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Home My WebLink About04-30-13 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 n�� Name• Lois Jean Cloutman File No: 21-13- �� a1k/a: (Assigned by Register) a/k/a: ��a� Social Security No: 167-26-3235 Date of Death: March 14,2013 Age at death: 79 Decedent was domiciled at death in Cumberland County, pennsylvania (sraxe) with his/her last principal residence at 109 BriQhton Drive,Carlisle.PA 17015 South Middleton Township Cumberland Street address,Post Offce and Zip Code City,Tow,nship or Borough � County Decedent died at 109 Briehton Drive,Carlisle,PA 17015 South Middleton Townshin ' �Cumberland • PA Street address,Post OfTice and Zip Code City,Township or Borough Cosmty State Estimate of value of decedent's property at death: If domiciled in Pennsylvania..... ......... .. ...... ...... All personal property $ 150,000.00 If not domiciled in Pennsylvania. ..... ......... ...... ... Personal property in Pennsylvania $ If not domiciled in Pennsylvania. ....... ... ... ..... ..... Personal property in County •$ Value of real estate in Pennsylvania............... ...... .... ...... ........ ... .. ...... ....... $ TOTAL ESTIMATED VALUE. ... $ 150_000.00 Real estate in Pennsylvania situated at: 109 Brighton Drive Carlisle PA 17015 South Middieton 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 August 4,201 l and Codicil(s) tbereto dated None. ,,� State relevant circumstances(e.g.renunciation,death of executor,etG) � %� �^7 4't7 �. � � ts 3 �_ . Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was n�ii�"ced;was�a pa�t�pe�ding divorce proceeding wherein the grounds for divorce had been established as defined in 23'Aa.C.S. §33��ri@'�tiid not hav�:a•�cli�l borp or adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. � � � � Ny � Q NO EXCEPTIONS Q EXCEPTIONS U? o� t�� j <"� —ty -r" . � � � . `�! � B. Petition for Grant of Letters of Administration (�f appticabte) �� c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lit�duC�Uzte abse�{tt�?dur�'teP7t7inoritate .—i r o If Administration,c.t.a. or d.b.n.c.t.a.,enter date of Will in Section A above•aud ce�nplete list�ei�s.' -ri ,_ � ,. 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 Q EXCEPTIONS Petitioner(s),after a prop'er search has/have ascertained that Decedent left no VUill and wag sprvived l�y the folloWing spouse(if any)and heirs(at[ach additional sheets, if necessary): � ' Name Relationshi Address " , � , . � , . Fo,m nw-oz rev. roiniaol� Page 1 of 2 Oath of Personal Representative °�e�'a'°S�°"ly CdMMQNWEALTH OF PENNSYLVANIA } } SS: Ct3UNTY OF �UM�ERLAND � Petitianer{s}Printed Name Petitianer{s}Printed Address Debra C.Dortch. 44 Hicko ltoad Carlisle PA 17013 The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregaing Petition ara true and correct to the best of the knowledge and belief of Petitioner(s}and that,as Personal Representative{s)of the Decedent,the Petitioner{s}wili we(i and truly administer the estate accarding to(aw. Sworn t r� rrned an sub�cribed bef re 1/� � l��-�`"` Date� 1�P� 2�1� me t ' d f ! , �� Date �'� By: Date c:i � y� Fcer the Register- �► � D2t��"j � � �--� �J --1 C`S � � � � �•.� � BOND Required: � YES �NO To the Regi.rter of Wills: � � � %� FEES: Please enter my appearance by my s�tatur�``belo� � "=•� _+�j��t} V `� � 4GtflV•� � Q -•� .� .t- '°� Letters. . . . . . . . . . . . . . . . . . . . . . $ Attorney Signature:, �a C "4q �.-j { g }Short Certificate(s).. . . . . � � � �� t7T �� ` _...� �., ( � }Renunciatian(s�.. . . . . . . . �.Q(� _----t7� �� ( )Codicit(s). . . . . . . . . .. . . `� { )Affidavit{s}.. . . .. .�.. .. � Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: Lee Mandarino,Esquire Commissian. . . . .. . . . . . . . . . . . . Supreme Court Other . . . . . . . . ID Number: 31�$�� ' �E" "'�AXi.�i11. . �•(3�7 Firm Name: Rominger&Assaciates . . . . . . . . ��`,� Address: 155 Souxh Hanover Street .-,,, � C'`arlisle,PA 17013 . . . . . . . Phone: 71'7-241-6(}70 Autamation Fee. . . . . . . . . . . . . . . Fax: 717-241-6878 JCS Fee. .. . . . . . . . .. . . . . . . . . . Email: TOTAL. . . . . . . . . . . . . . . . . . . . . $��L�8�8�' DECREE OF THE REGISTER Estateof �.��"�'1 �� }�J�„�i�''"�_�,1"� FileNo: �'"' �R�.."' �� a(kla: AND NOW, °' V ��~�� ,�D! 3 _,in cansider tion of the foregoing Pctition, satisfactory proof having been pres�nted befare me,IT IS D CREELI that Letters ~ �y � ' � are hereby granted to . in the above estate and{if ap�licable}tl�at the instrument(s)dated described in the Petition be a �tted to probate and filed of record as the last Wi11(and Codicil(s}}of Decedent. 'Register of Wills (��yy�,,,, . �o,-�Rwoa r�,�. �oirii2nir � Page 2 of2 ��.�-�.�.�.,,�,��,.��.��. HI05.805 REV(9/71) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: it is illegal to duplicate this copy by photostat or photograph. ��c�� a��c� o� Fee for this certificate, $6.00 �,-r ,,,,��-�-... This is to certify that the information here given is ��S i ;;.�� Q�' �;1��c�,��,,o�EP�jH OF pE�;y: correctly copied from an original Certificate of Death p ��'c,y`� `r�, duly filed with me as Local Registrar. The original :'�13 :1P� 30 �� 2 ; ��_ =;�� ii certificate will be farwarded to the State Vital �� -y = a� Records Office for permanent filing. :* *; P 19429224 cL��K c�- _o�, � �?,,�° . �RPHANS" COI,'R7 _ �q9lMENTOE�EP° , Certification Number ��g��A�p ��. PA � '��""'��'' ocal Registrar Date Issued , Typ�/Print In COMMONWEALTH OF PENNSVLVANIA•DEPARTMENT OF HEALTH�VITAL RECORDS "°""'"`"` CERTIFICATE OF �EATH Blaek Ink State Fila Number: 1.OecetlenYS Legal Name(First,Mltltlle,Last,Suffix) 2.S�x 3.Social Security Number 4.Date of Death(MO/Day/Yr)(Spall Mo) Lois Jean Cloutman Female 167-26-3235 March 14, 2013 Sa.AQtrLart BlKhday(Yrs) Sb.Undar 1 Year Sc.Under 1 Da � 6.Date of BIKh(MO/Day/Year)(Spell Month) 7a.Birthplace(City a�d Stafe o�Foratan Country) Mo�m: osv: Hou�: nni�uces Canonsbur PA ' / 79 August 24, 1933 7b.Birthplace(COUnly) �,.�8 yl n ton 8a.Resldence(Stste ot Foreign Coun�ry) Sb.R�elda�ce(Str�et and Number-Include Apt No.) 8c Oitl Decedent Live In a Township? pA 109 Brighton Drive ��e:,de�eae��u�ea i., South Middleton i,,,,P. 8d.Rasidanca(COUnty) Cumberland Se.Residence(Zlp Code) 17Q],rj ONO,decetlsn�Ilved wlthln Ilmlcs of clty/boro. 9.Ever In VS ArmeA Forces7 30.Marital Stat�as at Time of Death Marrled [$Widowed 11.Surviving Spouse's Nrme(It wlf�,give name prior to first marrlage� DVas �No �Unknown 0 Dlvorced �NeverMarried DUnknow N/A 12.FatheYS Name(First,Mlddle,Last,SufFlx) 13.Mother's Nsme Prior to First Marriaga(First,Mlddle,Last) Louis Cook Estelle Koaharaky 14a.Informant's Name 34b.Relstionship to Dacedent 14c.Informant's Malling Adtlress(Street and Number,Clty,Scst�,2ip Code� g D rt ti Dau hter 44 Hickor Road, Carli�le, PA 17015 G ...................••-•-•--•°•----.........••-........... .---..................................---�-°•°...---a:.._agg-"----9.:..,...°S..p^..one .. ......... ....... ¢ If Death Occurrwd in a Hos Ital: �In tlent =1f D�ath Occurretl Somewhere Othat Tl�an a Hospital: �� p pa �Mospice Facillty �DeG�tlen!'s Mome � O Emerg�ncy Room/OUtpatlent O Dead on Arrlval Nuroing Home/lon -T�rm Care Fac111[y Other(Specify) 35b.Facility Nama(If not insticutlon,gNa scroat and numbcr; •ISC.Cliy or Town,Stata,a tl 21p Cotle 15tl.Cou�ty of Daath 109 Bri hton Drive Carlisle� �PA 17015 Cumberland �, 16a.MethOd of DisposiNOn � Burial Q Cremat{on 16b.Dace of DisposiHOn 16c.Place of OlzposlNOn(Name of camatery,cremrtory,or othar place) � �Removal f�om State �Donation oin�r�soe��N) Mar. 23� 2013 Queen Of H�aven Cemetery � 16d.Loptlon of Olsposltion(City or Town,Sta[a,and Zip) I7a ture of Funeral S�rvic�Llcense�or Perzon In Charge of Incerment 17b.Llcense Number McMurray, PA 15317 a�� ..�- FD-014283-L 17c.Name antl Complete Adtlress of Funeral Faclllty Salandra Funeral Service Inc. 304 West Pike Street n 1 � I8.DeceAent's Education-Check th�bo�t that best describes the 19.�ecetlent of Hlspanic ONgln-Check the 20.Decedant's Ra<e-Check ONE OR MORE races to Indicate what - � hiphest tlesree or level o�school complet�C a[[he cime of death. box that best describes wh�thar the deced�n< the decetlent consid�red hlmself or henNf to be. � Hth grade or less Is Spanlsh/Hlspanic/Latlno. Check the"NO" �Whlte Q Korean Q No diploma,9th-12lh grade box H decedent iz not Spanish/Hispanic/�stlno. �Black or AfACan American � Vletnameze � Hlgh school graduate or GED compl�t�d �No,not Spanlsh/Hlspanlc/latlno �Am�rican Intlla�or Alaska Naciva Q Other Aslan 0 Somt college c�edll,but no deg�ee O Yes,Mexican,M�xlcan American,Chicano 0 Aslan Intlian Q Native Mawailan �Assoclate d�groa(a.g.AA,AS) �Ves,Puerto Rican 0 Chlnese �Guamanlan o�Chamorro 0 Bachebr'z degree(e.g.BA,AB,BS) Q Yez,Cuban �FIIlpino � Samoan � Mastcr's degr�e(e.g.MA,M5,MEng,MEd,MSW,MBA) O�'es,other Spanish/Hispanic/Laflno 0 Japanese' O Othe�Paclfic Islantler 0 Doctorate(e.g.PhD,EdD)or Proiessionaltlegree (SpecHy) �Other(Specl fY) .MD DDS DVM LLB lD 21.Decetlent's Singl�Race Self-Oeslg�ation-Check ONL�/ONE to indlcste what the dacadent consldered hlmself or herself to be. 22a.Decetleni's Usual Occupatlon-Indicatelype of work �Whlte Q lapanasa 0 Samoan tlone Curing most of working Iife. DO NOT USE RETIREO. 0 Black or African Ame�rican 0 Korean 0 Other Paciflc Island�r p �AmeACan Intllan orAlaska NaHVe �Vletnamese 0 Don't Know/NOtSUre O erator � 0 Aslan Indian Q Oth�r Asian �RefuseC 22b.Kind of Busin�ss/Intluslry � pcno,e� QNativeHawallan Oocne.�sPe��.� Tele hone Com an 0 illipino 0 Guamenian or Chamo�ro P P Y ITEMS 33a-23 MUST BE COMPIETED 23a.Date Pro ounc�d D�ad Mo Day r 23b.Slgnaiure of Person Pronouncing Daa�h Only whan appllea le 23c.Llcense Number . 6V PERSON WMO PRONOUNGES OR I� ��/\. ,__ '2 � Q� � � CER7'IFIES DEATH J T _.J ��`/a ��-�� A "��F..7I�--t-T(o� 23tl.Da Signed Mo/Da r) 24.Time o/f Daatl� +-� (,,,� . -� 25.Was Matllcal Examiner or Coroner Contact�tli O Yas No CAUSE OF DEATH ApproxlmaSa 26.PaK 1. Ent�r[ha chain of s anis--tllsaases,Injuries,or complicatlons--that tllrectly caused the death. DO NOT antar�erminal avants such as ca�dlac arrest Ini�rval: rosplratory arrest,or ventricula�Flbrlllatlon w/lYthout showing the eHO^logy'.-D�O NnOT ABBREVIATE. Ente/r oIn_ly oln-e causs on a Ilne. Atld addiflonal Iines If necessary Onset to Death IMMEOIATE CAUSE ---------------> a. "'�� `�� V�GC9 C�(��-"7' ��WV� � (Final dlsease or<onditlon Due fo( S quenta of): resultl�g In doath) �J..., „��/, � �1^`i-j ; ...�_`^ b. t l/\li� �CJV 1 �/(i� F�" � Sequentlslly Ilst contlitlons, Dve to(or as a consequence of): Hany,leadingtothecause 1 1 u,�e„ 'Q,_l` h^ Iist�tl on Iine a. Enier fhe �-�'\. ci� �Ul�5 ��r • UNpERLY1NG GAUSE Due to(o�as a consequenc�o�: (disease or injury fhat FInitlated Me avents resulting d. j � In d�ath)LAST. p�e to(or as a conzequancw of): � 26.Yart 11. Ent�r Other but not resulting in th�undlrlying<iuse g{van In Part 1 27.Wa5 in eYtOpSy �A atli � 28.Were Outopsy fln Ings avallabla � to complete the csuse o1 doath? Fi Vas � No � 29.If F�mal�: 30.Ditl Tobacco Use Cantributs fo Oeath? 31.Manner of DealN � � Not pregnant wlthin pasi year 0 Vas 0 Probably � Natural 0 Homicltle 0 Pre`nant at Hme of death 0 No � Unknown �Accldent 0 Pending InvesHgeHon � 0 No!pregnant,but pregnant wi�hln 42 days of dealh �Suicide � Coultl noi be daterminetl � 0 Not pregnant,but pr�gnant 43 days to 1 year beforo d�a2Y 32.Date o�Injury(MO/Day/Yr)(Spell Month) 0 Unknown If pregnanf within ihe past yea� . 33.Time of Injury 34.Place of Infury(e.g.home;constructlon site;farm;scliool) 35.Location of InJury(Streat and Numb�r,City,5[afe,Zip Cod�) � 36.Injury at Work 3l.If Transportation Injury,Sp�clty: 38.Dcscriba How Injury Occurrad: � �Ves �Drive�/Operator 0 Pedestrian 0 No Q Passenger � Othar(SpedTy) 39 CeKNbr(Check only one): V 0 Cartifying�phyaiclan-To the b�st of my knowl�dge,daath occurred due to the ea�se(s)and m siatetl ..@�Pro ncing 8.C�rtifying phyzician-To ihe besc of my knowledga,desth occurred aS�he time,data,and place,and due to tha cause(s)antl manner stated �' O M�Gical Examiner/COron - th asis of examinefion,and/or InvasHgsHOn,i�my opinlon,d�a�th7\oecu�r/re-d�at the time,dace,and place,and Oue to che cause(z)antl m��L�7 fatetl 'Q SiQnatu�e of cert{fler. TIlle of certifler: L�+V ' Licanse Number:�-��-f /� 39D.Nams,A drcss e�d Zip Code of e on Co plsting Guse aath(I�wm 2B) 39c.Date Sign�d(MO/Day/Yr) � S '�° � - 3 40.Nagistr IsiNCt Num r 41.Reglst�ar'S SI`naty� � �Q� 42.R�gistrer Flle Date Mo Day Yr) l3-s�s- bt'"• .3-/9-/3 � aa.nr„�r,ar��.,ss � 0886228 �ios-iaa Dlsposltion Permit No. REV 07/2011 WILL OF LOIS J. CLOUTMAN I, Lois J. Cloutman, of Cur�,berla�id County, Carlisle, Pennsyivania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, qravemarker and adn�inist�ative exnenses sh�l! bP �2?� from m;� r�.s��uary estate a� soon a�, practic:;bie after my death. 2. I direct that all ��he��tance, estate, transfer, succession and death taxes of any kind •_Nhatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct th�t my entir�: E:state be distributed as follo�vs: A. I direct that my entire estate be sold and proceeds go to my children, Melinda Marie MacDonald and Debra C. Dortch in equal shares. B. Should either of my childr;;n prec�ecease me their share shall iapse and be divided into equal shares between their chiidren. 4. I appoint Melinda Marie MacDonald and Debra C. Dortch, as joint Executrixes �f this n�y last Will. 5. The Executrix of this Will shall have the power to distribute: �ry estate in kind or in cash, or partly in eii��er. 6. I direct that na Executrix acting under this Will shall be required to Qnter bond in any jurisdiction. IN W TNESS WHERE I ha•✓e her u t �e��t,my ha.iib tf�s ��,.' °� _,. _ day of � -�' , �11.�M � �, �: t's -=� r;-j ;:�:� LAW OFFICES OF �'-'�e ~ � � ^r�F -';"' Lois J. lout �" �� STEPHEN J. HOGG �� r� ._,� c` ��,:�1 19 S.HANOVER STREET '-"� �-� _ , � �� SUITE 101 �"~ �'� =K= r�'. CARLISLE,PA 17013 ;� 'i � �--- � G7 G'a CO "r� � � � V•v - , ' The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by ' Lois J. Cloutman as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesscs hereto. , � , � u �- TNE S � ITNESS LAW OFFICES OF STEPHEN J. HOGG 19 S.HANOVER STREET SUITE 101 CARLISLE,PA 17013 . ' kCKN(�WI_E.!�GMENT . State of Pennsylvania ss County of Cumberland � I, Lois J. Cloutman, the Testatrix, whose name is signed to the attached �r foregoing instrument, having been duly qualified according to law, do hereby acknowlc-dge that i signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. pf o-�..: I pic �. ,!O!.Rt,'1'l�n Sworr, to nr affirmcd an ac;!�nowled d before Lois J. Cloutman, the Testatrix, this � da� �f M , 11. rypTAR1Al SEAL �p1�n J.Hogg�No�nr PubHc CarNale Bora,Cumlbarl�rr4d Co.1�A �' — My co„��,�,,��3i�'$ Notary Public/Attorne� AFFIDAVIT State of Pennsylvania ss County of Cumberland R Vr/e, � ° �... � and �� 11. G� 1�er�', the witnesses whose names are signed to tt�e att�ch�d or foregoing instrument, being duly �ualified accoraing to taw, do depose and say that we were present and saw the Testatrix sign and execute the instrumer�t as her last Wili; that thc Testatrix signed willingly and executed it as her free and voluntary act foi the purposes therein expressed; that each subscribing witness in the hearing and sigh� of ihe Testatrix signed�the WII1 as a witness; and that to the best of�ur kn ledge the Testatrix was at that time 18 or more years of age, of so an mind nd �er no constraint or due influence. . � .� �� orn to or a �r ed and s cribed to before me by witnesses, this day of , 2011. Lnw oFF�cES oF NOTARIAL SEAL STEPHEN J. HOGG 8tephen d.Hogg,td�tary Publlc i 9 s.xANOVEx sTxEET ca�t�e Boro,Ca��,t�r�n�co.N�ta P u b I ic/Atto rn ey suITE lol Yy comm{aslAn Exptr�x+s�eNOs�3,201s CARLISLE,PA 17013 """""""�""�"—"'�' A '=; �s �.-> � P�`4 � � � � � --v �'��"I � C9 � f'; W-� +'�T D. r' (�.J ,-��; r,1 A � � � :.."': �::.� „,�- � �': G` c::, C� � �,,,, �'r' 6 �S 1�''�(:�'�'Z�11'�1 o c � =� ;A '� V r� �,�� ,. i i t � �� _I_' "d' -�, REGISTER OF WILLS � CUMBERLANLI eQtJNTY,PENNSYLVANIA Estate af Lois Jean Cloutman Deceased �� , Melinda MacDona?d ° in my capacity/relationship as ` (t'r�,u xame) Executrix of the above Decedent,hereby renounce the right to adrninister the Estate of the Decedent and respectfulty request that Letters be issued to Debra Dortch �� (IJate) f rure) 1510 Millikens Bend Road (StreetAddress} Herndon, VA 2Q 170 (�'iry,srare.Zip) �xecuted�n Register's Uffice Executed vut of Register's O�ee Sworn to or affirmed and subscribed $efore the undersigned personally appeared the before me this day party executing this renunciation and certified of , that i�e or she executed the renunciation for the purposes stated within on this �3 T" day af A�R i� , �o!?�_. _`� __ ,� , Deputy for Register of Wills Nolary�Public ,��`"�""""'��c�, Commission Ex ires:�c��-caE� 3 i Zo i 5 \\\�,�`\� J, ME(��;,��i P � \. �.,.ONW EA�Ty�S��Ratf�pe a�d Seal of Natary or other ofFrcial qualified to ��,•�S� NNQdininis�oaths. Shva date of expiration of Nota�y's Commission.j - w�� St�j\�b5 S�: _ _ m :,�yE6 �3�1M��P\�� • _ � ��•..My��2�,��.0 � � �2 ��0�\� FormRW-05 rer./A.13.06 ��i� ''•.,�F V��?G•'J \� ��%i��NOTA�2�Q��`\�