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HomeMy WebLinkAbout03-28-13 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 ;0- I ff- e361 Name: GLORIA G.WRIGHTS File No: aWa: (Assigned by Register) aWa: aWa: Social Security No: Date of Death: March 19,2013 Age at death: 57 Decedent was domiciled at death in Cumberland County, Pennsylvania (State)with his/her last principal residence at 2 Willow Drive,Shinnensburg,PA 17257 Southampton Township Cumberland Street address,Post Office and Zip Code City,Township or Borough County Decedent died at Chambersburg Hospital 112 N 7th St,Chambersburg,PA 17201 (Chambersburg Borough)Franklin 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 $ 10,000.00 If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $ If not domiciled in Pennsylvania. ....................... Personal property in County $ Value of real estate in Pennsylvania......................................................... $ 150,000-00 TOTAL ESTIMATED VALUE. ... $ 160000.00 Real estate in Pennsylvania situated at:.2 Willow Drive,Shippensburg,PA 17257 Southampton Township 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 February 15,2008 and Codicil(s) thereto dated Karen F_Elliot will rennunce in favor of Ronald R_Elliott(aka Ronald R_F.11in t,Sr_)and La=i._Elliott 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(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. 0 NO EXCEPTIONS 0 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 for di�*qrce had beenablisd=defined in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated pers W © M n 0 NO EXCEPTIONS 0 EXCEPTIONS W C> G Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the fol speeuse(may)a> (attach additional sheets,if necessary): M vo t1) Name Relationship ARr�s c) "0 -n Cam `. r\,) r— t"i"f D N Form RW-02 rev.10/11/2011 Page 1 of 2 Oath of Personal Representative Official Use Only _...., COMMONWEALTH OF PENNSYLVANIA } C © w 1.70 m } SS: X C rn C> COUNTY OF CUMBERLAND = r N go Petitioner(s)Printed Name Petitioner(s)Printed Addr ;;0 Cy r Ronald R.Elliott aka Ronald R.Elliott Sr 1548 Orrstown Road Shippensburg,PA 17257 2' Larry L.Elliott 179 Chamberlin Road,Shippensburg,PA 17257 z ►-- = C-) A► �--* Cn C) 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 Deceogt,the Petitioner(s)will well and truly administer the estate according to aw. Sworn too affirmed subscribed before /6 .� Date .31,?a/,3 me thi p4Say o /'4 L- i Date,/,' By: f� Date ..*Register Date BOND Required: Q YES (E) NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Lett $ � Attorney Signature: ( )Short Certificate(s).. . . . . ( l)Renunciation(s).. . .. . . . . 0 ( )Codicil(s). . . .. .. . . . . . . ( )Affidavit(s).. . . . . . . . . . . Bond.. . . .. . . . .. . ... . . . . . . . . . Printed Name: Thomas P.Gleason Commission. .. . . . . . . .. . .. . . . . Supreme Court Other . . . . . . . ID Number: 82259 D Firm Name: Thomas P.Gleason,Esquire Address: 49 West Orange Street . . .. . . Suite 3 . . . . . . Shippensburg,PA 17257 . . .. . . Phone: (717)532-3270 Automation Fee. . . . . . .. . . . . . . . Fax: (717)532-6673 JCS Fee. . . .. . . .. . . . . . . . . . . . . 6 Email: tomgleacen c(�i om leasonlaw_cnm TOTAL. . . . . . . . . . . . . . . . . . . . . $ 9 7fj D DECREE OF THE REGISTER Estate of GLORIA G.WRIGHTS File No: a/k/a: AND NOW, /�D , �d/ ,in consideration of the foregoing Petition, satisfactory proof having been presented before me,IT IS DECREED that Letters Testamentary are hereby granted to Ronald R.Elliott(aka Ronald R.Elliot,Sr.)and Larry L.Elliott in the above estate and(if applicable)that the instrument(s)dated February 15 2008 described in the Petition be admitted to probate and filed of re d i the last Will nd Codicil(s))of ecedent. Register of Wills Form RW-02 rev.10/11/2011 Page 2 of 2 'ZI-13-541 LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, GLORIA G. WRIGHTS, of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment of all my legal debts, funeral expenses and all } expenses of my last illness, state, federal estate and inheritance taxes and administration costs shall be paid as soon as may be conveniently done following my decease leaving all specific bequests free of tax to the legatee. SECOND: I give, devise and bequeath to my daughter, April C. Wrights, all my property be it real, mixed or personal. THIRD: If any of the beneficiaries under this my Last Will and Testament is under the age of Twenty One (21) years (hereinafter minor), then in that event, I give, devise and bequeath said minor's share to Ronald R. Elliott and Karen F. Elliott, or if both should fail to serve or be unable to serve then to Larry L. Elliott, as Trustee of my estate, to invest and reinvest the same during the minority of the said minor with the following powers in addition to those currently given under law: C, , C= Q w rn c' a. The power to use the income from the said minor'sFBh*e forge rnrn support, health, maintenance and education (incluciuhderYPaduat� graduate or technical schools) of the said minor. c> .s: rn b. The power to use the principal if the income should prove insufficient for the support, health, maintenance and education (including undergraduate, graduate or technical schools) of the said minor C. The power to distribute the then remaining principal and interest to my daughter as follows: 50 % upon her graduation from high school and all remaining principal and interest when she attains the age of Twenty One (21) years, upon a good and valid release without the necessity of adjudication by the Orphan's Court. FOURTH: I nominate and appoint Ronald R. Elliott and Karen F. Elliott as guardians of any minor child. FIFTH: I nominate and appoint Ronald R. Elliott, Karen F. Elliott and Larry L. Elliott as Executors of this my Last Will and Testament. My Executors are to serve without bond of any nature or kind. IN WITNESS WHEREOF, I, Gloria G. Wrights, to this my Last Will and Testament S set my hand and official seal this �._ day of lee(-u 2008. (SEAL) Gloria G. Wrights Sworn to and subscribed, declared and Published by Gloria G. Wrights, as Her Last Will and Testament, and so Done in the presence of we the Witnesses, who sign at her request, And in her presence, and in the presence Of each other. fr `UZ rf. r' COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND I, Gloria G. Wrights, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. p Gloria G. Wrights Sworn to and acknowledged, before me, By Gloria G. Wrights the Testatrix, This day of 2008. Notary Public COMMONWEA M OF PENNSYLVANIA Notarial Seal H.Anthony Adams,Notary Public Shippensburg Boro,Cumberland County *Commission Expires May 31,2616 COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses, and that to the best of our knowledge and belief the Testatrix was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. � /1 t c Sworn to and subscribed before me by, Darlene M. Bigler and Sharon Coleman Adams, The witnesses, this � _ day of 2008. Notary Public C0NiM0NW i�..Th OF YECvNSYLVANIA NotaRai Seth H.Anthony Adams,Notary Public Shippensburg Boro,Cumberland County My commission Expires May 31,2010 H105.805 REV 9/11) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. RECORDED OFFICE OF Fee for this certificate, $6.00: R o This is to certify that the information here given is a)L� NTH correctly copied from an original Certificate of Death 28 l; duly filed with me as Local Registrar. The original Z certificate will be forwarded to the State Vital °v a Records Office fo permanent filing. CLERK �_� = ��*o�• P 19333170 ORPHANS" COQ zz CUMBERLAND IMENTO�,�llll Certification Number ,r a Registrar Date Issued Y Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH-VITAL RECORDS Permanent Black Ink CERTIFICATE OF DEATH State File Number: 1.Decedent's Legal Name(First,Middle,Last,Suffix) 2.Sex 3.Social Security Number 4.Date of Death(Mo/Day/Yr)(Spell Mo) Gloria G Wrights Female March 19,2013 Sm.Age-Last Birthday(Yrs)1Sb_Under 1 Year 15c.Under 1 Da 6.Date of Birth(MO/Day/Year)(Spell Month) 7a.Birthplace(City and State or Foreign Country) Months Days Hours Minutes Ohs barsbu 57 November 18,1955 7b.Birthplace(County) Franklin Sm.Residence(State or Foreign Country) 8b.Residence(Street and Number-Include Apt No_) Sc.Did Decedent Uve In a Township? 1 PA 2 Willow Drive 1KYes,decedent lived to Southampton t,,, 8d.Residence(County) p' 8e.Residence(Zip Code) 17257 ONo,decedent lived within limits of city/boro. .p S.Ever In US Armed Forces? 10.Marital Status at Time of Death Married Widowed 11.Surviving Spouse's Name(If wife,glue name prior to first marriage) 0 Yes No 0 Unknown 1$Divorced 0 Never Married Unknown 12.Father's Name(First,Middle,Last,Suffix) 13.Mother's Name Prior to First Marriage(First,Middle,Last) Ray W.Elliott Pearl C.Biser y 14a.Informant's Name 14b.Relationship to Decedent 14c.Informant's Mailing Address(Street and Number,City,State,Zip Code) April C.Wri hts P g Daughter 2 Willow Drive Shippensburg PA 17257 ....................................................... .................._.__...................,.......... a. ace o at Check on one ... .... .. ........... ... ... ... ......... ... ....... ..... 'e_` If Death Occurred in a Hos Ital: ..........................................Y........ ... ... ........ .. .. ... ... ...... .. .. p Inpatient Ilf Death Occurred Somewhere Other Than a Hospital: D Hospice Facility �Decedent's Home ° Emergency Room/Outpatient 0 Dead on Arrival i Nursing Care Facil B sty Other(Specify) 15b.Facility Name(If not institution,give street and number) 15c.City or Town,State and Zip Code lsd.County of Death Chambersburg Hospital Ch,ambersburg,PA 17201 Franklin ry 16a.Method of Disposition a Burial 0 Cremation 16b.Date of Disposition 16c.Place of Disposition(Name of cemetery,crematory,or other place) !YJ Remoyat from State �Donation Spring Hill Cemetery Other(Specify) March 23,2013 P 9 rY 16d.Location of Disposition(City or Town,State,and Zip) 17m.SI ture of Funeral Service Ucens or Person In Charge of Interment 17b.License Number Shippensburg,PA 17257 FD-014351-L 17c.Name and Complete Address of Funeral Facility Fogelsangar-Bricker Funeral Home 112 W King St.PO Box 336,Shippensburg,PA 17257 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 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. 0 Sth grade or less is Spanish/Hispanic/Latino. Check the"No" ]N White 0 Korean 0 No diploma,9th-12th grade box If decedent is not Spanish/Hispanic/Latino. [3 Black or African American 0 Vietnamese =High school graduate or GED completed ]W No,not Spanish/Hispanic/Latino 0 American Indian or Alaska Native 0 Other Asian 0 Some college credit,but no degree 0 Yes,Mexican,Mexican American,Chicano 0 Asian Indian 0 Native Hawaiian O'Associate degree(e.g.AA,AS) 0 Yes,Puerto Rican 0 Chinese 0 Guamanian or Chamorro 0_Bachelor's degree(e.g.BA,AS,BS) 0 Yes,Cuban 0 Filipino 0 Samoan Master's degree(e.g.MA,MS,MEng,MEd,MSW,MBA) 0 Yes,other Spanish/Hispanic/Latino 0 Japanese 0 Other Pacific Islander 13 Doctorate(e.g.PhD,Edo)or Professional degree (Specify) 0 Other(Specify) (a.m.MD DOS 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 a White 0 Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED. 0 Black or African American 0 Korean 0 Other Pacific Islander Deputy Director American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure 0 Asian Indian 0 Other Asian 0 Refused 22b.Kind of Business/Industry 0 Chinese 0 Native Hawaiian 0 Other(Specify) 0 Filipino 0 Guamanian or Chamorro Naval Depot MUST BE COMPLETED 123a.Date Pronounce Dead Mo Day r 23b.Signature of Person Pronouncing Death Only when applicable) 23c.License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH 23d.Date Signed Mo Day r) 24.Time of Death 7;20 PM 25.Was Medical Examiner or Coroner Contacted? 0 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 cardiac arrest. I Interval: respiratory arrest,or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line.Add additional lines if necessary Onset to Death 3 IMMEDIATE CAUSE ------____> a_ Brain death and sever anoxic brain damage (Final disease or condition , Due to(or as a consequence of): I resulting In death) i b. cardiac arrest and cardiogenic shock Sequentially list conditions, Due to(or as a consequence of): If any,leading to the cause listed on line a. Enter the c. NSTEMI :i UNDERLYING CAUSE Due to(or as a consequence of): (disease or injury that I initiated the events resulting d. Acute respiratory failure secondary to brain damage in death)LAST. Due to(or as a consequence of): 26.Part 11. Enter other significant conditions contr{butina to death but not resulting In the underlying cause given in Part 1 27.Was an autopsy performed? 4 Yes No 28.Were autopsy ndings available to complete the cause of death? Yes 9L No 29.If F a 30.Did Tobacco Use Contribute to Death? 31.Manner of Death 1 Nole:t pregnant within past year 0 Yes 0 Probably Natural [3 Homicide ' Pregnant at time of death ]54 No 0 Unknown 0 Accident 0 Pending Investigation Not pregnant,but pregnant within 42 days of dean ) 0 B Y 0 Suicide 0 Could not be determined 0 Not pregnant,but pregnant 43 days to 1 year before death 32.Date of Injury(Mo/Day/Yr)(Spell Month) 0 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,City,State,Zip Code) 7 i 36.Injury at Work 37.If Transportation Injury,Specify: 38.Describe How Injury Occurred: 0 Yes 0 Driver/Operator 0 Pedestrian 0 No 0 Passenger 0 Other(Specify) a 39a.Certifier(Check only one): 10 Certifying physician-To the best of my knowledge,death occurred due to the cause(s)and manner stated 0 Pronouncing S,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 0 Medical Examiner/Coroner-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:/mss Cisrs�r>�ys.EuE .� Title of certifier: M.D. License Number: MD437988 39b.Name,Address and Zip Code of Person Completing Cause of Death(Item 26) 39c.Date Signed Mo Day r) Pshtiwan A Tahir,M.D. 112 N 7th St,Chambersburg,PA 17201 March 21,2013 40.Registrar's District Number 41.Registrar' ure eg stray lie Date o Day r 43.Amendments 0881930 H IOS-143 Disposition Permit No. REV 07/2011 Z I -13-- 361 U- .- Q V) r-4 -< ---� I-- a-C\j S C5 iz c-:-- 6 c ce. 14- ? C-1) < � RENUNCIATION CO rk: w ct., w � ..a w REGISTER OF WILLS w © x CUMBERLAND COUNTY, PENNSYLVANIA v Estate of GLORIA G. WRIGHTS , Deceased I, Karen F. Elliott , in my capacity/relationship as (Print Name) Executor/Sister-in-Law of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Ronald R. Elliott and Larry L. Elliott r C March 27,2013 ` (Date) Si ture) (Street Address) ( tj U/Ic A � (City,Stat,kip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the before me this day party executing this renunciation and certified of that he or she executed the renunciation for the purposes stated within on this day Of /.3 Deputy for Register of Wills 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.) COMMONWEALTH OF PENNSYLVANIA Notarial seal H.Anthony Adams,Notary Public shippensburg Boro,Cumberland County Form RW-06 rev.10.13.06 My Commission Expires May 31,2014 Member..Pennsylvania Association of Notaries