 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 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 A '-' ~ ~ Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the fc~w~g spouse ~ny) aR! his (attach additional sheets, if•necessary): ~ ~ n r.~ ~ ~ ~7 ~ .-- ,-.,~ C7 Name Relationshi A'171#cl srn ~"' ~! C7 Alicia D. Faircloth Wife 716-B Carpenter Park ~ p b Patuxent River MD 20670 ~ ~ ~ ~ ~ Q C ~ ~ --~-~ t- ~ f !'i C/~ O -J "t7 Fern, Rw-nz ,-ev. rniluznll Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND Official Usc Only ~~~ ~~~lG~~ 4F` Petitioner(s) Printed Name Petitioner(s) to dress Alicia D. Faircloth 716-B Ca enter Park Patuxent River" 0 P I 1 Z 5~ D CO., PA 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 Deced t, the Petitioner(c1 11 well and~.tru~l administer the estate according to law. Sworn to r affirmed ubscribed before j'i n~_,G"-'d ~ _ Date ~ ~ met _ day of '~ `l~L By: I For the Regi~aer Date Date Date BOND Required: ~ YES ®NO FEES: Letters ...................... $ (3 )Short Certificate(s)...... ~ S ~ U~ ( )Renunciation(s)........ . ( )Codicil(s) . ........... . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ~~•••~•• 1~1h Tea ~-~~ ~,n ....... ~t~ ~cJU Automation Fee . .............. b • ~ JCS Fee ..................... .. O TOTAL ..................... $ ~ ~ 0 00 To the Register of Wills: Please enter my appearance by my signature below: Attorney S~• nature .I// f/1, '~~ Printed Name: Bruce J. Warshaw, Esquire Supreme Court [D Number: 58799 Firm Name: Cunningham & Chernicoff, P.C. Address: ~'i~n Nnrrh CP~nnrl Street T-Ta~,Shurg~ PA 171 10 Phone: 717-238-6570 X235 Fax: 717-238-4809 Email: 1ij xi n (`[`la x~n ~nm DECREE OF THE REGISTER Estate of JONATHAN DEAN FAIRCLOTH a/k/a: AND NOW, ~~'(~C,C \ ~~ G~~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters ,'!~~ ~~S ~~,~~~ are hereby granted to Alicia D. Fiarcloth ~ in the above estate and (if applicable) that the instrument(s) dated l ~ described in the Petition be corm Rw-oa rw. rniniznn File No: ~ ~ - ~~J ~ ~~ to probate and filed of record as the last Will (and Codicil(s)) of Decedent. egister of Wills -r Page 2 of 2 STATE OF HAWAII DEPARTMENT OF HEALTH Name of Decedent Jonathan Dean Faircloth ~ , taav , 9, CERTIFICAT~1~51 - .::'~:'y , m ~ _ ~ n• a~~„~ t~ d~ Q ~ e c7 ~4-a.'~• r~ o -ors ~~ .: ~ ~ -a :a~ 2~1 - ~~66 cn to ~ ~y t--~ ~ ~ ~ ~ o ~. t m r- cn ~ ,a~ -.] ;, "a Citv. Town or Location of Death Countv of Death Island of Death ~~~:=J MCBH KANEOHE BAY HONOLULU OAHU '. ~ ~;; P-~ Actual or Presumed Date of Death Actual or Presumed Time of Death Date of Birth Aae at Death 4 ~~' ~-; March 29, 2011 9:41 PM May 07, 1988 22 YEAR(s) `;1 ~ ~ Y Sex Race Citizenship Ever in Armed Forces? r: .~ ri, ~x MALE Caucasian USA YES [[L ~~C ~.?~ %~ ;_- I Social Security Number Marital Status Survivino Spouse Qf Wife. Name Prior_to First Marriage) %;~~~ 166-74-7032 MARRIED Alicia D. Foresee s ~tt Father's Name Mother's Name (Prior to First Marriage) 1~ ~,f s Dean S. Faircloth Beverly N. Yost ~J .: {r r`'r~ ;~~,;, Disposition _ __ --- _-- <F REMOVAL cemeteryicrematory: Malpezzi Funeral Home ';';`:~ Date: April 7, 2011 Location: Mechanicsburg, PA 17055 ;;`~~~ i Permit#:55868 FuneraiHome: BORTHWICKMORTUARY s'<~ ~ Certifier Scott Luzi, M.D. MEDICAL EXAMINER/CORONER ''`~: Y 4 Date Certified: March 31, 2011 original Date Certified: March 31, 2011 ~ ~;~" Date Pronounced Dead: March 29, 2011 Time Pronounced Dead: 9:41 PM `~ :-~ Cause of Death: ~`~` `~;~ _ `~ ~i ', ., .: ~~ ~~~I a. MULTIPLE BLUNT FORCE INJURIES ',' '; : ~ Manner of Death: ACCIDENT Date of Injury: March 29, 2011 ~`~.-'~ How Injury occurred: Helicopter mishap Time of Injury: 7:35 PM r 5;{'~ Injury at Work? YES Place of Injury: Kaneohe Bay, MCB Hawaii ~.;°'. ,: Location: Kaneohe Bay Sand Bar, MCBH KANEOHE BAY, HI 96863 E', r, ;i: ~; ~, << f,: ;~ Date Filed by State Registrar: April 5, 2011 '. '' ~ `~ !?41SM 12 (Rev. to/08) Thfs copy serves as prima facie evidence of the fact of death in any court proceeding. [HRS 338-13(b), 338-19] ~ 166905 ~* ~;%>~, ;fir r'. ~ ~ ~ ~ • ~ ~ ~ ~ ~ "?. ~~