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HomeMy WebLinkAbout03-05-13PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUM81;'RLRND COUNTY, PENNSYLVANIA Petitioner(s) named below, who is-are 18 years of age or older, appIy(ies) for Letters as specified below, and in support thereof aver(s) the follow ink and rzspectfully regt:est(s) the grant of Letters in the appropriate form: Decedent's Information Name:_~atwfGnct K. ~hofnosen '-S' a/k/a: Lc.,wrtdnct ~'r-t3lar Tkndmn5on T' a/k/a: a/k/a: Date of Death: .Sar- . z $ , 2013 Decedent was domiciled at death in Ctxx~n~Q,tc~ County, principal residence at ~ ~'tOtnrJ~etn Lane. - CQrli~(t=, __^ Street address, Post'Office and Zip Code File No• 02~' ~~^' ..~,~~ {Assigned by Register) Social Security No: a,Dy"oZ8-o~a3 Age at death• ..] $ (Stare) with hisl~last Borough County Decedent died at fi1.s• ,Ner3hey Il(1~e~tCa` Cranf'e.r H2dr•S~y ~a.~,~h:n P1~' Street address, Post Of u:e and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: ~c Ijdomiciled in Pennsylvania ........................... .All personal property $ St Dpp, Oa Ijnot domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ Ijnot domiciled in Pennsylvania ........................ Personal property in County $ Value ojrea[estatein Pennsy/vania ......................................................... $ TOTAL ESTIMATED VALUE.... $ S pG1D . Da Real estate in Pennsylvania situated at: N~/F (Attach additional sheets, ijnecessary.) Street address, Post Of£ce and Zip Code City, Townsh[p or Borough County j~ A. Petition for Probate and Grant of Letters Testamentary Petitioned} aver(s) he/sheli~ isf~C the Executordtfjl named in the last Will of the Decedent, dated _ /~zty[{.S,L ~ ZOd(a --mid-C'ot}i~i{(s~ thereto dated State relevant circumstances (eg, renunciation, death ojexecutor, 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 bom 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 lire, durante absentia, duranteminoritate 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 C'1 ~ Petitioner(s), afrer a proper search has/have ascertained that Decedent left no Will and was survived by the fo[IA~itt~pouse (if ati~) andirS~nach additional sheets, ijneeessary): ~ --~ ~ .,._ CC~~ r*i ~ c-~ ~ ~ ~o Name Relationshi A e~ fr'i d"rt d"t"d G1'7 G`+ c;a ~ • ~ ~~, ~ -re _v i ~"3 ~t) tU 'S.7 t.... L f-s Cia O Fonn RW-0_7 rev. ID/11/011 Page I of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } ~~~, } SS: ~~ COUNTY OF C U fYlOE ~-~-~~~ } .,-., l'ertionerls) Printed Name Petitto ~ r(~j rented. ddress rn an., Loti~se Thompson ~•4, ~ i= ~ l7t7 IS 4Ka Mai ~.ou Tko soot OR~HAPiS' ~®E~RT CUM 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 Petitio ) ~ tl well a y administer the estate ace rding to law. Sworn io or affirmed a subs ribed before ~ ate 3 me t day of ~ Date "' gy Date For size Register Date BOND Required:QYES NO FEES: Letters ...................... $ ( (,Q )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) . ........... . ( )Affidavit(s)........... . Bond ........................ Commission ................. . tYL ...... ~<; Automation Fee .............. . ]CS Fee . .................... • t`7 TOTAL ..................... $ •c`7C To the Register ojWills: Please enter my appearance by my signature below: Attorney Signature: T Printed Name: [~/?Q/'~CS E. ~/!ie%s-' ,71 • Supreme Court ~ Qs~3 ID Number: O Firm Name: af~S •E. o~~i~G/~s .~tt- Address: /7o SS Phone: 7/7 7~o~i--o.ZO Jr Fax: 7/T- S- Emait: CCJ ;eJp~s 3 g CMI~Q . /7G DECREE OF THE REGISTER ~ ~C File No• ~-~~~ ty~lP Estate of QW CC 1~, e a/k/a: LctW rert ct Kt+3 i ~ ~p/,- /d. AND NOVV, ~~(~ ~~ , -s; in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters are hereby granted to LO /Ss• sn ,~ o /YI1~3ov1 in the above estate and (if ap icabte} Ehat the instruments} dated described in the Petition be Fo,,~, itw-nz rev. tniiv?nli tted to probate and filed of record as the last Will ~'~JA~~IiNG: 9i Es iEfec~al ¢~ dup~i~;ai~ ~~+ _ -~;~ )~;r ,=M ~,,~~ ,i ~:~ ~;,, ,t REC4RDEC 4~FlCE OF ~_~<~ ~(,, r~~E;> . (~~~i~~(:;t.. ,;~ ~,;a REGis~rE~ a~ ~~~lLLS , i ~ I •. ?OI3 ~flfl 5 F~ 2 16 ~~~~`~ _ ''- I r ~ . f I ~ ,;1, ~ ~~ `;~ , . it . i~~i,~ _~(.:~ ~a CLERK 6 '$ v_ ~~ .~~ , _~ _~ - y ~ P 19 0 5 9 4 4 oRPHAr~s• cov€~r ,~ 3 1 ~ 13 ~ r~ rv I PA _ ~ r __. "'""/' ""' I^ COMMONWEALTH OF PEN NSVLVANIA ~ ,~ DEPARTMENT OF HEALTH VITAL RECORDS Permanent f° a 1. Decedent's Legal Name (First, Middle, Last, Suffix) v ~ v .-. r r a Stare File Number: 2. Sex 3. Social Security Number 4- Date of Death (MO/Day/Yrj (Spell Mo) Lawrence Kesler rh o son IIi male 204-28-0423 Januar 28 2013 Sa. Age-Last Birthda (Vrs) Sb U d y . n er 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Near) (Spell Month) ]a. BlrrS5hplace (City and State or F i ore gn Country) Months Days Hours Minutes JOt1i"1S tOWn Pa 78 November 16 1934 ]b Bi h l . rt p ace (cot,nty) Sa. R~esidence (State or Foreign Country) 86. Residence (Street and Number - Inciutle Apt No.) 8c. Did Decedent Live in a Township? a Bd. lies ide^^e (~^..ntv) 7 1~1o son Lane OYes, decedent livetl In Dickinson M,p. Cumberland Se Residen Zi . ce ( p Cotle) 1701 QNO, decedent lived wlthin limits of city/bor0. 9. Ever in USyjn~r.metl Forces? SO. Marital Status at Time Of Death ~ Married p widowed 11. Su rviVing Spouse's Name (If wife iven a Q Yes LNNO Q U am i k , g pr n or to first marriage) nown ~ Divorced Q Never Married Q Unknown MaY' Loll Glossar 12. Father's Name (First, Middle, Last, Suffix) ' 13. Mother s Name Prior to First Marriage (First, Middle. Last) Lawrence K. 'Iho son Jr . Ann Crawford 14a Informant's N g . ame 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Cotlei Mar Lou 'Thom C son Wife 7 rho son Lane Carlisle Pa 17015 ..................................................... P ace o eax C e .....~ ...... ..............................,...D th O ec on y one .._ If Death Occurred in a Hosplta l: npatient ilf ea ~~~ ............... ccu rred Somewhere Other Than a Hospital: ~] Hospice Facility Q Emergency Room/Outpatient ~ Dead on Arrival ~ Decedent's Home ~ Nursing Home/Long-Term Care Facility Other 5 ( Pecify) 1Sb. Facility Name (If not (nstltution, give street and number; •15 I LL c. C S y or Town, State, and Zip Code 15d. County of Death M. Hershe Medical Center He h P rs e a. 17033 Dau hin 16a. Method of Disposition ~ Burial Cremation 166 ~ . Date of Disposition 16c. Place of Disposition (Name of cemetery, c [ory, or other place) 0 Removal from State ~ Donation rema Other (Specify) ~13 Hollin er Cremator Ja 16d a18 31 g . Location of Disposition (City or Town, State, and Zip) of Fu 1 or P i -; erson n Charge of Interment 1]b. License Number Mt Holl S ri s P 0 a 011654-L 1]c. Name and Complete Address of Funeral Facility m r° 18. Decetlen['s Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE O highest de ree or level f h l g o sc oo R MORE ra s to indicate what completed at the time of death. box that best describes whether The decedent the decedent ~ 8th id d cons gra e or less ered himself or herself to be. Is Spanish/Hispanic/Latino. Check the "NO'• White ~ No tli lom a 9th 12 p , - ~ Korean th grade box If decedent is not 5 Ish His Pan / Panic/Latino. ~ Black or African American ~ High school raduate GED O g or completed Vietnamese Some colle [XNO, no[ Spanish/Hispanic/Latino ~ gmerican Intlian pr Alaska Native Q O ~ Be credit but no d h , t er Asian egree ~ Yes, Mexican, Mexican American, Chicano )~ Asian Indian ~ N ~ Associate degree (e AA qS) ti .g. , a ve Hawaiian Q Yes, Puerto Rican Chinese Q Bachelor's degree (e.g. BA, AB, BS) Q Yes ~ Guamanian or Cha mono Cuban O , Fill ~Mas[er's degree (e.g. MA, M5, MEng, MEtl, MSW, MBA) ~ Yes, other Spanish/Hispanic/Latino ~ Pino 0 Samoan ~ Ja a p octorate nese ~ Other Pacific Islander (e.g. PhD, Etl D) or Professional degree S ( pecify) ~ Other (Specify) _ . MD DDS, DVM LLB, JO 21..~~yOVecetlent's Single Race Seif-Designation -Check ONLY ONE [o Intltcate what the decedent considered himself or herself to be 22 D Whi ' . a. tp ecedent s Usual Occupation -Indicate te ~ Japanese ),~ Samoan type of work done tlurln ~ Black or African American ~ Korean ~ Other Pacific Islander B most of working life. DO NOT USE RETIRED. ~ American Indian or Alaska Native ~ Vle[na mese ~ Don't Know/Not Sure Physician A i ~ s an Indian Q Other Asian Q Refused 22 b. Kind of Business/Industry Chinese Q Native Hawaiian Q OTher (Specify) ~ Filipino ~ Guaranian or Chamorro 51 Ln_banon V O$ 1 t ITEMS 23a - 23d MVST BE COMPLETED 23a. Date Pronounced Dead (MO Oay/Vr) 236 gnature of P BY PE . RSON WHO PRONOUNCES OR erson Pronouncing Death (Only when ap plicablei 23c. License Number CERTIFIES DEATH ~ I Z,Q 2.O 23d. Date Signed (MO/DaY/V r) 24 T ime of D eath l~ -l1 ~ y vZ ~ l/ v 25. Was Medical Examiner or Coroner Conte cted? ~ Ves No CAUSE OF DEATH 26. Part 1. Enter the chain of events--diseases, Injuries, or complications--that direct) Approximate y caused the death DO NOT t . en respi rato r ven ry arrest, o tricolor fibrl er terminal events such as cardiac arrest Interval: ll atlon witho u t sh o w ing the etiology. DO N OT A BBRE VIATE Enter o l ; . 77 n JJ '' y one cause on a line. Add atlditional lines if necessary Onset to Death __`` ~ / ~ t ' ~ IMMEDIATE CAUSE --------__.___> a T~IQh~ McKXC C i C TG - ^ ' . . 4R /pr ~t V -~yy- ip N 'S~{1t~~IC S~1'..(~ ( (Final disease or condition J Due to (or sequence of): resulting in death) as ~~ !! ~~ b. '~'~.'>(aOXtL. Y'C.SPi Y-U ~ ry l'ct ~ ~ L r-G L. Sequentially Ilst conditions, D a ue to ( r as a consequence of): if any, leading to the cause _ listed on line a. Enter the V NDERLYING CAUSE Due [o (or sequence of): (disease or Injury that as a con Initiated the a nts resulting d. e In death) LAST. Due to (or as a consequence of): 0 26. Pert 11. Enter other s~nif'canf Condit S Ib ti t d th but not resulting in the uncle rlying cause given in Part I ~ 27. Was an autopsy pertormed? ~ Ves No $ 28. Were autopsy findings available -^~' t o c0 plefe the cause of death? 29. if Female: o ~ Yes No 30. Old Tobacco Use Contribute to Death? Q Noi pregnant within past year 31. Manner of Death m O Homicide ~ Pregnant ax time of death ~ Nos O Vnknobwn ~ Natural ~ Nat b ~ pregnant, ut pregnant within 42 da Accident ~ g gation Ys of death Pendin Invests ~ Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Inju ~ Suicide 0 Could no[ be determined (MO/D /V ry a r) (Spell Month) ~ Unknown If pregnant wlthin the pas[ year Y 33. Time Of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Nu b C m er, ity, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38 D ' . escribe How In u J ry Occurred: Q Ves ~ Driver/Operator ~ Pedestrian ~ No ~ Passenger 0 Other (Specify) 3 9a. Certifier (Check only one): Q Certifying physician - To the best of my knowledge, death occurred due [o the c se(s) and manner stated Pronou i ffi nc ng Certifyingg..FP~~ysician - To the best of cn wledge, death occurred at the time, date, and place, and due to the cause(s) and ~ Medical Examiner/CO~er ~ On th b ~ e manner stated asis of a nano //d/or investigation, In mY opinion, tleat~c~d a[ [he time, date, and place, and due to r. h e Cause(s) d manner statetl Slgnatu re of ce rtifl xC ~ 1 ~ / a 3 ) er:_ ~ - (1 ~ A ~Q , A TI[le of certifier: " L License Number: / i r T~9 LJ Q 96. Name, Address and Zip de of P r on Completing Ca D h (Ite 26) ` ~ Y~I:~ e~ ,C ) ~ . 17033 39c- Dafe Signed (MO/Day/Yr) ers~ley Medical Center, Hershey Pa a 4 , . 0. Regist d's District Numbe r 41. Registrar's 51 ~ J 42. Registrar File Date (MO/Day Yr) OC ~- +T ~/ ~ 4 3.Amendments ~/~3~ / ~~ Disposition Permit NO.C /C/~VV ~~ H105-143 REV 0]/2011 LAST WILL AND TESTAMENT OF LAWRENCE K. THOMPSON III I, LAWRENCE K. THOMPSON, III, currently of Dickinson Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. C7 C rte; ~~ w :U '~ r I . ~ ~ ~[] ~ .D y yrnj C O I direct the payment of all my just debts and funeral expenses as soon after ~'in~'d~eas as tlreis me ~ can conveniently be done. :~ c'? ~~' ~ "~° '~' ~ i"7 =::3 -ry .. ~._~ c,, ~,.~ i;4 J 'Y'1 All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise, and bequeath to my wife, MARY LOUISE THOMPSON, a.k.a. MARY LOU THOMPSON, to her own use and benefit absolutely. 3. In the event, however, that my said wife, MARY LOUISE THOMPSON, a.k.a. MARY LOU THOMPSON, should predecease me or die at about the same time as I die, such as from an accident or disaster common to both of us, I give, devise and bequeath my said Estate to my three children, LAWRENCE K. THOMPSON, IV, MARK B. THOMPSON and ELIZABETH THOMPSON JUST, in equal shares, per stir es. 4. I nominate, constitute and appoint my wife, MARY LOUISE THOMPSON, a.k.a. MARY LOU THOMPSON, to be the Executrix of this my Last Will and Testament. In the event that MARY LOUISE THOMPSON, a.k.a. MARY LOU THOMPSON, is unable or unwilling to act as Executrix, I appoint my daughter, ELIZABETH THOMPSON JUST, to be Executrix in her place and stead. In the event that ELIZABETH THOMPSON JUST is unable or unwilling to act as Executrix, I appoint my son, LAWRENCE K. THOMPSON, IV, to be Executor in her place and stead.. In the event that LAWRENCE K. THOMPSON, IV is unable or unwilling to act as Executor, I appoint my son, MARK B. THOMPSON, to be Executor in his place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this y~t day of ~GCA , A.D. 2006. t C~~~~~ ~ ~ ~~ (SEAL) `/~~G~G~ LAWRENCE K. THOMPSON, III Signed, sealed, published. and declared by the above-named LAWRENCE K. THONIPSON, III, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. RECOROL~ 0¢-i=4^L OF REGIS ~ ~ ~~ C~ ~°p,~~' S r~~i3 f1A~ 5 ~(~ 2 16 c~il~~~ 0 P AN5' CC1JR~ OATH OF SUBSCRIBING WITNE~,~~'~A~O ~0., PA REGISTER OF WILLS C (,~/y~~l~.,D COUNTY, PENNSYLVANIA Estate of L~rrt~e ~• / ~[0/l1l~JB/~ 7~ tikv ~ wrutc~. ~~ fdr ~ T ~n~~.s~- ~ ,Deceased ~ic~ie/% .T..T r~c% ,{sash-}-~ subscribing witness to (Prin/ Names) the Will ~~-Ee~ie~s) presented herewith,-Feae~ being duly qualified according to law, depose(s) and say(s) that she ~• was /-~sr$~ present and saw the above Testatoi~'~stat~- sign the same and that she-L-lie-yep signed the same and that shaie~` signed as a witness at the request of the Testator / '''°-~~ in .l~e~-/ his presence and in the presence of each other. (Signature) (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this of Deputy for Register of Wills day ~ lC~J1~ (Sign/azure) tn? ~~~~~~ ~ I~ ~~ (Street Address) l~'1eG~~esburq. P~ l7oSS (City, State, Zip) Q u ~o e ~o F z > ~ ~ c ev ~ p N V O Executed out of Register's Office ~ z z ~ 3~~g~ Sworn to or affirmed and subscribed m ~;.» e a ~~~ ~ .. before me this t~~ 1~i day ~ N Z ~t~ ~, ~ N O ~ Z 2 - of ' ~ ~ ~ ~ s © ' I s ^ ~ ~~~ m W ` 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.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Forte RW-03 rev. l0.l3.OG F~ECORDE~ ~==r~,c ~~= ~'~1i3 (~ OATH OF SUBSCRIBII~IG WI~~~S~S~ ? 6 c~E~~ cr_ REGISTER OF WTM T rp R P HA N S' C € d~ }~ i G um/J~~~COLTNTY,1PE~NNS~~~''I~~ 0•. PQ Estate of ~Rrd/'E/!C[ X a~~M ~~" ~`~^~"~ N.~14r ~h°~yf°'r ~ ,Deceased ~r~t5 ~. C~iG4~ ~ ~ ,-Eeas}~}-a subscribing witness to (Prin[ Names) the ®Wil presented herewith, feRek) being duly qualified according to law, depose(s) and say(s) that -eke-/ he-l was 1-were- present and saw the above Testator~~ sign the same and that el;e-f he L.t~e~ signed the same and that slur; he ~#hc~y, signed as a witness at the request of the Testator./ in -kerb his presence and in the presence of each other. l ~ , X (Signature) ~1 Q/"3~CS ~, .5~7~~l-,/CAS ~ ClouSu- CQoa~ (Street Address) ~p,~ani'~sdur9, ~~ /7a ss (City, Slate, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~ ~ day of ~J~-(C~ ' r) I~"~ .~~~.~.Q,~.~ ~ !~~QCt~t~~dh ~ eputy for Register of Wills (Signature) (Street Address) (City, State, Zip) Executed out of Register's Office Sworn to or affirmed and subscribed before me this day of 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.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notari2a[ion. Form RN'-03 rev. 10.13.OG