HomeMy WebLinkAbout11-08-13 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 specifled below, and in support thereof aver(s)th�
following and respectFully requests the grant of Letters in the appropriate form:
Louise S. Nicholson
DecedenYs Information
Name: Helen P Stover File No: 21-13 -'��3
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 201-16�554
Date of Death: 10/27/2013 Age at Death: 89
Decedent was domiciled at death in Cumberland County, pA (State)with his/her last
principal residence at 648 Yorkshire Drive,Carlisle 17013 Carlisle Cumberland
Street address,Post Otfice and Zip Code City,Township or Borough County
Decedent died at 1 Longsdort Way
Street address,Post Office and Zip Code City,ToNmship or Borough County SNate
Estimate of value of decedenYs property at death:
If domiciled in Pennsylvania........................ All personal properiy $ 50,000.00
If►rof domiciled in Pennsylvania................. Personal property in Pennsylvania $
If not domiciled In Pennsylvania................. Personal property in County $
Va/ue ofreal esfate in Pennsylvania........... $ 200,000.00
TOTAL ESTIMATED VALUES Z 0,000.00
Real estate in PennsyNania situated at 648 YOfkshl�e D�IVe CefIISI@,BOfOUyh Cumberiand
(Attach adddanal sheets,if necessary.)
SYreet address,Post OfFice and Zip Code City,Tovmship or Borough � Caunty�
:� w � �
❑A Petition for Probate and Grant of Letters Testamentary � � � � p
Petitioner(s)aver(s)that he/sheRhey is/are the Executor(s)named in the Last Will of the Decedent,dated Q3 („��Codicil(s)
thereto dated �j r"' j'1'� CT1
�r � iL9 _
� - 7'�
(State relevant c'rcumstances,e.g.,renuxiation,dea�of�ecuta!etc.) CJ � �,, 'T1
Exce t as follows:after the execution of the instrument(s)offered for robate,Decedent did not ma was not divorced,was n6t��tyTB"�a endin � W
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.�§��3323(g),and did not have�cl5rld born or T-�g �•��- �
adopted;and Decedent vras neither the vidim of a killing nor ever adjudicated an incapacitated person. � �'3 fV
�NO EXCEPTIONS Q EXCEPTIONS � � �"'� � ��zt
❑X B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.; . .n.; . .n.c. a.; n � ; uran e a sen ia; uran e mmo a e
If Administration,c.ta or d.b.n.c.La.,errter date of Will in Section A above and complete list of heirs.
Except as follows:Decedent was not a party to pending divorce proceedin 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 a�udicated an incapacitated person.
QX NO EXCEPTIONS Q EXCEPTIONS
Petitioner(s),after a proper search haslhave ascertained that Deoedert left no Will and was survived by the Tollowing spouse(f any)and heirs(attach
additionalsheets,i(necessary):
Name Relationship Address
Louise S.Nicholson,136 F.Street,Carlisle,PA Daughter
17013
Leslie C.Stover,PO Box 89,Plainfield,PA 17081 Son
Larry R.Stover,404 Beetem Hollow Road, Son
Newville,PA 17241
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Oath of Personal Representative off�cialUseony
COMMONWEALTH OF PENNSYLVANIA }
} SS:
courvN oF Cumberland }
Petitioner(s) Printed Name Petitioner(s)Printed Address
Louise S.Nicholson 136"F"Street
Carlisle,PA 17013
Name as listed in Will: 717-243�034
Leslie C.Stover PO Box 89 ;� � ;,� rn
Plainfield,PA 17081 � R1
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The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are true and corr�qgt fo'�the best f he k��p'yvI e and
belief of Petitioner(s)and that,as Personal Representative(s)of the Decedent,Petftioner(s)will well and truly;i9dminister the�ate�cCor�rig to law.
Sworn to or affirme�and 5ubscribed before � �� v �-�-" o�e //� �//3
me!hi �� ay of E� 0�3 - oate // 7 ?
By i � !�. t'L��/�''�/
� / Date
Fv the Register Date
t_
BOND Required? � Yes � No To the Register of Wills:
FEES Please enter my appearance by my signature below:
Letters............................................ $ �L� , �(�� Attorney Si nature: �_
( � )Short Certificate(s).......... �.�. �L,�
( )Renunciation(s)............... -
( )Codicil(s).........................
( )Affidavit(s)....................... Printed Name: Robert G Frey
Bond.............................................. Supreme Court
Commission................................... ID Number: 46397
Other
l t�l�( � ��C�'Z� Firm Name: Frey and Tiley
Yl C� �`�•��� Address: 5 South Hanover Street
-t-��, .,,�� �S.t����
Carlisle,PA 17013
Phone: 717/2435838
Automation Fee............................. �-,-�'L' Fax: 717/243�441
JCSFee......................................... ` �C
, E-mail: rtrey@freytiley.com
TOTAL........................................... $ ��S ,�',
DECREE OF THE REGISTER
Date of Death: 10/27/2013
Social Security No:
Estate of Helen P Stover File No: 21-13^��G��
a/kla:
AND NOW, (� in considerati n of the foregoing Petition,
satisfactory proof having been resented before me,IT IS DECREED that Letters 'Festartl�i[8Ty' �
are hereby granted to Louise S.Nicholson and Leslie C.Stover
in the above estate and(if applicable)that the instrument(s)dated 08/28/1997
described in the Petition be admitted to probate and filed of record a t e st Will( d Codic�of Decedent.
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R gister of Wills � JIn � �� � �\/1 _
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HIOS.ROS REV(9/1I)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is iilegal to duplicate this copy by photostat or photograph.
RECORDE� OF�iC� OF
Fee for this certificate, $6.00 �,,,,����""'���--.. This is to certify that the information here given is
R E G�ST�� 4 F �d i l..L S ,,,,,,,`��p�,TN-OF pFij%,y�_ correctly copied from an original Certificate of Death
�,��o`Z` �` duly filed with me as Local Registrar. The original
t�l� �Q� g pi� 12 17 :G = � ":_ z; certificate will be forwarded to the State Vital
�� �' a� Records Office for permanent filing.
� CLERK OF '_o�,� - `, ,�?,,,�''
� � � � � � � � � nRPHANS� GOURT ` '99l � E�EP\`'�� ``Z�,ux�. �,.!��--c-�ex- OC/f 2 9/2013
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Certification Number ��MgERLAND CO•R p� �����°���������//'' Local Registrar Date Issued
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Type/Print In COMMONWEALTH OF PENNSYLVANIA�DEPARTMENT OF HEALTH�VITAL RECOROS
PefTd�e�` CERTIFICATE OF DEATH
Biack Ink Statc File Number:
1.Decedent's Legal Name(Fint,Middle,L t,S�fflx) 2.Sex 3.Social Securliy Number 4.Date of Dcach(MO/Day/Vr)(Spell Mo)
H�Lc-�1 n S?ei/t-✓� F �el - � 6 - 4S�y- OcTOr�c-ft a� .�0/3
Sa.Age-Last 6irtliday{Yrs) Sb.Untler 1 Vear Sc.Under 1 Da 6.Daie of Birth(MO/Day/Year)(Spell Month) 7a.Birthplace(CIt�v{and Statc or Forelgn Country)
'( Months. Days �HOUrs Minutes �Y'11S1E P�
vl gg . August 2� �9Q4 �. 76.Btrthplace(COUnty) r �
Sa.RESidence(State or Fo�etgn Country) 86.Residence(St�ee[antl Number-Include Apt No.) 8c.Did Decedent Live in a Township?
PA O�'es,decedent Iivetl in
8d.Residence(Caunty
648 Yor}csl-iire Drive �wo.
��II�Y' and � se.nes;de„�e(Zip Code) �NO,decedent Ilved withln Ilmits of �r11S12 city/boro.
9.Eve�in US Armed Forces? 10.Marital Status at Time of Death �Married � Widowed 11.Surviving Spouse'S Name(If wife,give name prior to fl�sf marriageJ
E1wes �No Q Unknown Q Divorced �Never Marrled �Unknow
12.Father's Name(Firs[,Middle,Last,Suffin) 13.Mother'S Name Prior to First Marrtage(First,Middle,Last)
Fred Piti�n Maiy Keadle
14a.I�forman['s Name 14b.Relationship to Decedenf 14c.Informani's Mailing Address(Street and Number,City,$tate,Zlp Codej
s
Louise S_ Nicholson Dau hter "I36 "F" Street, Carlisle, PA �'7p�3
0
G ............................ . 15a.P ace o Deat
......".'"'"'""""".........�-..v...Pa..................................r.."""""......
c 1f Death Occurretl in a Hos ital: . ""...........'""'"".....ec on y one.......""""'......."'""'" '"""'"". ... .....""' "' ...."" ""... .....
p u In tient ;If Deaih Occurred Somewhcre Other Than a Hospt[al: `��HOSpice Facility�� �[��petedent's Home
� 0 Emergency�ROOm/OUtpatient �� Dead on Arrival �Nursing Home/long-Term Care Facility Q Other(Specify) �
�d 15b.Facfiity Name(!f not Instlt�t�on,give street antl number; •15c.City orTOwn,State,and Zip Code . 15d.Couniy of DeaSh'�
GtiunY�erland Crossin s R�t_ Coxtun_ Carlisle PA 'I'70'I 5 Gt�nberland
�'" 16a.Method of Dispositlon � Buria) 0 Cremation 166.Date of Disposition 16c.Place of Olsposi[lon(Name of ceme[ery,crGmatory,or othe�place)
� �0 RemoVal.from State �Donatlon
� ome��sPe�ih.� �O 31 201 3 G�Snberland Va11e Manorial Gard�ns
y16d.Location of OlspOSition(GiCy o�Town,State,and Zip) 37a.Signature of Funeral Servtce Licens in Charge of Interment 176.license Nvmbe�
$ Carlisle, PA '170�3 �� FD 012633 L
E 17c.Name and Complpte Adtlress of F�neral Faclltty �
° ' B F H =nc S_ Han var St. rli 1e PA '1701
� 18.Decedeni's Education-Check the box that best dcscribes the 19.Decedent of Hispanic Origin-Check the 20.Decedent'S Race-Check ONE OR MORE races to indicate what
� highest tlegree or level of school compleied a�the Hme of death. box ihat besf describes whether Yhe dr�cedet�t the decedent considered himself or herself to be.
� 8th grade or less is Spanish/Hispanic/laSino. Check the"NO" �'White � Korean
0 No tllploma,9th-12th grade box if decedent is not Spanish/Hispanic/Latino. 0 61ack or African American � Vietnamese
��Hlgh school gratluate or GED completed �$'No,no[Spanish/Hispanic/Latino �AmeNCan Indian or Alaska Native � Other Asian
0 Some coliege cretli[,but no degree �Yes,Mexlcan,Mexican American,Chicano 0 Asfan Intlian � Native liawailan
� Associate degree(e.g.AA,AS) �Yes,Puerto Rican CM1inese
� Bachelor's d¢gree(e.g.BA,AB,BS) Yes,Cuban � � Guamanian or Chamorro -
� Master's tlegree(e.g.MA,MS,MEng,MEd,MSW,MBA O O F���Plno � Samoan
) O�'es,other Spanish/Hispanic/Latino Q Japanese O Other Pacific Islandcr
� Doc[o�ate(e.g.PhD,EdD)or Professional degree (Spectfy) 0 Other(Specl£y)
.MD DDS,OYM,LLB JO
21.Oecetlent's Single Race Seif-Designation-Check ONLY ONE to indicate what tM1e decedent<onsidered himsell or herself to be. 22a.Decetlent's Usual Occupation-Indicate type of work
�'a'White 0 Japanese �Samoan done d�ring mosC of working Iife. DO NOT USE RETIRED.
�Black or Afrtcan American �Korean 0 Other Pacific Islander
9 Q American Indian or Alaska Native 0 Vietnamese � Don't Know/NOt S�re H�]caz-
�Asian Intlian �Other Asian � Refused 22b.Kind of Business/Intlustry
� �Chinese 0 Nat(ve Hawalfan 0 Other(Specify)
�F���P��o 0 Guamanlan orChamorro H2Y OVJ21 Y1CHil2
ITEMS Z9a-23A MUST BE CO PLETfiD 23a.Date Prono�nced Dead(MO Day/V�) 23b.Sign e of Person Pronouncing Death(Only when applicable 23c.License Number
BYPERSON WHO�PROMOUNCESOR � �
CERTIFlES pEATH OCT�J(��L �-�, o�Z d J 3 -
..�. �N sq�(--I g-c.�
23d.Oate�Signed�(MO/Day/Yr) 24.Time of Death .
('7 G7013 C--�fl �'3-.� a.0/� 5: l C M 25.Was Medlcal Examiner or Coroner ConcaccedT �O ves No
� CAUSE OF DEATH .aPProai..,ace
26.Part 1. Enter the chaln of evenYS--diseases,injurfes,or complicatlons-that directly caused the tleath. 00 NOT enter terminal events such as cardiac arrest Interval:
respiratory a�resf,or vent�ic�lar fibrillatlon without showing the etfology. DO NOT ABBREVIATE. Enter oniy one cause on a Iine. Atld additlonal lines if necessary Onset to Death
IMMEDIATE CAUSE -------------> a. �¢4� ����,� C'¢�C G✓ ' °
(FI al tlisease o condition Duc to(e az a consequence of):
rGSYILing In death)
b.
Sequentially list condiHOns, Due fo(or as a consequence
if any,leading eo�he< ���
Ilsted on Ilne a:�Enter tM1ec
UNOE0.LVING CAVSE �ue to(of as a consequence of):
(disease o infury that
= Initiatetl the events res�lting d.
n death){,qST. Oue to(o as a consequenre of):
� �26.Part II. Enter other siR�ificant conditions contribvcine t d th but not res�liing in the underlying cause given in Part I . 27.Was an autopsy parformetlT
�
�Ves B No
� 28.wcre autopsy flndings available
m . � xp complete fha cause oi deaSM1?
°1 � �Ycs ��No
<`+ 29.If Fe le: 3D.Did Tobacro Use Contribute to Oeath? 31.Maj� er of Death
oNot pregnant within past year �J Ves 0 Probably �latural Q Homlclde
� Pregnant at Hme of death � No � Unknown � Accident Q Pending InveSYigation
0 Not pregnant,but pregnant within 42 days of death � Suicide 0 Could not be determined
ti- � Not pregnanf,but pregnant 43 days to 1 year before death 32.Date of Injury(MO/Day/Vr)(Spell Month)
� Unknown if pregnant wlthin the pasf year
33.Time of Injury
� 34.Place of Injury(e.g.home;construction site;farm;school) 35.Location of Injury(Sireet and Numbe�,City,State,Zip Gode)
�1J
�
` 36.Injury at Work 37.If Transportaifon Injury,Specify: 38.Describe How Inj�ry Occurred:
/ 0 Ves Q�river/Operator � Petlestrian
��� O No 0 Passenger � Other(Spec(fy)
39�rtifier(Check only one):
ZGertifyi�g physician-To the best of my knowledge,death occ�rrcd dve[o[he cause(s)antl manner stated
�ll � Pronouncing 8.Certifying physician-To che best ot my knowledge,deaih occurred at the time,date,and place,and due to tt�e ca�se(s)and mant�er stated
� � Medical Examiner/Co/ry/J�{//-O h b sis f e jj'�n}�/j�ior and/ /iJJJ/���`}tIig�atlon,In my opinfon,deat�h A' d at the timc,date,and place,and due to rtie (s)and an tatetl
�.� SignatureofcertiFler: / '"-CC�� ��/�"` ����`"�-� TiH ofcertlfler �/V`�� Lic erv�,,,ne���'{��dd'3� 3cF=�
39b.Na�m:e,Address and 27p de f Person Completing Ca�se of Death(I[em 26) C - ( -/ n 39c.Date 5 gnedy�o/Day/Vr)
�ZS- ,���k /a'treuv�er �c 1'�.e.� �s. /73as� /afzt'l ��
�j 40.Regisirar's District Number 41.Registrar's 5 gnafure 42.Ragtstfaf Flle Date Mo Day/Yf
�- \O �vii.�.'���1�.���c c�01�
43.Amendments
O
�Q
Z
(��_f.� ..._f S HSOS-143
Disposition Permit No. \1 `i d.l 7-��� aF_v o7/Jn11
RENUNCIATION
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Helen P Stover , Deceased
�
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"� � � � G:7
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�, Larry R. Stover , in my capacity/rela�hi�s .� "��" �
(R�int Name) � � � �T'S
G7 4 'T9 .�"�.°-. �
son of the above Decedent, hereby�h�nce th�ght�""e �
r--
�—i p
� � � �
administer the Estate of the Decedent and respectfully request that Letters be issued to '�
Louise S. Nicholson .
;'
�
> �/� _
11/07/2013 �
(Date) (S' twe , t ve r
404 Beetem Hollow Road
�so-��add�ss�
Newville, Pennsylvania 17241
(CGy,State,Zip)
Executed in Register's Offrce Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
party executing this renunciation and certified
before me this �� day that he or she executed the renunciation for the
of � , ��� . purposes stated within on this day
of ,
_� ; �� ���� �,�-� ��.r
eputy for Registe f Wills Notary Public
My Commission Expires:
(Signature and seal of Notary or other official qualfied to
administer oaths. Shrnvdate of expiration of Notarys comm'ssion.)
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