Loading...
HomeMy WebLinkAbout10-14-13 4 � 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 requests the grant of Letters in the appropriate form: Jeffrey L.Gruver and Letti M.Gruver Decedent's Information `^/- Name: Donna N.Gruver File No: 21 ���''Vl.�� a/k/a: (Assigned by Register) a/k/a: a/k/a: Sociai Security No: 208-24-2292 Date of Death: 09/23/2013 Age at Death: 81 Decedent was domiciled at death in Cumberland County, pq (State)with his/her last principal residence at Green Ridge Village/Swaim Heaith Center,Newville 17241 West Pennsboro Cumberland Street address,Post Office and Zip Code City,Township or Borough County Decedent died at Chambersburg Hospital,7th Street,17201 Chambersburg Franklin PA Street address,Post Office and Zip Code City,Township or Borough County State Estimate of value of decedenYs property at death: If domiciled in Pennsylvania...................... All personal property $ 481,716.00 If nof domiciled in Pennsylvania................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania................ Personal property in County $ Value of real estate in Pennsylvania................................................................... $ 140,000.00 TOTAL ESTIMATED VALUE $ 621,716.00 Real estate in Pennsylvania situated at 307 Franklin Way,Shippensbu�g 17257 Southampton Township Frenklin (Attach additiona/sheets,if necessary.) Street address,Post Office and Zip Code City,Township or Borough County ❑X A. Petition for Probate and Grant of Letters Testamentarv Petitioner(s)aver(s)that he/she/they is/are the Executor(s)named in the Last Will of the Decedent,dated 04/16/2010 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,w5s not divorcec�.�nR,as not�p�rty to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§33�(g�and did not have aschild born or adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. � - - , �NO EXCEPTIONS � EXCEPTIONS t�1 --� �:� --.:.� r r ;w �... ❑ B. Petition for Grant of Letters of Administration (If applicable) ; � ;-: —�- - ' c.t.a.,d.b.n.,d.b.n.c.t.a.,p�nteNte,durante absent(a;durante minoritate ;a {•.i . , If Administration,c.t.a or d.b.n.c.t.a.,enter date of Will in Section A above and comolete list of heirs, ���3 Except as follows: Decedent was not a party to pending divorce proceeding wherein the grounds for divorC�152ii been e�t�blisheef as tlefined in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adJudicated an incapacitated person :� � +�F _.., � . �NO EXCEPTIONS � EXCEPTIONS �� �-� `'" �rt c� Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse(if any)and heirs(attach additional sheets,if necessary): Name Relationship Address Robert C.Gruver Son 406 Lurgan Avenue Shi ensbur PA 17257 John T.Gruver Son 9177 Sporting Hill Road Orrstown PA 17244 Letti M.Gruver Daughter 410 Scott Drive Shi ensbur PA 17257 Jeffrey L.Gruver Son 430 North Earl Street Shi ensbur PA 17257 See continuation schedule attached Form Rw OZ rev.10-11-2011 Copyright(c)2011 form software only The Lackner Group,Inc. Page 1 of 2 � w Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } Petitioner(s)Printed Name Petitioner(s)Printed Address Jeffrey L.Gruver 430 North Earl Street Shippensburg,PA 17257 Letti M.Gruver 410 Scott Drive `_, � - ' Shippensburg,PA 17257 � `-'-' y , ' ` C> ' rri `. - ,.v :,,� e _. ,- ,. r -.:. � , �- `; " , ' - .; t : The Petitioner(s)above-named swear(s)or affirm(s)the staterne s in the f reg ng Petition are true and conect�S�the best of�the knbwledge and belief of Petitioner(s)and that,as Personal Representative(s)of t e ce etitioner(s)will well and trulyadminister thece�tate�ecdre�ing t law. � [yc� �-_� /c�'- —/ Sworn to or affirmed and ubscri ed before "_ , _ Date me day of � Date � By Q/�ti. Date For the Regisfer Date BOND Required? � YES �O To the RegisterofWills: FEES: � Please enter my appearance by my si nature ow: Letters.......................................... $ O �V C� Attor ey Signature: ( )Short Certificate(s)......... {,�j ,� n ( � )Renunciation(s).............. �-�I / ( )Codicil(s)........................ ~ ( )Affidavit(s)...................... Printed Name: Jerry A.Weigle Esqui Bond............................................. Supreme Court Commission.................................. ID Number: 01624 �C her �' ��'� Firm Name: Weigle&Associates,P.C. �"� Address: 126 East King Street Shippensburg,PA 17257 Phone: 717/532-7388 Automation Fee............................ .. Fax: 717/532-5289 JCSFee....................................... . TOTAL......................................... $ rl-1�•S� E-mail: DECREE OF THE REGISTER Date of Death: 09/23/2013 Social Security No: 208-24-2292 Estate of Donna N.Gruver File No: 21 .r�3" �(�(e� a/k/a: AND NOW, � , � ,in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Jeffrey L.Gruver and Letti M.Gruver in the above estate and(if applicable)that the instrument(s)dated 04/16/2010 described in the Petition be admitted to probate and filed of record as the I st Will(and Codi�(s))of Decedent. Register of Wills Copyright(c)2011 form software only The Lackner Group, c. � of 2 H105.805 REV(9/I I) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photastat or photograph. Fee for this certificate, $6.00 ;i�.��.` - � '?k� ,n�jdp�,ZH OF pE� This is to certify that the information here given is ��.��� yy : ��: , v ��,a�t�, y,y"'-_ correctly copied from an original Certificate of Death ����`�a`L` =_ `rl=, duly filed with me as Local Registrar. The original ;�T � , � �, �� � =° zz certificate will be forwarded to the State Vital � �L�13 �._�u t { �1�I � J� i° � a� Records Office r pgrmanent filing. ;* � � *,� �_ , �' 2 �� Q � a655 c��� ;� � _ �,�� � - O�� ~'', Z.� •�O t���i;����' L.��';i �9lMENT�OE„���'��, � Certification Number Local Registrar Date Issued CU�BE"r��f E�� ��:�., �� Typa/P�int In COMMONWEALTH OF PENNSYLVANIA��EPARTMENT OF HEAITH�VITAL ftECONDS Pe�a klnk` CERTIFICATE OF DEATH State File Number: 1.Decedent's Legal Name(firsT,Middle,Last,Suffix) 2.Sex 3.Social Securiiy Numbe� 4.Date of Death(MoJDay/Vr)(Spell Ma) Oonna N.Gruver Female 208-24-2292 Septem6er 23,20'13 Sa.Age-Last B{Khtlay(Yrs) Sb.Under 1 Year Sc.Under 1�a 6.Dace of Birth(MO/�ay/Year)(Spell Monxh) 7a.Birchplace(City antl Staca or Forelgn Counfry) nnonu,s Oays nours nn�nuces Shippansburg,PA _ B� Maroh 4,'1932 7b.BiKhplace(co�r,cy) � Franklin Ba.Residence(State or Foreign Country) Sb.Residence(Sireet antl Number-Include Apt No.) 8c.Oid Decedeni Live In a TownshipT - PA 307 Franklin Way �ves,aeceaenc iivea in Southampton i,,,,P. Sd.Rcsidence(COUnty) Franklin 8e.Resitlence(21p Code) �72$7 �NO,tlecetlen[Iivetl wlthin Iimits of city/bo�o. 9.Ever in US Armed Forcesl 10.Marital Status at Tlme of Death Q Married Widowetl 11.Surviving Spouse's Name(If wife,give name prlor to ffrsi marriage) �Yes ]$[No Q LJnknown 0 Divorcetl Q Never Marrletl �Unknow 12.Father's Name(First,Middle,Last,Suffix) 13.Mother's Name Prlor io Firsc Marriage(Frst,Middle,Last) Roy Clament Nau9�a Ardella Sitas 14a.InfG�mant's Name 14b.Relailonshlp to Oeceqent 34c.Informant'a Mailing Address(Street and Number,Clty,Sca[e,Zip Code) � Jeffray L..Gruvar Son 430 N.EaA St. Shippansburg PA�7257 � ............... ..""......................�iI ."""""""'.._...................,........} acc o eat on y one a. � it oeam o«.,.ree io e Hos �cai: � io xio.,c -"'.........-o::�ewtie eC"..... ................"'-' ......"".....wa� .............."-'................ p p� pa Ilf Deaih�OCwrred 5 re Other Than a Fl�ospital: ��Flosplce Facllity y Decetlent's Home � O EmergenCy ROOm/O�Tpati¢nt Q Daad on Arrival Nursing Home/long-Term Car¢Facility Other(Sp¢cify) oat SSb.Facll(ty Namc(If not instituilon,give streei and numberj .35c.City or Taw�,State,and 2ip Cade ISd.County of Death __l� � � � Chambarsburg Hospital Chambersburg,PA�720'I Franklin � � 16a.Method of Dtsposltlon Burlal � Crematlon 16b.DaTe of DlspoalHOn 16c Place of Dispositlon(Name of cemetery,crema[ory,or other place) . � Q Removal feom State p Donanon $ fin HI�I CBTBLB � OCher(SPedfy) September 26,20�3 P 9 rY � 16 .Locatl�on of Uisposition(City or Town,Siate,and Zip) 17a.Stgna of Funeral Servic�Licensee or Person in Charge of InTerment 17b.License Number � Shippensburg,PA�7257 F�-O'1493'I-L �' 17c.Name an Complete Address of Funeral Faciliiy .$ Fogelsangar-Bricker Funaral Home'I'12 W King St.PO Boz 336,Shippensburg,PA�7257 � 18.Deccdent's Educatlo�-Check�he boz fhaf best descrtbes the 39.DecaAen[of Mispanic Origin-Check[he 20.Decedeni's ftace-Check ONE OR MONE races[o I�tlicafe what highest tlagrea o�level af school completetl at the[ime of dcath. box ihat besc ticscrlbas whe[her ihe tlecetlent tha decedeni consitleretl himself or herself fo b¢. p arn graae or iess Is Spanlsh/Hlspanic/La[ino. Check the"NO" �White Q Korean 0 No diploma,9[h-12th gratle box if tlecatlent is not Spanish/Hispanic/Latino. 0 Black or African Amerlcan �Vietnamase �High school g�aduafe or GED completed �(No,not Spanish/Hlspanic/Laiino �American Indlan o�Alaska Nattve �Othe�qsian 0 Some college credif,bu[no tlegree Q Yes,Mexlcan,Mexican American,Chlcano Q Asian Intlian 0 Na[ive Hawailan �Associate degree(c.g.AA,AS) Q Ves,Puerto Rican �Chinesa �Guamanian or Chamo��o � Bachslor's degree(e.g.BA,AB,BS) 0 Yes,Cuban �Filipino p Samoan � Masier's Aegree(e.g.MA,M5,MEng,MEtl,MSW,MBA) 0 Ves,ofher Spanish/Hlspanic/Latino 0 Japanese �Ofher Pacific Islantler 0 Doctorate(¢.g.PhD,EtlD)or Profcssional tlegree (SpeUfy) 0 Other(Speci fY) .MD DDS pVM LL6 JD 21.Decedeni's Single Race Self-Designation-Check ONLY ONE to indicate wha[the decedent consitleretl htmself or herself to be. 22a.Decetlent's Usual Occupation-Intlicate type of work �(WhiCe 0 Japanese 0 Samnan done tluring most of workinQ Ilfe. DO NOT USE RETIRED. 0 Black or African American 0 Korean 0 Other Pacific Islantler Am¢rican Intlian o�Alaska Naiive Vie[namese LPN � O � O Don'[Know/Nat Sure 0 Aslan Intlian 0 Othar Asian �Refused 22b.Kind of Business/Industry � p cno-,ese p Native Hawa{lan O o<ner�spe«sy) Health Care []Filipino Q Guamanlan or Chamorro ITEMS 2!a-23 MUST BE COM L� ED 23a.Date Pronounce Deatl Mo Oay �) ,23 . ignature o Person Pronauncing�eath On y w en applicable 23c.L ce�se Numb�r HY PERSON WHO PRONOUNCES OR CERTIFIES DEATH 23tl.Dafe Signed�(MO/Day/Vr) 24.Tlme of Deatli "I:40 AM 25.Was Medical Exeminer or Coroner Gontacced7 ]$[ Ves � No . CAUSE OF UEATH Approximate 26.PaR 1. Enfer the chaln of e ents--diseases,Injurles,or compllcatlons-that directly wus¢d the tlea�h. UO NOT en�er terminal events such as cardtac arrest, j Interval: resplrafory arrest,or ventricular Nbrillatlon witho�t showing the e[iology. DO NOT ABBREVIATE. Eniar only one cause on a Iine. Add atltlitional Iines If necessary � Onset to DeaTh IMMEDIATE CAUSE > a AGUSB on Chronic�iastolia Congestive H08f2 F811U!'B � CJe�/S (Final disease or conditlon Due to(or as a consequence of): � reswn.,g tr,poa�n) . y. Sepsis ; deys Sequentlally Ilat conAltlons, � Due to(or as a consequencc of): F If any,IeadinH to the cause . � us�oa on une a. enaer cne � Acuta on Chronic ranal failure � days UN�ERlY1NG CAUSE Due to(or as a consequ¢nre of): (ais.ase o��olurv mac � F InKfated the evanss resul[ing tl. ; � �n death)LAST. Oue to(or as a consequence of): : � i _ 26.PaR 11. Enter o[her but not resulting In thc undcrlying cause given in Part 1 27-Was an autopsy performetl] g Mechartical Aortic Vaiva vas rio � � 28co comp�ece meicaasa of aeam'z � 0 Yes 'No cs 29.If Female: 30.Ditl Tobacco Use Contribute to DeathT 31.Manner of Death E �NOt preQnant within pas(year �Yes � Probably �Natural 0 HomiclAe S Q Pregnant at time of tlea[h No unknawn °�6' Q No[pregnant,but p�egnant withln 42 days of tleaih � O 0 Sutcide t �Co Id not b¢tl¢gteriminad � Not p�egnant,but pr¢gnant 43 days co 1 year before death 32.Date of Injury(MO/Day/Vr)(Spell Month) 0 Unknown If pregnant within the pas2 year 33.Tlme ot Inj�ry 34.Place of Injury(e.g.home,construction site;farm;school) 35.location of Injury(Sireet and Number,Qty,County,Siate,Zip Cotle) 36.Injury at Wo�k 37.IfTransportailon Injury,Specify: 38.DescHbe How Injury Occurretl: �Ves 0 Driver/Operafor � Ped¢seriaR � No Q Passenger 0 Other(Specify) 39a.Lertifler-physiclan,certifieA nurse p�acYltio�er,metlical e mine�/co r(Check onlyone): -� �[Certifying only-Tothe best of my knowledge,deaih occur ed due to che cause(s)anA manner siaced. O Vronouncing 8.Certifying-To the b¢si of my knowledge,deach occurretl at the time,dace,antl plare,and du¢io ih¢cause(s)anA manner statetl. �MeAical Examiner/COroner-On the basis uf ezaminacion antl/or investigatlon,In my opinion,death occurretl a[the tlme,date,and place,antl tlua to the cause(s)and mann¢r statetl. Z �j >� MD450088 �� Stg�ature of ceRifle�:�/�_�.ssr.E ay?/,ace�G:r. �J7� Title of certificr: M� � ticense Numb¢r: 39b.Neme,Acldress 2ntl Zip Cotle of Person Compleiing Cause of Death(I[em 26) � ' 39c.Date Signed(MO/Oay/Yr) D�Kemsha 2 Huslin,MD '112 N 7th St,Chambersburg,PA'i720'i y� Saptembar 23,20�3 �Qyy . eg IstYicc ber . � 41.Registra atur¢ " . 42.Ra is r File Date Ma Oay 6 �� ��`������ � � 43.AmenAmenta . � � n 0970579 H105-143 Dispositlon Permit No. (iEV O7/2012 �AST tiVILL�11VD �'F_S7'AMEIVT I, Donna N. Gruver, presently residing at 11260 Old Mill Road, Shippensburg, Southampton Township, Franklin County, Peruisylvania 17257, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and 'I'estament, hereby revokirig and making void all Wills by me at any time heretofore made. FIRST. I order and direct tlie payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give, devise and bequeath all of my estate, real, personal and mixed, whatsoev�r and wheresoever situate, to my children, in equal shares, �s follows: A. One(1) share to my son, Robert C. Gruver; r, _ ._;� � �;; ,.�, :,.~,, � ,.._ -` :�; ": B. C�ne(1) share to my son, John T. Gruver; j �_ _j -, - , ;= � C, One (1) share to my son, Jeffrey L. Gruvei•; and:'�° � ; = "- � ' .__ . . . {. __. --, . , � ll. One (1) share to my daughter, Letti M. Gruver , = �-�' : �;w� = :�, r'" ;_.,.: ;';.i In t�ie event that any of my aforementioned children pred�cease�e, I then�e, ti�v�e and bequ�.ath sa:id deceased child's share to my children who survive me. TH[RD. I nominate, constitute and appoint my son, Jeffrey L. Gruver, pi�esently re5iding at 430 North Earl Street, Shippensburg, Pennsylvania 17257, and my daughter, Letti 1VT. Gruver, presently of 11260 Mongul Road, Newburg, PA 17240, or the survivor thereof, to be the Co-Executors of this my Last Will and Testament. FOURTH. I direct that my personal representatives shall not be required to give bond �i�r t'tie faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, Donna N. Gruver, have hereunto set my hand and seal to this t7iy L,ast Will and Testament, written on one (1) page, this t �,___ day of ��, � ! , 2010. --- �..�,� ,^ `�, , �__��.,�r�c� �v. ., -ts-u� (SEAL) WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 1 ♦, ' This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at lier request and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. �,�1.c�'-c� �F` ',. __�-� —V- — ----- -�. ' �C s��•G1�/��p i� �— / /,� �.- G� C��L.��'�,%' � `-'� .���—- – COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : I, Donna N. Gruver, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. -- � . `�..� U�c�. � �-�—— `,� �worn or affirmed to axid acknowledged before me by D nna N. Gruver, t Testatrix, this l��day of_ ____, 2010. . _--- Q_ , , CCMMONWEAITN 0�►ENN3rLV�1N1A NOTARIAL SEAL Jarry A. Weigfe. Notary Pualie Cityof Sh�ppensburg,CumbeNandCoun My Comm�ss�c� E tiu�res October 0�,101 WEIGLE 6c ASSOCIATES, P.C. — ATTORNEVS AT LAW — 126 EAST KING STREET — SHIPPENSBURG, PA 17257-1397 A►N�'rs.*c'NN3cx ir; t+' ,A3�a.t'?t<:•�,+:i:: `�+....�»..... .b. J...wI v...._,.�,,..��...... �rr+ i ,� ; . . . ;�r� .,, .. , ;r;���� � � . i� _. . �. .. . .. , COMMON WEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : /,�%� �/� We 1-����1 C ,G �r , %� \ .�, >.�:c�. �'.� �2-�•'C_ , -�-- and _ ��o��v�Q. .S • C-�''�-��___ ___, the witnesses whose names are signed t� the foregoing instrument, bein� duly qualified according to law, do depose and say that we were present and saw Donna N. Gruver, the Testatrix, sigri and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; t�aat each of �as in the hearing and sight of the �i'estatrix, signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at the time eighteen (18) or rnore years of age and of sound mind and under no constraint or undue influence. C. —_/_C���C�.Gk•��'� - � ------`� -- C�- � � r � _�����;-��- V � ` -- . � Sworn or affirmed to and subscribed before me � . by--�ct �� �� _ � ;'� � , Q�,�i'c'� �•��-�__ � � ✓ �?`�1'"2 � ana ox�,c��:�. witnesses, this /��day of____ , 2010. —�----1�— --� ' -- - — � COMMONWEALTM QR i�ENNS VANIA NOTARIAL SEAL Jerry A.Weiflle, Notary Public ity Of Shippensburp,Cumberbnd COU�tY M�r Commission Expi��s OCto�r q�,�0/0 WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 �- , a . . . � , . °t'MM;�- . , . , , . ___ . . .. ._ . _..: . __ ._.�....._,.,, . �; � .. � ' ... • . � .� � . � . . � i `,(: . . .. . . � . _ . ... � ,. ,. �ll;3S . '�`��:tJ .. ._ .:.. `''�t;