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HomeMy WebLinkAbout02-13-13PETITION FOR GRANT OF LETTERS REGISTER OF WII.,LS 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: JOHN R. GIBBON File No: 21 '" ~~ 4~ 'rl a/k/a: (Assigned by Register) a/k/a: a!k/a: Social Security No: Date of Death: 12/25/12 Age at death: 79 Decedent was domiciled at death in Cumberland County, PA (State) with his/her last principal residence at 425 Chestnut Street Aft. 2 17065 Mt. Holly Springs Borough Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 425 Chestnut Street, Apt. 2 17065 Mt. Holly Springs Borough Cumberland PA 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 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... . ~1 ~~ ~ Real estate in Pennsylvania situated at: 327 North Baltimore Avenue 17065 Mt. Holly Springs Boro Cumberland (Attach additional sheets, if necessary.) 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 10/17/00 and Codicil(s) dated None. 1~r,~y ~~ State relevant circumstances (e g. renunciation, death ojexecutor, 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. ® 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 life, durante absentia, durante minoritate If Administration, c.~a. or d.b.n.c.~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. ^ NO EXCEPTIONS ^ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the additional sheets, if necessary): ca ~ c~qa ,e (if any) d heirty ~h ~ ~ ~ ~ Name Relationship Ad ss~" t"' ~"''' tT1 f~'t z v' ~ ~ sa -rt ~ ~ aC ~ c.~ r ~~ cn ~~ A ~..,,, Form RW-02 rev. 10/11/2011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } Official Use Only Petitioner(s) Printed Name Petitioner(s) Printed~ld s ~-"-' ~ rn 1000 Goodyear Road ,~, ro rnrn ~ ~~~rr Cath J. Gibson n/k/a Cath J. Murtorff Gardners m z ~ P l iti24 7A- F--+- a-rt rn A~~ cn w ~` ~a~Q ~ ~~ • ~O CJ t"-'" ~ ~"' ~-,~,1 - p 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 Petitione will well~d truly administer the estate according to law. °f re /~"/~i~ Sworn to or affirmed and subscribed b., o Date ~ • l3.1.~- me '~'~ y f Ar Zo i3 - Date By: 7' Date o the Register Date BOND Required: ^ YES ^ NO FEES: ~~~ od Letter ....................... $ ( ~) Short Certificates(s) ...... ' ~' ( )Renunciation(s) ......... . ( )Codicil(s) ............. . ( ) Affidavit(s) ............ . Bond ......................... Commission ................... . ~ ~ oe Off/ ......... ~"" L76 Automation Fee ................ . JCS Fee ....................... 3-,5'~ TOTAL ...................... $ ~'. ,~0 To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: ~~ J Printed Name: Seth T. Mosebey Supreme Court ID Number: 203046 Firm Name: Martson Law Offices Address: 10 East High Street Carlisle PA 17013 Phone: (717) 243-3341 Fax: X717) 243-1850 Email: smosebey~a~martsonlaw.com DECREE OF THE REGISTER Estate of JOHN R. GIBBON a/k/a: AND NOW, ~ /" l,/ ~ Zo ~ 3 , in consideration of the foregoing Petition, satisfactory proof having been presen ed before me, IT IS DECREED that Letters Testamentary _ are hereby granted to Cathy J. Gibson n/k/a Cathy J. Murtorff in the above estate and (if applicable) that the instrument(s) dated October 17 2000 described in the Petition be admitted to probate and filed of record as t~e last Will (and Codicil(s)) of Decedent. File No: 21 `-'/ 3 -~~~ Register of Wills ,%/~j/h (,(~~~~1~/j.G Form RW-O2 rev. 10/11/2011 / Page H105.805 REV (9/11) ~~~ ZJ-/ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 R ~ ~ a R ~ ~ ~ ~ ~ ~ ~ ~+ ~ ~ ~ R~~tSTER OF '1~.~.S 1013 FHB 13 ~~1 ? ~~, This is to certify that the information here given is =. correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ~. ~ ~O 80 c~.ER~c c~ ~~ ~. o c 27 Zo~2 a. Certification Number HA~~ /~~J /~/1~~/~~~~~T Local Registrar - _ Date Issued ____ /(/ Type/Print In ~~~~ ~~~ ~~ ~ TOIM I17fC7NV1~E OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Permanent /"I~QT~C~f"ATC AC /1L A'Tu W - xaxe me number. 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spelt Mo) John. R_ Gibson M December 25, 2012 Sa. Age-Last Birthday (Yrs) Sb. Vnder 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) 1 ` ,79 Months Days Hours Minutes ~r1181e, PA Ma 3 O , 1 93 3 7b. Birthplace (County) r and Sa. Residence (State or Foreign Country) Sb. Residence (Street and Number -Include Apt No.) 8c. Dld Decedent Live In a Township? PA 425 Ct1@StnLlt S.t _ A .t, _ B DYes, decedent Ilved in ~p Sd. Residence (County) r p G~nberlarid 8e. Residence (Zip Code) o, decedent Ilved within limits of Mt . Holly SAr1.nQS city/boro. 9. Ever In US Armed Forces? 10. Marital Status at Time of Death ~ Married ® Widowed 11. Surviving Spouse's Name (If wife, glue name prior to first marriage) Q Ves ~ No Q Unknown ~ Divorced ~ Never Married ~ Unknown _ 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name PNor to First Marriage (First, Middle, Last) John Z_ Gibson Erma - S clc 14a. Informant's Name 14b. Relationship to Decedent Cath J Murt rff D h 14c. Informant's Malling Address (Street and Number, City, State, Zip Code) g y _ o aug ter 1000 Goodyear Rd_ Gardners, PA 17324 - G _ c ......................................................... ...P ............................_ 15a. P ace o eat C ec on y one .............................. .'....r.......... ^ ............................................... ................................... ................................... If Death Occurred in a Hospital: In anent :If Death Occurred Somewhere Other Than a Hospital: `~ Hospice Facility ~~Decedent's Home Q Emergenry Room/Outpatient ~ Dead on Arrival 0 Nursing Home/Long-Term Care Faclltty Other (Specify) • 15 b. Facility Name (If not institution, glue street and number; lSc. City or Town, State, and ZIp Code SSd. County of Oeath~ 425 Chestnut St . A t _ B Mt _ Ho11 Sprin s , PA 1 7065 G~nnberland m 16a. Method of Dlsposltion ~ Burial ~ Cremation 16b. Date of Disposition 16c. Place of Dlsposltion (Name of cemetery, crematory, or other place) ~ Removal fmm State ~ Donation Other (Specify) 12/31/2012 Plainfield Church of God C in t -e e e 16d. Locatton of Dlsposltion (City or Town, State, and Zip) 17a. Signature of Fu era Service License so harge of Interment 17b. License Number Plainfield, PA a FD 012633 L ~ 8 17c. NaSife and ~omple a Address Funeral Fa 111 rothers ~unera~ ~Ic t win = 0 S H 6 ~ ° g a te , nc _ , _ 3 anover St _ , Car11S1e , PA 1 701 3 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hlspanlc Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to lndlcate 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 ~ . B 8th grade or less is Spanish/Hlspanlc/Latino. Check the "NO" B'Tlyhlte ~ Korean ~ No diploma, 9th - 12th grade box if decedent is not Spanish/Hlspanlc/Latino. ~ Black or African American ~ Vietnamese ~ High school graduate or GED completed B'N o, not Spanish/Hlspanlc/Latino ~ American Indian or Alaska Native ~ Other Asian Q Some college credit, but no degree Q Yes, Mexlca n, Mexican AmeNca n, Chicano 0 Asian Indian ~ Native Hawaiian ~ Associate degree (e.g. AA, AS) ~ Yes, Puerto Rican 0 Chinese ~ Guamanian or Chamorro ~ Bachelor's degree (e.g. BA, AB, BS) ~ Yes, Cuban 0 Filipino ~ Samoan Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Yes, other Spanish/Hispanic/Latino ~ Japanese ~ Other Paclflc Islander ~ Doctorate (e.g. PhD, EdD) or Professional degree (Spectfy) ~ Other (Specify) e. MO DDS DVM LLB JO 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 -lndlcate type of work ~1Nhlte Q Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED. ~ Black or African American Q Korean Q Other Paclflc Islander production line Wi'~rker ~ American Indian or Alaska Native Q Vietnamese - ~ Don't Know/Not Sure Q Asian Indian ~ Other Asian ~ Refused 22b. Kind of Business/Industry Q Chinese ~ Native Hawaiian ~ Other (Specify) FiII Ino ~ P 0 Guamanian or Chamorro Carlisle Tire & Rubber CO _ ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (Mo Day r) 23 b. Signature of Person Pronouncing Death Only when appllcab a 23c. Ucense umber CERTIFIES DEATH PRONOUNCES OR DeCanber 25 , 2O 1 2 23d. Date Signed (Mo/Day/Yr) 24. Time of Death A r}C _ 1 1 = 0 0 a _ Z[1 _ 25. Was Medical Examiner or Coroner Contacted? Yes ~ No CAUSE OF DEATH = Approximate 26. Part 1. Enter the chain of events--diseases, Injuries, or complications-that directly caused the death. DO NOT enter terminal events such as ca rdlac arrest = Interval: . respiratory arrest, or ventricular flbrlllatlon withouy's~ in g the etio l ogy. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional Ilnes if necessary Onset to Death \w / ~ ~ ~ ' ~ IMMEDIATE CAUSE ---------> a. ~ -.iL /.J~~yi ~ (Final disease or condition Due to (or as a consequence of). j resulting in death) " b. _. C ~ ~GO/'~/G. ~4i~/ E Sequentially Ilst conditions, ue to (or as a consequence of): If any, leading to the cause i listed on Ilne a. Enter the c. i% / /~ s UNDERLYING CAUSE Due to (or as a consequence of): ~ (disease or Injury that ~ Initiated the events resulting d. L3 In death) LAST. Due to (or as a consequence of): j S 26. Part 11. Enter other slaniflcant conditions contrlbutin¢ to death but not resulting in the underlying cause given in Part 1 27. Was an autopsy performed? ~ O Yes o 28. Were autopsy findings avatlabte ~' to complete the cause of death? Q Yes No a 29. If Female: 30. DId Tobacco Use Contribute to Death? 31. Manner of Death E ~ Not pregnant wtthln past year ~ Yes 0 Probably Natural ~ Homicide as 0 Pregnant at time of death ~ No Unknown ~ Accident ~ Pending Investigation a~ ~ Not pregnant, but pregnant wtthln 42 days of death Q Suicide ~ Could not be determined ro- Q Not pregnant, but pregnant 43 days to 1 year before deatF 32. Date of In u Mo Da j ry ( / y/Yr) (Spell Month) Q Unknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, Clty, State, 2Ip Code) 36. Injury at Work 37. If Transportation Injury, Specify: - 38. Describe How Injury Occurred: Q Yes 0 Driver/Operator ~ Pedestrian Q No ~ Passenger ~ Other (Specify) 39a.sertlfler (Check only one): ~f Certifying physlclan - To the best of my knowledge, death occurred due to the cause(s) and manner stated ~ Pronouncing ga Certifying physlclan - 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 - O I f xaminatlo nd/or Investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and man ner stated d Slgnatu re of certifier: Title of certifier: ~ti ~ License Number ~ ~ O~~ ~ 30 39b. Name, Address and ZIp Code of erson CompletJ~ing Cause of Death (Item 26) 39c. Date Signed (Mo/Day/Yr) ~ ~ O / ~- ~ 40. Registrar s District Number 41. Registr 's l~u re ~ 42. Registrar Flle Date Mo Day r ~ ~ ` 43. Amendments Dlsposltion Permit No._(~~~,3 V H305-143 REV 07/2011 Z/-I3-/~l CERTIFICATION OF EXCERPTS FROM MARRIAGE LICENSE RECORD STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND I, GLENDA EARNER STRASBAUGH CLERK OF ORPHANS' COURT in and for said County, hereby do certify that the records in this office, as contained in Marriage License Docket, Vol. 2006 Page 222 show that Marriage License No. 222 was issued on April 7 7, 2006 to MURTORFF JAMES E (Last, Fiist, Middle) and GIBBON CA THY J that the Return to (Last, First, Middle) said License shows that said persons were married on May 6, 2006 a t MT ROLL Y SPRINGS by FRANK APONTE MINISTER MURTORFF JAMES E stated his date of birth was March 2, 7965 his birthplace CARL/SLE PA and the names of his parents MURTORFF PAUL E MURTORFF MARGARET S and GIBBON CA THY J stated her date of birth was March 74, 7964 her birthplace CARL/SLE PA and the names of her parents GIBBON JOHN R GIBBON SHIRLEY M IN TESTIMONY WHEREOF, I have hereunto set my hand and the seal of said court this ~3th day of February A . D . , 20 ~3 F:\FILES\DATAFILE\WiLLS\10161-h.will '".,~.. ...~ '~ C.~.~ .~ ' . ~"1 LAST WILL AND TESTAMENT rn ~ ~ ©o to OF ~~~ w ~~ JOHN R. GIBSON ~ rr? ~ ~ ~,, Q ,~., a ~-~ -~ -n g gh rally Spnngs, I JOHN R. GIBBON ale al resident of the Borou of Mou ~ ~ ~ ~` ~ °`'~ c~ Cumberland County, Pennsylvania, being of sound and disposing mind,nory, and ~-~- understanding, do hereby make, publish, and declare this as and for my~,ast Will ~d T v sta~hent, 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 direct that all taxes that maybe assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as apart of the expense of the administration of my estate. THIRD: I devise and bequeath the residue of my estate, of every nature and wherever situate, to my wife, SHIRLEY M. GIBSON, provided she shall survive me by thirty (30) days. Should my wife, SHIRLEY M. GIBBON, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the residue of my estate, of every nature and wherever situate, to my children, equally, provided that the share of any child who predeceases me or dies on or before the thirtieth day following my death shall be added to the share or shares for my other children and shall not be devised per stirpes. FOURTH: I nominate, constitute and appoint my wife, SHIRLEY M. GIBSON, Executrix, of this, my Last Will and Testament. In the event of the renunciation, death, resignation, or inability to act for any reason whatsoever of the said SHIRLEY M. GIBBON, I nominate, constitute, and appoint my daughter, CATHY J. GIBBON, Executrix, of this, my Last Will and Testament. I hereby relieve my Executrix or her successor from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act, insofar as I am able by law so to do. IN WITNESS WHEREOF, I have hereunto set my han~~nd seal to this, my Last Will and Testament, consisting of one typewritten page, this ~---day of ~l't~'E~ , 2000. ' (SEAL) ohn R. Gibson, Testator Signed, sealed, published, and declared by the above-named Testator, John R. Gibson, 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. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, John R. Gibson, 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; 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 John R. Gibson, the Testator, this / ~ day of ~~ , 2000. Te tator, John R. Gibson l~ Notary Public NOTARIAL SEAL CORRINE L. MYERS, Notarryy Public Carlisle Boro, Cc~mberlandCounty My Coi'i'i~iS~io~1 Exir~~ ~=9~~,~ 27, 203 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND We, Edward L. Schorpp and a ~ ' a. ,the witnesses whose names are signed to the attached or foregoing instrument, be g 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; that John R. Gibson 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 eighteen or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed and subscribed to before me by Edward L. Schorpp and r ~ . witnesses, this ~`~^ day of ~~~8--(,vn., , 2000. • (SEAL) Witness, Edward L. Schorpp ~!,~4.,~-<-~- r ~~9 ~ (SEAL) Witn ss (SEAL) Notary Public CORRINE L~. MYERSSNo e Public Cariisl~ Eoro, Cumberland~ounty ~,~, ~ ,,-,,.-;~,~. _~,~ ~~~~lrs ~~ay 27, 2003