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Home My WebLink About12-16-13 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.Taylor File No: �� "�� ' �%2� 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 (srare)with his/her last principal residence at 121 Coventrv Drive,Carlisle,South Middleton Townshin,Cumberland Countv,Pennsvlvania 17015 Street address,Post Offce 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 real estate in Pennsylvania......................................................... $ 30�,nnn.no TOTAL ESTIMATED VALUE. ... $ 350,000.00 Real estate in Pennsylvania situated at: 121 Coventry Drive,Carlisle,South Middleton Township,Cumberland County,PA 17015 (Attach additional sheets,if necessary.) Street address,Post Offlice 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 �Codicil(s) thereto dated - �7 -,.. O ° C7 State relevant circumstances(e.g.renunciation,death of executor,et�j r'� -- (T� Ri 7 n C—J G+"� � -�- w_i t.� Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,w�o�2tiv�ed,was not a-parC}}4o a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. §�32�);.�nd dig�iot had��a�-c�ild bom or adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated perso� ` %� ,� � t_�' �NO EXCEPTIONS �EXCEPTIONS t°� � � �rA —� ; '�� ..-,.� �--? r � 5..... �'� �{� � x j�� B. Petition for Grant of Letters of Administration (If applicable) ' --i - c.t.a.,d.b.n.,d.b.n.c.t.a.,pendent�rte,durante a s'"tia, urax�tg minoritate If Administration,c.t.a. or d.b.n.c.t.a.,enter date of Will in Section A above and complete list of 6eirs. 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, ifnecessary): 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 Fo�nw oz .ev.ioi�iizo» Page 1 of 2 �� Oath of Personal Representative ors��a�use on�y 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 tra.�e and conect to the best of the knowledge and belief of Petitioner(s)and that,as Personal Representative(s)of the Decedenty T�ie PetitioneJr(s)ys�ill well a truly administer the estate according to law. c�..-.,r Sworn to or affii-med and subscribed before , , L' �``---- Date /�� 'C� � �� me i day�f ,_� (" �...�'�' Date $��: � � Date For the Register f � Date�.._ � � C17 '� � � � BflND Required: 1� YES Q NO To the Register of Wi[Is: � j� t� � �� '� �7. --�Z r:7 FEES: Please enter my appearance by m�-s� ' t�e below: �-;-,� �ri � �� f .. Letters. . . . . . $ 'C•� Attorney Si ature: ° ' %'"� G� � ( 8)Short Certificate(s). . . . . . �f� � r' r"" � _;".� , - � ~ ._._ ( )Coduc listion s. . . . . . . . . �'".' � ( ) - = ca ( ) :� -� ��_ i�s ( )Af£idavit(s).. . . . . . . . . . . �, t�--s C�� G Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: Bruce J.Warshaws s uire � �� Commission. . . . . . . . . . . . . . . . . . Supreme Court Other . . . . . . . . ID Number: 58799 1 . . . . . . fs.i�U ��y�.�.+� . . . . . . c�.l`� Firm Name: Cunningham&Chernicoff,P.C. �. . . . . . . . Address: 2320 North Second Street . . • • . • • • Harrisburg,PA 171 10 . . . . . . . Phone: 717-238-6570 X235 Automation Fee. . . . . . . . . . . . . . . J. Fax: 717-238-4809 JCS Fee. . . . . . . . . . . . . . . . . . . . . . Email: �jwnccla�nmc_cnm TOTAL. . . . . . . . . . . . . . . . . . . . . $ � DECREE OF THE REGISTER Estate of Daniel J.Tavlor File No: �� 3�'��2��j a/k/a: AND NOW, �� "f �.��,(�1,�:'�- , �'�'� ,in consideration of the foregoing Petition, satisfactory proof having been presented before me,IT IS DECREED that Letters Administration are hereby granted to Lori Taylor in the above estate and(if app�icable)that the instrument(s)dated described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s))of Decedent. ,, _ / �, .� ^ ,� il -� ,�� , ,��, �� ti Register of Wills � "�, 7 � � � �� a��.1i�1��l !�.�"��.�."� : Fo,�,nw oa rev.]0/11/2011 � �Page 2 of 2 H105.805 REV(9/I1) . LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.��C��t��` ��t'�� 4� �u��° � This is to certify that the information here given is �'"�SH DFp"" ��G(��'�� a� ��!�,�,� ,,,''''d�,P-_ - Ey" correctly copied from an original Certificate of Death �`L`� = y� dul filed with me as Local Re istrar. The ori inal ;``�o ` G: Y g� g� �� o �� certificate will be forwarded to the State Vital y � Records Office for permanent filing. :* *`\ P � � � � � � � � CLE�K C 'o ' - ��,� , � N S' C+J U�t T ��99lMENT OE,�`Eao�''� �`u"�.'� `!ex- D E� 4/2 013 ; �--.,,,,,,,,,,,,, C e rt i f i 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 _- - - (/�. /}��{ j[}�� L _ _ _ _ _--- _ _ ___ -- �- Type/P�Int In �� Y��/'��`�� aIJIMOMNEALTH OF PENNSYIVANIA•DEPAf2TMENT OF HEALTH�VITAL RECORDS Pe��'a�e�` ` CERTIFICATE OF DEATH Biack 1nk State File Number: 1.Decedent's Legal Name(First,Middle,Last,SuHix) 2.Sex 3.Social Security Number 4.DaSe of Oeath(MO/Oay/Vr)(Spell Mo) r� c�r, ; e_\ �'. T c�l�- (oi- M \ S-7 -s Z -�roa -0��..,k... -L zo.-3 Sa.Age-Last 61rthAay(Vrs) 56.Under 1 Year Sc.Under 1 Da 6.Oate oT Birth(MO/�ay/Year)(Spell Montti) 7a.Btrthplace(City and Statc or Foreign Country) 1 �� Months Days Ho�rs Minutes 18 11 P A pr:l Z 3 ��LP�'I 7b.Birthplace(COUnty) � � 8a.Residence(5tafe or Fo�eig�Co�n(ry) gb.Residence(Street and N�mber-Incl�de Apt No.) 9c.Did DCCedent Live in a TownshipT' 121 Coventr'y Dr-. �Yes,decetleni Iived In South Middleton i,,,,P. 8tl.Residence(COUnty)�� . CL1Ill}�CL'1311G�. � �8e.Residence(21p Code) �No,decedent Iived within Iimits of clty/boro. 9.Ever(n US Armed Forces7 10.Marital Stat�s at Time of Death g(J Ma i d p Widowed 11.Survlving Sp se's Name(If wife,give name prior to Hrst marNage) O`�es [�No 0 Unknown � Divorced � Never Married rr�Unknow Lori Price 12.Faiher's Name(First,Middle,Last,S�ffix) 13.Mo[her's Name Pri So Flrst Marriage(FIrSS,Middle,LasL) � Joseph R_ Taylor ' Martha Pe�German 14a.Informant'S Name 146.Relationship fo DecedenL 14c.1 formant's Mailing Address(SSreet and Number,Ci �taC Zip Code Lori Taylor wife 6-��'8 N_ Hanover Street� Car�is�e, P�, 17013 G _ _ _ �_ 15a_P ace o Deaf �C ec o e � � If Death Occurred in a Hosp(Fal� �(� InpaNent . �If Death Occurred Somewhere Othe Than a Hospital d Hospice Facility T7 DecedenC's Home � Q Eme�gency.Room/Outpatieni � � O Dead on Arrival O Nursing Home/LOng-Term Ca�e Facility �Oiher(Specify) � �d SSb.Faclllty Name(If not instit�tlon,give stree[and number) ,ISC.City or Town,Stafe, d 2ip Code 15d.Counry oT. each� � Carlisle Re ional Medical Center Carlisle, PA 17015 Cumber�and $LL 16a.MeShod of�ISpositlon � B�rlal � Crematlon 166.�ate of Disposition 16c.Place of Olspositlon(Name of cemetery,cremafary,o�ofher place) o Remo�ai+�ort+srate o oo„a��o„ nec 9, 2013 Mt. Olivet Cemetery � � o o=ne�(saeafv� . 16d.LocaSton of Disposition(Ciiy or Town,State, nd Z(p) 17a.Sig re of Funeral Se icensee or Person in Charge of Interment 17b.License Number � New Cumberland, PA 17070 138504 E 17c.Nam�and Com lete Adtlress of F�neral Facility 3 Hof£man-�2ot1-� Funeral Home & Crematory, 219 Norti-► Hanover Street, Carlisle, PA 17013 °� 1S.Decedent's Education-Ciieck the box that best describes ti�e 19.�ecetlent of Hlspanic Origin-Check the 20.DeceAenY's Race-C eck ONE Oft MORE reces to indicate what � highest degree or level of school completed at the Sime of deach. box Shat best describes whether the decetlent Tlie decedant considered hlmself or herself to be. 0 Sth grade or less Is Spanish/Hispanic/lat(no. Check the"No" �White � Korean O No diploma,9th-12th grade box if tlecedent is noC Spanish/Hlspanic/LaNno. � Black or African American O Vletnamese � High school graduate or GED<ompleted [�No,not Spanish/Hispanic/Lat(no �American Indian or Alaska Native � O[her Aslan Some college credit,but no degree O�'es,Mexican,Mexicar�Am¢rican,Chicano �Asian Intlian � Nat(ve Hawaiian 0 Assoclate tlegree(e.g.AA,AS) O Ves,Puerto Rican �Chinese � Guamanian or Ciiamorro � 6achelor's degree(e.g.BA,AB,BS) �Yes,Cuban � FIIlpino � Samoan � Master's degree(e.g.MA,M5,MEng,MEd,MSW,MBA) 0 Ves,other Spanish/Hispanic/Latino �lapanese � Other Paciflc Islander � O Doctorate(e.g.PhD,EdD)or Professlonai tleg�ee (Specify) O Oiher(Specify) .MD DDS DVM LLB JD 21.Decetlent's Single Race Self-Designation-Check ONIY ONE to indicate what[he decedent consideretl hlmself or herself to be. 22a.Decedent's Usual Occupation-Indicate�ype of work �White �Japanese � Samoan done during mosi of working Iife. DO NOT USE RETIRED. � Black orAfrican American � Korean 0 Ofher Pacific Islande� �American Indlan or Alaska Native O Victnamese 0 Oon't Know/NOt Sure .S.e1��710E Manager � 0 Asian Indtan � Other Asian � Reivsed 226.Kind of Business/Ind�stry � � Chlnese � Native Hawailan � Other(Specl a O Filipino p �„ �cna�„o��o �� Car DealersYaip ITEMS 23a-23d M VST BE COMPLETED 23a.Datea ran ed Dead(MO/Day Vr) 236.5t ure o Person Pronouncing Death(Only whcn appl{cable) 23c.License Number BV PERSON WHO PROMOUNCES OR �J oun CERTIFIES OEATH L Q � �� I�� 23d�Dai Igned( /Day/Vr) 24.Tj�/C�f D ath � � �(/� 25.Was Medical Examiner or Coroner ContactetlT � Ves �$- No CAlJSE OF DEATH ; App�oxlmate 26.PaK i. Enter the chaln of even[s--diseases,injuries,or compltcatlons--that directly causetl the death. DO NOT enter terminal evenis such as cardiac arrest, Interval: respiratory arresi,or ventricular fibrillation withou[sF�owing the etlology. �O NOT ABBREVIATE. Enter only one ca�se on a Ilne. Add additional Ilnes if neccssary. 1 Onset Co Death IMMEDIATE CAUSE -------------> a. G��KtG b�c�� '.�-,�"--� � (Ftnal disease or conainon ou�eo(or as a co.,seque ce of): � resulting In death) � b, C G��\O.c. G-r�t-��'� � � Seq�entially Ilst conditions, Due to(o a consequence of): � if any,leading io the cause • 5 � IlztQd on line a. Enter the Y G 3�t �G�'C 4y � C1\_\,X�$� � 1 UNDERLYING CAUSE � Due to(or as a conseq�ence o�: � W (disease or in)ury that . ` � F InlCiated the events resulting d. � � in tleath)I.AST. Due to(or as a consequence of): � � 26.Part 11�. E�fer other si¢nificanc conO'tions contrih tl t d th b�t not resulting in the�nderlying ca�se given in Part 1. �27.Was an autopsy pertormed7 � O Yes � No �' 28.were auiopsy flndings avaiiable to complete the cause of deathT � O Ves NO a 29.If Female: 30.Did Tobacco Use ConCribute fo peathT 31.Manner ot Death E O Not pregnant within past year O Yes � �+° � Pregnani at time of death O Probably � Natural � Homidde � Not pregnant,b�t pregnant within 42 days oF death � No ($Unknown � Accident � Pendingolnvestigatlon l �- 0 Not pregnant,but pregnant 43 days to 1 year before death 32.Date of In'u Mo Da /Vr 5 � Sulcitle � Could S be determined ` � Unknown if p�egnant within the past year � ry� � Y )� Pell Month) 33.Time of InJury 34.Place of Inj�ry(e.g.home;const�uction site;fa�m;school) 35.Location of InJury(Street and Number,City,County,Stafe,Zip Code) 36.Injury ai Work 37.If Transportatlon Injury,Specify: 38.Describe How InJury Occ�rretl: � Ves � Driver/Operator p Pedestrlan � O No � Passenger � Othe�(Specify) Q39a.CertiHer-physician,certiffed nurse practitioncr,medical ezaminer/coroner(Check only one): - ( ��2e rtlfying only-To Yhe best of my knowletlge,tleaih occurred due to the cause(s)and manne�sfated. � �Pranouncing 8.Cer[ifying-rTO the best of my knowledge,deaih occurred at ihe time,tlate,and place,anC due to She cause(s)and manner scated. ` � Medical Exam(ner/COr e -On che basis of examination and/or Invesilgation,in my opinlon,death occ�rred aL fhe time,date,and place,and due to tM1e cause(s) d �9 tated. \`� Signature of certitier- . Tttle of certifier: � Lice�se Num6e�:�� //�� 4 396.Name,Address and TIp Cod¢of Person Completing Cause of Death(Item 26) /iy LC,ie 9c a�e 51 ned(MO/�ay/V�) � �d l . �?..�l-r✓ �!�- : • 7 � `l�� 40.Regisf�� ' District Number . 41.Registrar'S Signat ar 5�_ `O �y J� �^� �42./Re�gisir�a�Flie Oate(MO Oay r) OC �fYt i-f:�C�+��'�t Qi(` �1JQ�, 43.Amendments O � Disposition Permit No. C� `1J lJ 7C� H305-143 REV 07/2012