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Home My WebLink About12-06-13 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 Name: Daniel J.Tavlor File No: �� "�,3 - �%� a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 187-52-9084 Date of Death: December 2,2013 Age at death: 49 Decedent was domiciled at death in Cumberland County, pennsylvania (Srate)with his/her last principal residence at 121 Coventrv Drive,Carlisle,South Middleton Townshin,Cumberland Countv,Pennsvlvania 17015 Street address,Post Office and Zip Code City,Township or Borough CounTy Decedent died at 361 Alexander SnrinQ Road,Carlisle,Cumberland,Pennsvlvania 17015 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 Pennsylvania............................ All personal property $ 50,000.00 If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $ If not domiciled in Pennsylvania. ....................... Personal properiy in County $ Value of rea!estate in Pennsylvania......................................................... $ 'i��,nno.no TOTAL ESTIMATED VALUE. ... $ 350.000.00 Real estate in Pennsylvania situated at: 121 Coventry Drive,Carlisle,South Middleton Township,Cumberland Countv PA 17015 (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 Executar(s)named in the last Will of the Decedent,dated �Codicil(s) thereto dated - � T �../ � State relevant circumstances(e.g.renunciation,death of eacecutor,e� _� r=� --- � � � C`7 i9) � -.-,q �.:.5 Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,w�s-�a�2tiv�ed,was not ap�rCy Fo a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. §�32�);.�nd d��iot ha�a�'child born or adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated perso 4�' ~ �� G� ;Y� �NO EXCEPTIONS �EXCEPTIONS �� `';"; � � Yl� <...? .. ('„`; � B. Petition for Grant of Letters of Administration (If applicable) ` -i � ' � �� c.t.a.,d.b.n.,d.b.n.c.t.a.,pendent,P~1ite,durante a se tia,�ura�minoritate If Administration,c.t.a. or d.b.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 neither the victim of a killing nor ever adjudicated an incapacitated person. �NO EXCEPTIONS �EXCEPTIONS 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 Relationshi Address Lori Taylor wife 658 North Hanover Street,Carlisle,PA 17013 Devon M.Taylor c/o Lori Taylor daughter 658 North Hanover Street,Carlisle,PA 17013 Ava Taylor c/o Lori Taylor daughter 658 North Hanover Street,Carlisle,PA 17013 Form RW-02 rev.10/11/2011 Page 1 of 2 Oath of Personal Representative ofs��a�use onlY COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } Petitioner(s)Printed Name Petitioner(s)Printed Address Lori Ta lor 658 North Hanover Street Carlisle PA 17013 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 Decedent,tk�e Petitioner�(s)�rill we11 apd truly administer the estate according to law. c_��"` Sworn to,or affirmed and subscribed before :��`` , �� LI �"`--- Date %,� '� ' �3 me i ; day f ,�� C—i y�..�''—' Date By: Date For the Register n Date� H705.805 RPV(9/17) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee far this certificate, $6.��i Q��} ��i�� ,,,,��°'� This is to certify that the information here given is T� }, „ �,n��A��H OF pE�;y:_ correctly copied from an original Certificate of Death REG(S , L� OF �='��.1.� ,,�y> _ �;_ �''o`Z` r=; duly filed with me as Local Registrar. The original ?� `� =-. z= certificate will be forwarded to the State Vital �� 6 F Cl `i 13 ;° y a� Records Office for permanent filing. ° � �. � � � r� � Q � CLE�K �r� _�`��° - ��''�� C� � `'�+ /� �!pr �9lMENT OF�'�`P,�� ,vx�. o••-.,.�.+��-a�ex� �E/C 4�2 013 I'f J� V i�t3 tl 1 �''�.....iiiuu�dii C e rt i fi c a t i o n N u m b e r L o c a l R e g i s t r a r D a t e I s s u e d - )){[/ /}��(r}�R�( (`}j{.J1 (['��/1� _ _ _ _ __ _ _ _ _ ---- �- Type/Print In ��/�M 1.!`�1 Ll1 f 9� ��MONWEALTH OF PENNSYLVANIA�OEPAftTMENT OF HEALTH�VITAL RECORDS Permanent � Blacklnk CERTIFICATE OF DEATH StateFlleNUmber: 1.Decedent's legal Name(First,Middle,Last,SuHix) 2.Sex 3.Sociai Security Number 4.Date of Deatli(MO/Day/Yr)(Spell Mo) r� o�,r-,i �\ �. T �Y ��r M \ $-7 -S Z -�So8 T��a.,a-.. Z�o.^3 Sa.Age-Last 6trthday(Vrs) Sb.Under 1 Yaar Sc.Under 1 Da 6.Oate of Birth(MO/Oay/Year)(Spell Month) 7a.Btrthplace(City and Staie or Foreign Co�ntry) � �q Months Oays Ho�rs Minufes � ri` �3 '��y 1r� u p � 76.Birthplace(COUnry) � Sa.Residence(5[ate or Fo�reign Country) 86.Residence(Street and Numbar-Include Apt No.) Sc.Did Decedent Live in a Township'i" � � � �� . 121 CovEntY'y Dt� �Ves,decetlent ilved In South MiddletOn cwP. Sd.Residente(COUnCy) � � CL1211Y1@L'18T1G7. 8e.Residence(Zip Code) O No,decedent Ilved withln Iimlts of clty/boro. 9.Ever in US Armed Forces7 10.Marital Siatus at Time of Death �jJ Married O �Nidowed 11.Surviving Spouse's Name(If wife,give name prior to flrst marriage) �Yes [�No �Vnknown O Divorced � Never Married �Unknow L.OL'1 Price 12.Fathe�'s Name(Firsi,Middle,lasf,Suffix) � 13.Mother's Name Prl [o First Marriage(First,Midtlle,Last) � Joseplz R. Taylor ' t�7artha Pe�German 14a.Info�mani'S Name 146.Relation5hip to Decedent 14c.Informant's Mailing AdCress(Street and N�mber,CI $tat Zip Co Lori Taylor wife 658 N_ Hanover Street, Car�is�e, ��, 17013 G � .. ssa.c ace o oeac c e� o e � _ If Death OccWrred In a HosplEel: I� Inpatien[ � �if Death Occu�red Somewhe�e Ofhe Th�an a Hospital �Hospice Facility t]Oacedent's Nome ° O Emergency.Room/OUtpatlent O Dead on Arrival � Nursing Home/LOn -Term Care Facllity �Other(Specify) � 15b.Facllity Name(If not inscifution,give street and number) '15c.Clfy or Town State, d Zip Code � 15d.County of Death� � Carlisle Re ional Medical Center Carlia�e, PA 17015 Cumberland $ 16a.MeShod of Disposiiion � Burlal � Cremation 16b.�afe of Disposition 16c.Place of Disposition(Name of cemetery,crematory,o�other place) a Remo�ai f�om s�a�e o oo„ano., �c 9, 2013 Mt. Ol ivet Cemetery � � Other(Specify) � 16d.Locetion of D7sposiYlon(Ciiy or Town,State, d Zip) 17a.Sig re af FunCral Se Icensee or Person in Charge of Interment 17b.license Number s New Cumberland, PA 17070 138504 � E 17c.NaTe and Com lete Adtlress of Funera Facility 8 flo££man-�7.oth E'unera�l Home & Crematory, 219 North Hanover Street, Carlisle, PA 17013 m 18.Decedenc's Ed�catlo�-Check the box that best describes the 19.DeceCent of Hispanic Origin-Check the 20.Decedent's Race-Che<k ONE OR MORE races to Indtcaie what f- highest tlegree or level of schoot complefed ai the time of tleaih. box that besC describes whether xhe decedent the decetlent constdered h(mself or herself to be. � 8th grade or less is Spanish/Hispanic/LaHno. Check the"NO" � No diploma,9th-12th grade box if decedent is not 5 �Wh�Ce � Korean � High school gratluate or GED completed No,noi 5 ish H�SPanlsh/Hlspanic/Latino. O B�ack or African American � Viefnamese Some college cretlit,b�i no degree �. Pan / panic/Latino � American Indian o�Alaska Native Q Other Asian O Associa[e degree(e.g.AA,AS) �Yes,Puerto Rican%'car�American,Chtcano O Asian Intlian O Na�We Hawailan 0 Bachelor's degree(e.g.BA,A6,BS) �Yes,Cuban O FIIIi^Ino � Guamanian or Chamo�ro _ � P � Samoan Q Master's degree(e.g.MA,MS,MEng,MEd,MSW,M6A) �Yes,other Spanish/Hlspanic/Latino O Japanesc 0 Othe�Pac(flc Islander � � �octorate(e.g.PhD,EdD)or ProfesSlonai degree (Specify) � Other(Specify) .MD DOS OVM LLB lD 21.D�cedent's Single Race Self-Designation-Check ONIV ONE to indicate what the decedent canslderetl himself or herself to be. 22a.De�etlent's Usual Occupation-Indicate type of work QL WhIYe �Japanese � Samoan donc during most of wo�king Iife. DO NOT USE RETIRED. O Black o�AfNCa�Am¢rican � Korean � Other Pacific Islande� p� �Ame�ican Indlan or Alaska Nafive �Vletnamese � Don'i Know/NOt Su�e Se1��710E Manager 7� �Asian Indian � Oiher Aslan � Refused 226.Kintl of Business/Industry � Chin � Native Hawailan � Other(Specify) a � Filipino O �� cna..,o��o Car' Dealership ITEMS 23a-2Sd M1JST BE COMPLETED 23a.Dateanr ed Dead(MO/�ay Vr) 23b.SI ture of Person Pronouncing Oeath(Only when applicable) 23c.Lic0n5e Numbe� BY PERSON WMO PRONOUNGES OR ��u� O � CERTIFIES OEATH � �/�� /_ /�� 23d`Dat Igned( /Day/Yr) 24.Tj��Oi D atli '� � �� Z V o 25.Was Medicai Examiner or Coroner ConiactetlT � Yes l$� No CAUSE OF DEATH Approximate 26.PaK 1. En(er the chaln of e enis--diseases,in)uries,o mplicatlons--tha[directly caused[he death. DO NOT enter terminal e enis such a ardiac a est, , Interval: respira[ory arrest,or vent�icular fibrillation without showing the etiology. DO NOT ABBREVIATE. Ente�only one cause on a Iine. Add addiiional Iines if necessary. 1 Onset�o DeaYh IMMEDIATE CAVSE --------------> a. U�»LC br«�n �n�cJ-�'� � (Final tliscasc or condition Dtie to(or as a seque ca of): resulting in death) con ; . b, C G��\0 G. G'�Y fr Y� � . � sea�enctauy��sc coodicio..:, oue co(or a conscquence or): � If any,leadingato the caus � �±5 � Iistetl on IInG . Enie�thee Y G S�a �0."C a�-� T �,�y�„-.� � UNDERLYING CAUSE Due to(or as a consequence o�: (disease or in)ury that ' � = IniUated the events res�lting d. ' 1 In death)lAST. Oue to(o as a consequence of): � y � J 26:POrt 11. Eriter other si¢nlflcanC conditions conTrl6utln¢to death buT not resulc'ing in the underlying cause given in Part 1. 27.Was an avtopsy performed? a O Y�s � No .`�. 28.were autopsy findings available Yo complete the cause of deathT $ O Yes No _ 29.If Female: 30.�Id Tobacco Use Contribufe to DeathT 31.Manner of Death 0 0 Not p�egnant within past year 0 Yes � Probably � Natural � Homfcide � � Pregnant at Hme of death � No [$Vnknown O A«�dent � Gending InvesHgatlon � Not pregnant,but pregnant wichin 42 days of tleath 0 Suicide � Could nof be determinetl � � Q Not pregnant,buY pregnant 43 days to 1 year before death 32.Data of Injury(Mo/Day/Yr)(Spell Month) � Unknown if pregnant within the past year 33.Time of Injury � 34.Place of Injury(e.g.home;construction site;farm;school) 35.Location of InJury(Street antl Number,City,Caunty,State,Zip Cotle) 36.Injury at Work 37.If Transportation Injury,Specify: 38.Describe How Injury Occurred: � Ves O Oriver/OOeraior � Pedestrlan Ol � No � Passenger � OiFier(Specify) � O39a.Certifier-physician,certified n�arse pracfitioner,medical examiner/coroner(Check only one): _� ( �j��rtitying only-To the best of my knowledge,death ott�rretl due to the cause(s)and manner stated. � �Pronouncing 8.Certifying-rTO(he best of my knowledge,death occurred at tFie time,date,and place,and d�a to the ca se(s)and manner stated. � � Medical Examiner/COr e -On the basis of examinailon and/or InvesHgallon,in my opinlon,death occurred at the time,daie,and piace,and d�e to th�y e(s)'`d tated. �` Signalure of certiffer . Tiile of certifler. �� Uce a Number.I"/� �H�/�6 39b.Namc,Addr¢ss and 2ip Code of Person Completing Cause of�eath(liem 26) (/y `C,,e 5 9c afe 51 �ed(MO/Oay/Vr) � '�6/ Exs-� 'e f,.- � 7 2 20/ 40.Regisir �O{strlcC NVmber 41.Registrar's Signaf r0 42.R gistrar File Daie(MO Day r) � o��- �� .v��:'��.�'�c- e�r- '�e�_ � 43.Amendments � O � Disposttion Permit No. C J�p�J C1�+ H105-143 REV 07/2012