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HomeMy WebLinkAbout04-23-13 PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF t"J A41B `eA-AtNt Q 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 ii Name: _ Cofta" [ S C�Mxi�13 i L File No: 2-4 a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: cc-7-29-5-31X Date of Death: Age at death: 21 Decedent was domiciled at death in County, P,AiA (crate)with his/her last principal residence at lLigl #,WA PL6-tU,nCa DP- n ato tC. -u GQiLft n PA c T.ictitOPWLAw ifs Street address,Post Office and Zip Code City,Township or Borough County Decedent died at 4101-y 51i>10�t7- C"rV"13 t."LL_ C dtli ,r V3 ON 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 Pennsyl vania............................ All personal property $ 3ray� elC1l7 If not domiciled in Pennsylvania. ...... ................ Personal property in Pennsylvania $ If not domiciled in Pennsy lvania. ....................... Personal property in County $ Value of real estate in Pennsyl vania......................................................... $ TOTAL ESTIMATED VALUE. ... $ `fit Doc) Real estate in Pennsylvania situated at: 144 2,.. M 1ptP10-urea IS D "a.l`i C 0 M L-)r4LkK a Co 41 t3&Lt>i.#kJup (Attach additional sheets,ifnecessary.) 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)be/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 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 w {t} B. ?etition for Grant of Letters of Administration (If applicable) =D 4*> C--) c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente rt a ab ytia,d�► AMminoritate If Administration,e.t.a.or d.b.n.c.t.a.,enter date of Will in Section A above ant�o�p We li f h stn 001 Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds fuWivorcMad been estaidM0 as defined in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated pssof? C5 F-1 NO EXCEPTIONS M EXCEPTIONS C> Cs Petitioner(s),after proper search has/have ascertained that Decedent left no Will and was survived byt1404ing spouse i fan Fn8eirs(attach additional sheets,ifnecessaty): 3`r -n Name Relationship Address Form RW-02 rev.10/1112011 Page I of 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF C'y�1,L {Qt�i�sD } Petitioner(s)Printed Name Petitioner(s)Printed Address prNUQr �11 L;. CPr►MPQ, L 1442— 0AA-Pi-eW06D DR >`Ci e�r�t(3 2C��rniQ, l�l� 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 Decede t,t Pet ne (s will ell and truly administer the estate according to law. Sworn to or affirmed a d subscribed before DatL -Lj "o�J"l 3 me a' 17 flay of c� Dam i m B : O Dam G7 � For the Register -0 DatPi7 :V C" �;w M W :U (f) ::0 p :a BOND Required: Q YES NO To the Register of Wills: 7r, .D .� -n FEES: Please enter my appearance by mcsi&q e be-Iiav: t Letters . . . . . . . . . . . . . . . . . . . . . . $ .V(J Attorne ignatur CD t ( ) Short Certificate(s). . . . . . 3d• `T� R--' ( )Renunciation(s).. . . . . . . . ( )Codicil(s). . . . . . . . . . . . . ( )Affidavit(s).. . . . . . . . . . . Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: P)kVL_ L_. Commission. . . . . . . . . . . . . . . . . . Supreme Court [�� Other . . . . . . . . ID Number: -�"0-4 -t&XJ21M . . . . . . . L 15. Firm Name: -� I/ . . . . . . . Address: 3©D 3 @l 06)0- . . . . . . . . tj�ct3 Ci�G�(P3 .-L�•7�f C� PIS . . . . . Phone: Automation Fee. . . . . . . . . . . . . . . JMSD Fax: 2 7l"I 20- zN JCS Fee. . . . . . . . . . . . . . . . . . . . . Email: PAcu L �, PL:-Z PC,ce:-AA TOTAL. . . . . . . . . . . . . . . . . . . . . $ n,� (1 n�DECREE OF THE REGISTER /I,w, Estate of Y'Q �� �� L_l.C.► I L17, .L` File No: 2� ' 3 ' �q o a/k/a: AND NOW, a 3rd pF ( l , 2��3 , in consider tion of the foregoing Petition, satisfactory proof having been presented before me,IT IS DECREED that Letters are hereby granted to midy,&Z C7'. am r7 , e(, in the abo e estate and (if applicable)that the instrument(s)dated J 11 61 11, 2,D 12 described in the Petition be admitted to' obate and filed of record as the last Will(and Codicil(s))of Decedent. Register of Wills( Jn)Y m For RW-02 rev. 10/11/2011 "�'^ Page 2 of 2 H105,805 REV(9111) 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 REGISTER OF WI L I This is to certify that the information here given is �tt,11��P Fyy correctly copied from an original Certificate of Death 13 ppp 23 duly filed with me as Local Registrar. The original !!I 1► ( =, certificate will be forwarded to the State Vital Records Office for permanent filing. CLE�IRK OF P 19479888 ORPHANS' COURT o��99rElyioF��a~'t�t ,3�IsA�d Certification Number R E R A O f PA """J " Local RegistrDate Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS Pe ekI ,kt CERTIFICATE OF DEATH State f41e Number. 1.Decedent's Legal Name{Pint,Middle,Last,Suffix} 2.Sez 3.Social Security Number 4.Date of Death(Mo/DaY/Yr)(Spell Mo) Covalyn Stiles Campbell Female 007-28-5312 March 19 2013. Sa.Age-Last Sirthtlay(Yn) lSb.UnderlYear ISc.Li der 1 Clav 16.Date of Birth(Ma/Day/year)(Spell Month) 7a.Birthplace(City and State or Foreign Country) Months Days Hours Minutes Dix£ield Maine 81 November 19, 1931 7b,Birthplace(County) Be Residence(State or Forei¢n Country) Bb.Residence(Street and Number-Include Apt No.) BC.Did Decedent Live in a Township? Pennsylvania ®Yes,decedent lived In Lower Allen twp, 84,Residence(County) 1442 Maplewood Drive Cumberland 86.Residence(Zip Code) 17070 0 No,decedent lived within limits of city/born. 9.Ever to US Armed Forces? 10.Marital Status at Time of Death Married W Widowe 11.Surviving SPO .'a Name(If wife,give name prior to first marriage) 0 Yes ®No 0 Unknown Divorced 0 Never Married 0 Unknown 12.Father's Name(First,Middle,Last,Suffix) 13.Mother's Name Prior to First Marriage(First,Middle,Last) Alton V. Stiles Alice P_ Widber 14a,Informant's Name 14b.Relationship to DK dern 1114..informant's Mailing Address(Street and Number,City,State,Zip Code) Andrew Campbell- _ __--- _ Son - - 1442 Ma lawood Drive New-Cumberland PA 17070 - -_ _ a. ace o eat ec on Lon- _ _ If Occurred in a HOSpltai: ❑ 1npatleht ilf Death Occurred Somewhere Other Than a Hospital: ❑Mosplce Facility T7 Decedent's Home S [,tom E Emergency Room/Outpatient 0 Dead on Arrival 0 Nursi m 0 Hoe/Long-Term Care Facility Other(Specify) 15b.Facility Name of not{nititutlan,give serest and number) t SSC.City ar Town,States,and 21P Cada 15d.County of Death Holy S irit Hospital Cam Hill Penns lvania 17011 Cumberland 16a,Method o Disposition Burial Cremation 16b.Date of Disposition 16c.p acs of Disposition(Name of cemetery,crematory,or other place) 0 Removal from state 0 Donation 0 Other(speci ) C*3� 2 "2cw3 Cremation SOCiet of Penns lvania 26d.Loudon of Disposition(City or Town,State,and Zip) 17a.Slgnatur-of F ai rvlce Ucensaa or Person to Charge of Interment 17b.UCenae Number Ha"isburgl, Pennsylvania 17109 FD-013376-L 17c,Name and Complete Address of Funeral Facility Auer Cremation Services o£ Penns lvania lnC. 4100 Jonestown Road Havvlalpur st. Penns lvania 17109 1H,Decedent's Education-Check the box that best describes the 19.Decadent of Hispanic Origin-Check the 20.Oecetlent's Race-Check ONE OR MORE races to Indicate what i= 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 Breda or less is Spanish/Hispanic/Latino. Check the"NO" ®White 0 Korean 0 No diploma,9th-12th grade boz If decedent is not Spanish/Hispanic/Latino. 0 Black or African American 0 Vietnamese 0 High school graduate or GED completed IM 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 Amerlcan,Chicano 0 Asian Indian 0 Native Howell- 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 Samaan 0 Master's degree(e.g,MA,M5,MEng,MEd,MSW,MBA) 0 Yes,other Spanish/Hispanic/Latino 0 Japanese 0 Other Pacific Islander 0 Daetarate(e.g.PhD,EdD)or Professional degree (specify) 0 Other(specify) .MD DDS OVIA LLB JD 21.Decedent's Sin¢le Rasa 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 W 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 0 American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure Office Manager for Provident Asst. 0 Asian Indian 0 Other Asian 0 Refused 22b,Kind of Bustnesslindustry r.33 Chinese 0 Native Hawaiian 0 Other(Specify) Filipino 0 Guamanian or Chamorro Management rM 23a- N1 BE COMPLETED 231.Data Pronounced Dead Mo Oay 23b.signaturo o Person Pronouncing ezth On y when aRPilu a 23c.license Num er BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH 23d.Date Signed(Mo/Day/yr) 24.Time of Death / G r7 N7 125.Was Medical Examiner aY Coroner Contacted? 0 Ves 0 No CAUSE OF DEATH I Approximate 26.Part L Enter the chain of events-diseases,Injuries,or complications--that directly caused the death.00 NOT enter terminal events such as cardiac arrest, t interval: respiratory arrest,or ventricular fibrillstlon wither t showing the ethgy. DO NO ABBREVIATE. Enter only one cause on a line. Adtl additional lines If necessary. 1 Onset to Death . / 1 IMMEDIATE CAUSE ---------------> a. L-2C� 1 (Final disease or condition Due to(or as a consequence of): / resulting In death) b. I�D'✓) ...�/1iC"�C.P/wt."af �r_-.rf•GcCG.•^s�s'f�S ""� Sequentially list conditions, Due to(or as consequence of): if any,leading to the cause usted on me a. Enter the UNDERLYING CAUSE Due to(or as a consequence of): (disease or Injury that i Initlated the events resulting d. In death)LAST. Due to(or as a consequence of): 1 1 26.Part/�/,y En �pr tnt?com ,y i ot resultin= �jt, n'�Ifdying cause given in Parc 27.Was an autaPSY Performed? t 0 Yec ES.No 28.Ware autopsy findings svallabia -,� ,.g�,(/t�'L to CoOPIYeT the c N�death? * 29,if Female: ::::::.•./•/������'''"''''"' 30.Did Tobacco Use Contribute to Death? 3i..,,rMannsr of Osath iiNot pregnant within past year 0 Yes 0 Probably p Natural 0 Homicide Pregnant at time of death JIM No 0 Unknown 0 Accident 0 Pending Investigation E3 Not pregnant,but pregnant within 42 days of death 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) S.Location of Injury(Street and Number,City,County,State,Zip Code) 1/ 36,Injury at Work 37.if Transportation Injury,Specify: 38.Describe Haw Injury Occurred: O Yes O Drive r/Operat r 0 Pedestrian s 0 No 0 Passenger 0 Other(Specify) a. 39a.Certifier-physician,Certified nurse practitioner,medical examiner/coroner(Check only one): Certifying only-To the best of my knowledge,coat curred due to the cause(s)and manner stated. gPronouncin &Certt Certifying-To the a my kn dge,death a<curred at the time,date,and place,and due to the cause(s)and manner stated. 3 nature of ce 11 r` , Ination and/or investigation,in my opinion,death occurred at the time,date,and place,and due to the ca usa(s}and manner stated. w 6'f�4'../ Title of certifier: /✓r /J License Number: OW lfO/Z7'f 39b,N etlica Examiner o Gotle of Person Campletin Cause of Death(Item 26) 39c.Date Signed(MO/Oay/Yr) ante,Address and Zip g /CL tP1 g is /3 Gr srccr 1sf.fl at o ¢vc Gc.t it s, rTv tr :;nS-�h M J40,Registrars District Number 41.Registrar's n#tur • 42.Re¢IStr-1 F(ie Date Mo Day t 141.Amendments t.sp H105-143 Disposition Permit No. C7?�Le.IS..f 3� REV 07/2012 n rm � C _rnc -n rn :c G> „-i � LAST WILL AND TESTAMENT r- z m w ' Ca C) OF vt ZD -.I -n r . .. -n CORAL YNS. CAMPBELL C> I, CORALYN S. CAMPBELL, of 1442 Maplewood Drive, New Cumberland, Lower Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby expressly revoking all wills and codicils made by me heretofore, and dispose of my estate as follows: ITEM l: 1 direct the payment of my just debts and funeral expenses. ITEM 2: I direct all State and Federal Transfer Inheritance Tax, Estate Tax, Succession Tax or any other tax, including any interest, assessments or penalties thereon, that may become due and payable by virtue of my death, or by virtue of the passing of any property either under my Last Will and Testament, or in any other manner, shall be paid by my estate,just as if such taxes were my debts, and no beneficiary shall be required to pay or refund any part thereof. This shall not, however, include taxes for assets to be administered in any foreign country. Taxes on future interest may be prepaid. (�f(:2, 1 ITEM 3: I give, devise and bequeath all of the residue of my estate of whatever nature and wherever situate,to my son, ANDREW GEORGE CAMPBELL. ITEM 4: I nominate, constitute and appoint my son, ANDREW GEORGE CAMPBELL, 1442 Maplewood Drive, New Cumberland, to be the sole Executor of this my Last Will and Testament. Should ANDREW GEORGE CAMPBELL be unable or unwilling to act or continue to serve, then I nominate, constitute and appoint BRIAN JAMES CAMPBELL, 2667 Timberwyck Trail, Troy, Michigan 48098,to be the sole Alternate Executor of this, my Last Will and Testament. ITEM 5: My Executor and/or Alternate Executor shall have the following powers in addition to those invested in them by law and by other provisions of my Will applicable to all property, whether principal or interest, exercisable without Court approval, and effective until distribution of all property: (a) To retain any or all of the assets of my estate, real or personal, on their sole discretion. (b) To exercise any options to subscribe for stocks, bonds, or other investments. (c) To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities. 2 u�G (d) To sell at public or private sale, to exchange or lease, for any period of time, any real or personal property, and to give options for sales, exchanges or leases, for such prices and upon such terms as they deem proper. (e) To make settlements and compromises on such terms as my personal representative in their sole discretion may deem wise without the necessity of obtaining any court approval thereof, (f) To make distribution in cash or in kind, or partly in cash and partly in kind and in such manner as they may determine, and at valuation finally to be fixed by them. ITEM 6: I direct that no fiduciary appointed in my Last Will and Testament shall be required to give or enter into any bond or security in any jurisdiction, regardless of the state of their residency. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament consisting of six(E)typewritten pages,this // day of July 2012. r (SEAL) CORAL S. CAMPBELL We, the undersigned, hereby certify that the foregoing Last Will and Testament was signed, sealed, published and declared by the above-named Testatrix, CORALYN S. CAMPBELL, as and for 3 �G her Last Will and Testament, in the presence of us, who at her request and in her presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof,the said Testatrix was of sound and disposing mind and memory. residing at 7 },4 Ae K" 11 residing at ILOG 4 LO w.al L(- LAIII MQAJ-..' Ct-);M i3-&&LArN h, 4 COMMONWEALTH OF PENNSYLVANIA: : SS.. COUNTY OF CUMBERLAND We,the Testatrix, CORALYN S. CAMPBELL, and and PAUL L - ,the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. r � r CORALYN S. CAMPBELL Ai Wit Win s Subscribed, sworn to and acknowledged before me by the Testatrix, CORALYN S. CAMPBELL, and subscribed and sworn to before me 7dy and witnesses,this��day o July 2012. W4 NotarytVublic r My Commission Expires: (� Cp r K-NNSYLVANIA Notarial seal Elizabeth M.Maioli,Notary Public New 0AMWiand Born,Cumberland County My Commbsion Expires Dec.31,2014 MEMBER,PENNSMAM ASSOQATION OF NOTARM