HomeMy WebLinkAbout05-28-15 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF "&v/a4u�L COUNTY,PENNSYLVANIA
Petitioner(s) named below, who is/arc 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) the9 rant of Letters in the appropriate form:
Decedent's Information 1;L1 5^D59
Name: File No: . — I
a/kja: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: ,
Date of Death: 17- 2015 Age at death: 17 1
Decedent was domiciled at death in County,_ PA (State)with his/her last
principal residence at J"7 t90 A44 thr C42!p A,Zf I Pe--. /7 0
Street address,Post Office and Lip code City,Township or Borough County
Decedent died at Alars;L,1 *w-e-, /7,0 6 A 1,1y ffj
Street address,Post Office and Zip 0Ae City,Township or Borough Count3i, State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania........... .......... All personal property
Ifnot domiciled in Pennsylvania. ....................... Personal property in Pennsylvania
If not donticiled in Pennsylvania a. ....................... Personal property in County $
Value of real estate in Pennsylvania...... ............................................... $
4,074 e, TOTAL ESTIMATED VALUE. ... $ �LV I pim,
Real estate in Pennsylvania situated at:
(Attach additional sheets,rfnecessary.) 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 Executor(s)named in the last Will of the Decedent,dated f-,:Hud Codicil(s)
thereto dated
State relevant circumstances(e.g,renunciation,death of executor,etc.)
CD
Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was not diVbfc �dilig
.i.wagliot apqpty to i tl�
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. §3323(g),and:did'—hit ha4n chila.borivor
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
E�NO EXCEPTIONS M EXCEPTIONS
❑ B. Petition for Grant of Letters of Administration (If applicable) ry M
c.t.a.,d.b.n.,db.n.c.t.a.,penclente lite,duriatte absentia,dw-mite r6iftojcRte
1.1� r—
If Administration,c.t.a. or db.n.c.t.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 killing nor ever adjudicated all incapacitated person.
F—INOEXCEPTIONS [:)EXCEPTIONS
Petition;:i(s),after a proper search has/have ascertained th at Decedent Ieft no Will a nd wa survived by the following spouse(if any)and heirs(atta ch
additional sheets,if necessary):
Name Relationship Address
Form n1—v-02 rev.10/1112011 Page I of 2
Oath of Personal Representative official use Only
COMMONWEALTH OF PENNSYLVANIA }
SS: -6+o�
COUNTY OF
Petitioner(s)Printed Name Petitioner(s)Printed Address /�
�a ctpe 1 a es 2 3 (-o rrts Tr�Ace� 1-�« rris 6,, R 171a q
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 cedent,the Petitioner(s)will ell and truly administer the estate according to law.
Sworn t affirmed and subscribed before Date
me thi day of YY�Q a�(cJ Date
By: Qt^ Date
For the Register Date
BOND Required:❑YES �(No To the Register of Wills:
FEES: ` Please enter my appearance by my signature below:
Letters. . . . . . . .. .. . . . . .. . . . .. $ 0 Attorney Signature:
( 1 ) Short Certificate(s). . . . . .
( ) Renunciation(s).... . . . . .
( )
Codicil(s). . . . . . . . . . . . .
( ) Affidavit(s).. . . . . . . . . . .
Bond.. . . . .. . .. . . . . . . . . . . . . . . Printed Name:
7.
CommissiQn. . . . . . . . . . . . . . . . . . —� —� Supreme Court rr1
OtherV41 I 1:J ID Number: t c"
iAyim, i
y Y1i to
l �1 "�Z�� �.�Z--t....�'•"�Y.1 1� Finn Name: rr En.,- C2 c7
Address: t 7> r"t
v � -n
Phone:
Automation Fee, . . . . . . . . . . . . . Fax:
JCS Fee. . . . . . . . . . . . . . . . . . . . . Email: t--* U� =n;
TOTAL. . . . . . . . .. . . . . . .. .
. . Sz=
` DECREE OF THE REGISTER
Estate of e1ca-noy- MLLyy-' file No: ��f
a/k/a:
AND NOW, Ma U 1�5 , in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters
are hereby granted to 0=2�P F-- � V�
in the above estate and(if applicable) that
die instrument(s)dated KA UCAL 0-7 f d
described in the Petition be admittedto probate and filed of record as the last Will (and Codicil(s))of Decedent.
tA
i er of Wi
Form RI-V-02 rev. 1011112011 e 2 of 2
H105.805 REV(9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
R E C U TWAlW146.1 UsQiegal to duplicate this copy by photostat or photograph.
RDO'!S; WILLS
Fee for this certificat# � 2� C� 12 1� 4,I ,,,,fF����"'�-- This is to certify that the information here given is
��UU ii�� ,It, �p.TH OF pE�y_ correctly copied from an original Certificate of Death
r �k1`O� duly filed with me as Local Registrar. The original
CLF e Z certificate will be forwarded to the State Vital
"'' ?e Records Office for permanent filing.R PH
_ _ c
}�,{ .9 r E � ley / ` `/ 19 /z�
P 216 J 1 �S 2 7 �o�'O9 jMENT�E��P~?1
Certification Number """"""""'��� Local Registrar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH•VITAL RECORDS
Permanent
Black ink CERTIFICATE OF DEATH State File Number:
1.Decedent's Legal Name(First,Middle,fast,Suffo) Z.Sex 3.Social Security Number 4.Dale of Death(Mo/Day/Y1(Spell Me)
Eleanor Louise Murray Femal 193-16-7038 May 17, 2015
50.0,91-Iasi Birthday(Yrs) Sb.Under l Year 5e.Under 1 Da 6.Date of Birth(Mo/Day/Year)(Spell Month) 7a.Birthp7rG Q SLOne,r ip,elgn Country)
Months Days Hours Minutes Ci 1 Y%
91 July 14, 1923 7b.Birthplace(County) aye e
Ba.Resident,(Stateor foreign Country) eIt.Residence IS-and Number include Apt No.) Bc.Did Decedent live In a Township?
Pennsylvania 1700 Market St O Yes,decedmtlI.d In P.
Be.Residence(County)
Cumberland Be.Refill e.Ce(Zip Code) 17011 Q d,decedent llwdwithin limit,or Camp Hill chly/bore.
9.EVer In US Armed Forces? ]O.Martial Status,t Time of Deatn 0Married a-Widowed ll.SurYMN Spouse's Name(Ifwlfe.give name prior to first marriage)
❑Yes .B'Nd ❑Unknown 0 DlYorced 0 Never Marded 0 Unknown
12,Fathers Name(First.Middle,Last,SUNIx) 13."*I Name Prior to First Marriage(First,Middle,last)
John Nebraska Stella Stellnock
140.Informant's Name 14b.Relatlonshlp to Decedent Ilk.Informant's Mailing Address(Street and Number,City,State,Zip Code)
o Margaret Hayes Niece 2443 Harris Terr. Harrisburg, PA 17104
G _ _ u,.Place dDeII -cone) ___ _ ___
If Death Occurredlna Humph ❑
(. Inpatient Iif Death Occurred Somewhere0ther Th,n.W$Pltal: dMosPG Facility nDecedent's Home
I 2 O EmergencyRoom/Outp.ti'm 0 Deadon Arrival I ming Home/LoM'Term Care Facility O Other(Specl(y)
9 15b.Faclllty Name(it not Institution,give street and number( 15c.City or Town,State,and Zip Code 15d.County d(DeaN -
Manor Care Camp Hill, PA 17011 Cumberland
160.Method of Disposition $'Swill 0 Cremation I6b.Date of Disposition l6e.placeof DisposttIon(Nameofcemetery,crematory,orothe,place)
0 R-4 from sate o Den.1 o" Rollin Green Manorial Park
- ❑Other Specify) 5/21/15 g
Z16d.Location of Disposition(City or Town,State,and Zip) 17,.51{na ure fund, see or Person in Charge of Interment]]b.license Number
Camp Hill, PA 17011 ¢ ^_ FD 013239 L
e17c.Name and Complete Address of Funeral Faclllry
Neill Funeral Home Inc 3401 et St. Camp Hill, PA 17011
18.Decedent's Education-Check the box that best describes the 19.Decedent of Hispanic Origin Check the 20.Decedent's Race Check ONE OR MORE races to indicate what
o highest degree or level of school completed at the time of death. boa that best describes whether the decedent the decedent considered himself or herself to be.
0 9th grade dries, Is Span11h/Itmelli4/Latino.Check the"No" O<hite 0 Korean
0 No diploma,9th.12th gr,de boy if decedent is-1 Spanish/Hispanic/Lathe. 0 Black dr African Amerkan 0 Vietnamese
,er High school graduate or GED completed Eno,not Spmish/Hispanlc/Latino O American Indian or Alaska NatlYe ❑Other Asi,n
0 some calk{e credit,but ne del... 0 Yes,Mexican,Mexican Amerkan,Chkano 0 Asian Indian 0 NatlYe Hawaiian
0 Assdc1le degree(e.g.AA,ASI 0Yes,Puerto Rican ❑Chinese 0 Guamanian or Chamorro
0 Bachelors degree(e.g.BA,AB.BS) 0 Yes,Cuban 0 Filipino 0 Samoan
❑master's degree(e.g,MA,MS,MEng,MEd,MSW,MBA) O Yes,other Spanish/Hisp-di.,tine ❑Japanese 0 other Pacific Islander
0 Doctor-(e.g.PhD,EdO)or Professional degree (Specify) ❑Other(SPecify)
e..MD DD5 DVM LLB 10
Z1 O entNngle Pace Sell-Oeslgnatmn-Check ONLY ONE to indicate what the decedent considered himself or herselfto be. 220.Decedent's Usual Occupation Indicatetype of work
.�1Jhlte 01,P,nese ❑Samoan done during most If working life.DO NOT USE RETIRED.
❑Black orAfrkanAmerican 0 Korean ❑OtherPaclficlslander Insurance Adjuster
? 0 American Indlan or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure
0 Aslan Indian 0 Other Asian 0 Refused 22b.Kind of Business/Industry
y ❑Chinese ❑NatlYe Hawaii- [I Other(Speciry)
4 ❑Filipino 11Gua -l.n dr Ch.m- Commonwealth of PA
ITEMS 230.25 MUST BE COM P'E'ED Z3 a.Date Pronounced Dead IMo/Day r) 23b.Signature dl Person Pmmunc]M Death(Only when applicable) 23c.license Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH
23d.Date Signed(Mo/Day/Yr) 20.Time of Death
5:30 a7I ZS.Was MedkN ExOmineror Coroner Contacted? 0 Yes No
CAUSE OF DEATH I Approximate
26.Part1.Enter the chain of events Elseages,Injurles,drcompllcations.Hhatdirectlyu...Ifthe death.DO NOTenterterminal-entssuch as cardiac arrest, I Interval:
reiplratory arrest,or ventricularflbrlll tlo witlqut 5hovdM the eHolory DO NOT ABB IATE.Enter Doty one cause on line Add additional lines if necessary. I Onset to Death
a n
IMMEDIATE CAUSE ----------> S/lM
(Final di sea,inseorconditidn
,esu-IiAtloath) b. // `r •wM/'r _ `1 Vl'�1.,,�'1U21�1 �G1 �w,
s.geentidNlist conditions, od<to( ape o: J"
Ifany,leading to the cause 'AAAL�I��',I- ,oL ���.p I�yt�\/��\
list ed on lin.a.Enter lh. IV/W`�\ `nx`r'a-� I`/Y lel�''- 7jl�.'/
UNease o NGCAUSE c pye td'or esa con=eouence oN:
(disease juN wnt,at
re •xl
� initiated the events resulting d. (� -
in death)IAST. Due to for as a consequence of):
s 26.Pan ll.Enteroth-lmific-conditionse Mbutims to death but net resulting In the undedyingcrose{Men In Part 1. 27.Was an autopsy performed?
a 0 Yes
�I _/ 28.Were autopsy Fidingsavailable
m II/FSs V l '111JC u.V p/l�` m complete the ca u e f doth}
' V "_ ❑Yes
29 If Female: 30.151d Tobacco Use Conldbute to Dean? 31.Manner of Death
E of pre{nant wltMn pas[year 0 Yes 0 Probably Natural ❑Hdmlclde o
/{]Pregnant at Hme of death ..<No 0 Unknown ❑Accident 0 Pending Investigation
0 Not pregnanl,butpregn,nt within 120ays of death
7C 0 Suicide 0 Could not be determined
0 No[pregnant,but;::n n:
days to 1 year before death 32.Date df Injury IMO/Day/Yrl(Spell Month)
0 Unknown if pregnant within the past yea r 33.Time of Injury
34.Place of Injury(e.g.home;construction site;farm;school) 35.Locauon of Injury(Street and Number,City,County,State,Zip Code)
36.Ill.,
et Worts 37,If Transportation Injury,specify: 39.Describe How lnlury CK-nd:
0 Yes 0 Driver/OPerator 0 Pedestrlan
0 NO 0 Passenger 0 Other(Specify)
390. ertlFler Physlcian,cenIflednurse practitioner,medical examine,/cdroner(Ch.ckonlyone)'
ertlfying only-To the best of my knowledge,death occurred due to the cause(,)and mann,stated.
0Pronouncing&Certifying Td the best ofm n Mettle,deal occurred at the fime.dat.,and place,and due to the-se(s)and m-nerstated.
0 Medical Examinel/Vromer On the basis m1,,ti,n nd r i1Y*FdgltIcn,Inmy,pin I,n,de,t ccurretl at me nme,darc,ane place.and due to the e,usl(,)antl manner:tat-.
Signature of certifier: Title of certlihn: L/''V\ license Number. C�6ty
39 me,AdQpe and.P Code of Person CO ting Cau ,ID th Dte 26) 39c.Dat SiaG¢d(Mo/Day r)
a 1 hYe 7D1� T1nV f 1 11 l ( Zc�
40.Regls[rarSDistrtct Number Il.Reghlrar's Sl nature 42.Re lsirar Fl DatP(MO Day r)
i' 5 �fq ILS
43.Amendments
at
y-V7/7'7 H105-143
Dlspositlon Permit No. GGA / • ' / REV 07/2012
REGGf"; nrF 10L GF
FCA:fbk:8-}�1A -
MIS FIRY 28
LAS.' iO'LL AND TESTAMENT
ORP .F;, �. ...,
I, ELEANOR L. MURRAY, of Camp Hill, Dauphin County,
Pennsylvania, do make this my will, hereby revoking any and all wills at any time
heretofore made by me.
FIRST: I direct that my debts and the expenses of my last illness and
funeral be paid out of my estate as soon as may be convenient after my death.
SECOND: I give my entire estate, both real and personal, as follows:
A. I give 1/3 of my estate to my sister, Victoria M. Grottola, if she
survives me. If she should fail to survive me, then to her issue per stirpes
then living.
B. I give 1/3 of my estate to my sister, Catherine M. Adams, if she
survives me. If she should fail to survive me, then to her issue per stirpes
then living.
C. I give 1/3 of my estate to Margaret C. Hartley to hold in trust in the
manner hereinafter set forth:
1. The Trustee shall invest and reinvest the trust estate
in such a manner as the Trustee, in her sole discretion shall
-1-
FCA:fbk:8-10-10
determine, and shall make no distribution of the assets of the
trust until the seventeenth (17`h) birthday of Kyle Hartley.
At such time, the Trustee shall divide the principal of the
trust into as many equal shares as there are children of Adam
Scott Hartley and April Sue Hartley living at that time.
2. The assets of trust, if more than one, shall not be co-
mingled and shall be used solely for the benefit of the child of
each respective trust and for no other person.
3. The trustee shall distribute so much of the income or
principal of the trust as the trustee, in her sole discretion,
shall determine for the benefit of the child's health, welfare
and education.
4. When any child attains the age of twenty-five (25)
years, the trust for that child shall terminate and the balance
of the trust shall be distributed to the child free of any
restriction or limitation.
5. If any child for whom a trust has been established,
should die before reaching the age of twenty-five (25) years,
the principal and income shall pass to that child's issue per
stirpes then living.
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FCA:fbk:8-10-10
6. If at the time of distribution no child qualifies as a
beneficiary of the trust under the terms set forth above
at Paragraph C-1, then to the issue of Margaret C.
Hartley, then living.
D. In the event that Margaret C. Hartley is unable or unwilling to act
or continue to act as trustee, I appoint Fred C. Adams, Jr., as trustee with
full authority to carry out the terms of the trust.
THIRD: I appoint Margaret Hayes as Executrix of this my will. If she
in unable or unwilling to act or continue to act as my Executrix, then I appoint Fred C.
Adams, Jr., as Executor. I give to my Executrix, in addition to the authority conferred by
law, the power to compromise claims without court approval, and to sell any or all of my
property, real or personal, at public or private sale, at such time and for such price and
upon such terms and conditions as she may see fit, or in her discretion to retain the same
for distribution in kind. No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WHEREOF, I, ELEANOR L. MURRAY, the Testatrix
above-named, have hereunto subscribed my name and affixed my seal the �7-2 day
of , 2010.
Eleanor L. Murray
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FCA:fbk:8-10-10
Signed, sealed, published and declared by the Testatrix above named, as
and for her will in the presence of us, who at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as witnesses hereto.
(SEAL)
Fred C. Adams, Sr.
aLi 4" (SEAL)
Witness
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FCA:fbk:8-10-10
We, ELEANOR L. MURRAY, Testatrix, Fred C. Adams, Sr. and
D{' b r a ��� s , witnesses, respectively, whose names are signed to the
attached instrument, being first duly sworn, do hereby declare to the undersigned
authority that the Testatrix signed and executed the instrument as hers last will, that she
had signed willingly, that she executed it as her free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the presence and hearing of
Testatrix, signed the will as witness and that to the knowledge of each of them Testatrix
was at that time eighteen years of agcy or older, of sound mind and under no constraint or
undue influence.
Z/�k-4�� (SEAL)
Eleanor L. Murray
(SEAL)
F ed C. Adams, Sr. r
&&4# J ,fid."Pi--- (SEAL)
Witness
Subscribed, sworn to and
acknowledged before me by the
Testatrix, and subscribed and
sworn to before me by red C. Adams, Sr.
and 1e /. /A59 S,
witnesses, this ,Pday
of fil�iaSj, 2010.
Notary Public u
My commission expires:
COMMONWEALTH OF PENNSYLVANIA _
NOTARIAL SEAL -5-
MICHAEL R.CARANCI, Notary Public
Lemoyne Boro. Cumberland County
My Commission Expires June 15,2014