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Home My WebLink About05-01-13 �PETITION FOR GRANT OF LETTERS � REGISTER OF WII.,LS OF CUMF�F,itLAND 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 theteof aver(s)the following°and respectfully request(s)the grant o`f Letters in the appropriate form: � Decedent's Information I ?�, Name: MELVIN K.QUIGLEY File No: �l'" O? � �d� T + a/k/a: (Assigned.by Register) a/k/a: a/k/a: Social Security No:,.207-07-9946 Date of Death: SEPTEMBEK 3,2006 Age at death:89 ;'� � , , Decedent was domiciled at deat�h in CUMBERLAND �ounty,PF.NN4YLV NiA� ' (state)with his/her last principal residence at 131 COVENTRY DRNE CARLISLE PA 17015 SOUTH MIDDLETON TWP CUMBERLAND Street address,Post Oftice and Zip Code City,Township or Borough County Decedent died at 131 COVENTRY DRNE CARLISLE 17015 SOUTH MIDDLETON TWP CiJMEBEnAND PA Street address,Post Office and Zip Code City,TownsLip or Borough County State Estimate of value of deaedent's property at death: If domiciled in Pennsylvania............................ All personal property $ !�d o c�b .� If not do�niciled in Pennsylvania. ....................... Personal property in Pennsylvania $ If not domiciled in Pennsylvania. ....................... Personal property in County� $ Value of real estate in Pennsy[vania.................................. . .............:..... .$ TOTAL ESTIMATED VALUE. ... $ 0.00 Real estate in Pennsylvania situated at: (Attach addiKonol sheets,ifnecessary.) Street address,Post Office and Zip Code City,Township or Boroug6 County ❑ A. Petition for Probate and Grant of Letters Testamentarv Peritioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated and Codicil(s) thereto dated State relevent circumstances(e.g.renunciation,death of azecutor,eta) Ezcept 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 bom or adopted;and Decedent was neither the victim of a ldlling nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS Q EXCEPTIONS ' � B. PeHtion for Grant of Letters�f 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 db.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 ne'ither the victim of a]dlling nor ever adjudicated an incapacitated person. ' _:."" �y � C� � ;`t1 � �NO EXCEPTIONS Q E%CEPTIONS � C� r-, ` � ',� � � , �-- Petitioner(s),afteraproperseacchhas/haveascertainedthatDecedentleftnoWillandwassurvivedbyth�l�j,�!i�spou�(ifanyj'�eirs(attaeh � • additional sheets,ifnecessary): • � -� �-.-< ;:r: ' ;� � :'�`, c.^ �.; �= Name Relationshi �d�T�es� � "� WII.,MA J.CLARK DAUGHTER 131 COVENTRY DRNE 4=`. �'. ;--a � _.� � CARLISLE PA 17015 �•`"� �-� �'� -_= � � F--' = " .p-1 �,� c� . � . �, p , � Fo,m xw os r�.toir�izo�l Page 1 of 2 ! � � �� ' Oath af Personal Represei�tative °��'��°�y COMMONWEALTFI OF PENNSYLVANIA } _ _ } SS: _ COUNTY OF CL�3ERLAND � } . Peiitioner(s}Printed Name Petirioner(s)Prsnted Address ' , , WILMA J.CLARK 131 COVENTRY DRIVE CARLISLE PA 17015 � The Pe#itioner(s)above-nameii swear(s)or affir�n(s)the statements in the foregoing Petition are true and correct to the best of�he knowledge and bel}ef of Petitzoner(s)and that,a,P�xsonal Represent�rive(s)of the Decedent e Peririoner(s)will well and truly administer the es�te according to law. � Sworn to o ffirmed d subscribed before �� !�-~` Date � �'''. r � �� me ay�f ,�� (� Date By Date Far the Register Date B4ND Rey�ired: �}YES .{�"O To tTee Register of WiXls: > FEES: Please snter my sppearance by my signature belaw: Letters. . . . . .. . . . . . . . .... .. .. $ tX-1�+ " " Attorney Si ture: ' ( �)Shart Certificate(s).,.. .. ( }Renunciation{s}......... ( )Codicil(s). .... .. ..... . ( }Af�davit(s}.. .......... Bond.... . . . . .. . . . ... ... . . ... �rinted Name: HAR(JLD S. WIN,III Commission. ................. 3ugreme Caurt ,Orther_ , ,. .... ID Nnmber: 2�gZQ ��rL. .... . . _� ...,.. �_ Firm Name. IRW IN LAW 4FFICE . .. . . . Address: 64 S_�_pj'I°I'STRFF.T , ,�.....� CART.i�i.R PA 17013 - .... .. Phane: 7i7-243-6090 Automation Fee. .. . . . . .. ....'.. � Fax: 717-243-9200 4 ' JCS Fee. .... ....... . ........ Emsil: �nlawnffice(�sjmail enm TOTAL. . .. . .. . . . . . ..... ... . $ �- S• 8:�96- � � . , . . , DECREE,OF THE R�GISTER , Estate of MELVIN K.OUIGLEY ` � File No: ��—��""`CJIa:K-'I ? � a/k/a: � . �►ND NOW; 1� �� ' ,in consideration of the foregoing Petitian, satisfactary proaf having be rese ted efore me,IT IS DECREED that Letters of Aciministration aze hexeby granted to Wilma J.Clazk in the above estate and{if applicable}tha.t the instrument(s)dated " � described in the Petition be admitted to probate and filed af record as the last Will{and Co�> il{s)}of Decedent. �. . ;�� .,� t Register of ills �j/L, F��xw=oa r�:roirriaalr . Fage 2 of 2 H705.905 REV.(G/06) This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. ,,,,,,,,,,,,,,,,,., �.�.� � �oo�. ��'p��H OF pF�- � ��''E N`' Calvin B. Johnson, M.D., M.P.H. ,��`�O�t►� - yJ'L` Frank Yeropoli Secretary of Health t� :__ _� State Registrar . �°v a� �* *� �� 2 � � � � � �o��q9liyFNT�F�EP~?,,, c LCI � Z�i[� No. ,,,,,,,,,,,�� Da� � � w �, � o P*1 � �y -c �^ �.7 �! � � r� �� (� �J � :� C'J � ' °""C _ �7 � C° � � --^� "� C� � � � � � �� ,^�„�� _C tJ� q , O 'T7 Hios.i<3aev ov2aos COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH •VITAL RECORDS 088960 PERM�ENrN CERTIFICATE OF DEATH B(ACHMK STATE FlLENUMBER 1.Name ol Decedenl(FYSt mitlAe,lasl,suR�) 7.Sex 3.Social Secunry Number 1.Dale of Deam(Mmtl�,Eay,yex) iielvin K. Quigley ale 207 -07 - 9946 Septenber 3, 2006 s nye t��e.meavl u�� a um�i a s oa�e a a�,��m.e , a, �.a�m Ic a�d siak a r« �cwm ea.��w oeam cnea� � Knns oap Houn M'nuks HOSpitdl�. pTher. 89 �,� July 22, 1917 New Kingston PA �i„�„� �ERra�m� ❑oon �N�«r�yr� $]Resae�� oin��-s�ry: ' Bb.Lamly M DeaUi Bc.City.Baro.Tvq.olOealM1 BC.Fatilily Name(N nd msfilufion.Sive s4ce�aM nunher) 9.Wa Decedenl o(Hispanic Origin?�No �Ve5 70.Race:Ameriran Indian.Black.Whik.ek. (ttres.specityCUEan. (Speciy) � �( Cumberland South Middleton 131 Conventry Dr. ^kx��^.�^��^.ea� LTnite . 11.DecedenYS Uwa�Ofcupalion Nud of work done d ' mos�ol worki INe.Do rwl slale reUred.) 17.Was DeceEent ever in tlie 13.OeceeenYs Ee a�im(Spetly only hghesl gra0e compeiM) 1�.Man�al SIaWS'.Martied,Nevn Mamed, t5.SurviW�g Spause(II wde.9rve maden name) IGnd ol Work 1(iM of Busiriess I IMusby U.S.Armed Fwces? Elemenlary/Secwqary(0.111 Colkge(14 a 5,� Wbowtd.DivpceJ(SpeciM / Mechanic PA Railroad ❑v� �NO 8 Widowed 1 l . 16.DeCedenfs MaiYng AdErMS(Streel.cMy I town.stale,zy cade) DeceOenfs Did�ecetlenl j Au�R��a� »a s�are PA ��a i��v�.�mu�ea�, Soutn Middleton TwP _ .131 Conventry Dr. ��N r�,�sn�o� ��a�� Carlisle PA 17015 r,��,hPr�a„� nuwaum�m c�qie� 18.Falhei 5 Naine(Firsl.midGle,las�,su�x) 19.Motl�els Name(Firs�,miGCle,maEen sumame) George W. Quigley Alice Ritter 10a.IMamanfs Nxr�e(7ype I Rnp 20b.b�lormanYS Mailpig AdNe55lStreel,dty I bxn.sWle.zp oode) Wilma J. Clark 131 Conventry Dr. Carlisle PA 17015 Ita.MeMod d DisD�ilbn �Cremation �Donalbn 21b.Da�e ol Disposition(ManM.day.1'ex) zi�.�xe w asc�r�IN�a�e�en.cre�,a�«y a om�d�l 2ta.Location ICiry I w�m.siate.np cakl �Bunal �Removal hom$lak �W�y CrmWion o!Donatbn ANliorizM • ��,.s�«;y :nrw�,�E„�,iM,�co,o,�.,a �ve,�r� 9/7/2006 Rolling Green Cemetery Lower Allen Twp. PA U011 � 12a.$ignalure of iureral5ervice Licensee(a person acling as such) 216.License NumCer 12c.Nane ard AaMess ol Faciiry � ' ► � FD 012774-L Richardson F.H. Inc. 29 S. Enola Dr. Enola, PA 17025 compek i�s saac w+y when 2�a.To me oesi o� noweaqe.oeam ocarrea a me Wme.aak ana qace siarea.(s�s�auue am dnel zx.�Kmse numee� 23c.Date SigneA(Maith.day,year) dw�5 oa a��c�daeam m czm�y cbae d aeam. � nems 2q-Z6 mys�pe rqmple�yd q,persoti 24.Time 01 Dea�� 25.Date PrmouMM DeaG(MOntt�,Day,yex) 26.Was Case Re�MM l0 M dltal E�aminer I Cororier fa a Reason OC�er Nan Cremalion or Oonation? ` "'"°a"'"'"��am 9:OS A M September 3, 2006 ❑v� �No GAUSE OF DEATH(�Inslructlona antl��ampN�I ;Approumale inkrval�. Parl II�.Enler Mlier aqn firant rmtliuons mntriEUUno m deaM 18.OiE Tobacco Use CmtriWM W DeaM? IRVn 77.PARi I�. Enler Ihe�hzui.�even_I�-dseases,injwies,w canplicaGp�s�IAaI dixlly cau5e01M�eaN.DO NOT eMn le�minal evena 5uU as carGac arresl, 'Onsel b DeaN WI ral resulArg in iM un0ertyeg caux given in Part I. �Yes �ProEady respiroPoty Mest a ventrituld'HOrtllatbn witlau151qw�9�e�9Y.Lisl ony me wuse m ex�N�e. �ryp �Unknown NIMEdATE CAU3E Fnal Ciseau a I / ; n 29.tlFemak�. �ono�r�aw�y��aml � �u��id -iYSp.r7o�y c.i'i'cr7 . '1��..�cJ Due b(«+e e conxqum«ol�� ' ❑No1 pByn2n1 wilhin p251 ybar s�o�r��,doo�s.a�y. e. ❑a��u�a a��n kaC'rgb cwse Ns1e�on Gne a we w l«.a a conaequence on Nol pregnant,Dut pregnanl wtlhin a2 aays Enler iM UNDERLYING CAUSE ❑ (d'4ease n njury mat nka�ea ine d eealh �"��u�' oue ro(w as a consequenu op �NW pregnant,Wt pregnam/3 tlays ro 1 yea� a d EeaM �Unknown if pregnanl wlliin Me pasl yex 30a.Was a�ANOpsy 30�.WeR ANOpSY F'��ings 31.Manner ol Deail� 32a.Date M injury�MonM,tlay.yex) 32b.Deu+iOe How Injury OCtWred�. 9h.Place d Inryry:Honie.Farm,SYee�,Fatlory, Perfamed? AvailablePriabCanplelwn OMKeBuildig.elc($pecily) dCaneoiDeath7 ❑Natural �HOmcqe �Yes ❑No �Ves �No ❑Au'�e^t ❑Pendy Imesegation 31d.Tine d Injury 72e.Injury al Work? 32f.II Transportalion Inju7(Speciiyl 32q.Localim of In1�71S1ree�.cily I bwn.slate) �Suitide �CouNNOlbeDelMmimO ❑Ves ❑NO ❑DnverlOperabr �Passenget �PeGestrian , M. �ppipr.gpecih,. � 7Ja.CertiNer(checkorJyone) 33b.SignaWreandTitle CerK ' CartAY��9 PhY�icun IPhysitian ceNfying cause ol deaN wAen arrolirer phYSician has pmwnced Oeatl�and comWeied Aem 13) � ✓�'1� To Iha Wst ol my kiwwkEg�,Malh oceurred dua to lM wuea�s)and mannsr as sbtad � � � �� ' """"""""""""""""'_ � � . �� • Pronouncing and cMiFjin9 phriitim lPhysician�olli qorwurwing death arq ce�ifyirg ro cause ol dealh) r� To m.nn�w my wnoweeae.aw�«��•a�m.um.,eu...�e px..,oe ew�o m.o�Nq�e�oer n aa4e � 33c L�Kense Num6er 330.Dale Signe(MmU.tlay.year) o . ��E..��.,��oro� ----------------- „-,.�yac�J�y � � �?� � OQ Ne bHif of eaaminiEOn aM I of invalipitbn,m my Opinion,Malh otcurred al IM lirM,Aat�,a�M plia,m0 tlw to UN ous�Is)antl m�nMf a�6�MeA_� y� Name an0 Aedress a Person Wtw Canpeled Cause ol DeaN(Item 27)Tyye ml 0 e p J5.Registra'S g anO DisUicl �� 36 Date fdetl(MOnIh.tlaY.Yex) G�..( ,� u pf/ Yh� � ► c '�s"<2-!./I-"-_"' � °Z� ��°�� i� �l'�L dDd� v�/O F:�.�nz ,?��- .S:�c � �o,/..., �...t �� /�dJ% �- (See instructions and examples on reverse)