HomeMy WebLinkAbout10-31-05
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Register of Wills of __ Cumb~rlanL__ County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Scott Ian No. 021 - 05 - CA 51o
also known as
, Deceased
Social Security No. 225-98-1279
David A. DeCreny Sr.
Petitioner(s), who is/are 18 years of age or older, appl(ies) for:
(COMPLETE 'A' or 'B' BELOW)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the
the Decedent, dated and codicils dated
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
00 B. Grant of Letters of Administration
(c.t.a; d.b.n.c.t.a; pedente lite; durante absentia; durante minoritate)
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:
Name
elationshlp
esidence
)
See attached schedule
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her family
or principal residence at 203 Wood Street, Camp Hill, Pennsylvania
(list street, number, and municipality)
Decedent, then 48 years of age, died 10/16/2005 at 203 Wood St., Camp Hill
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
$
$
$
$
situated as follows: 203 Wood Street, Camp Hill, Pennsylvania.
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant
of letters in the appropriate form to the undersigned:
yped or printed name and residence
David A. DeCreny Sr. 205 Wood Street
Camp Hill, PA 17011
Prepared by the Pennsylvania Bar Association
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Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) or affirm(s) that 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, Petitioner(s) will well and truly administer the esta~ according to law.
Swom to o,"ffionod aod "Os""od /' J:?~ ~~ ~
Id A. DeC ny Sr
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before me this .:::;>, - day of
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PM. ~. C~ For the Regis
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No. c..J1- O~ - 0 Cf5<.o
Estate of
Scott Ian
, Deceased
also known as
Social Security No: 225-98-1279
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Date of Death:
10/16/2005
AND NOW,
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are hereby granted to
David A. DeCreny Sr., Administrator
, in consideration
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(c.I.a.; d.b.n.c.l.a.; pendente lite; durante ~~entia; ~nte miiiqr~~~)
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of the Petition on the reverse side hereon, satisfactory proof having been presented before me,:
IT IS DECREED that Letters 0 Testamentary 00 of Administration
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in the above estate and that the instrument(s) dated
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described in the Petition be admitted to probate and filled of record as the last Will of Decedent.
FEES
Letters........................................$ (:J(PO. OD
Short Certificate(s).....................$ L.{ 0 .DO
Renunciation..............................$ 15 . 00
Affidavits ( )...........................$
I.D. No: 29078
The Wiley Group, PC
Address: 130 W. Church Street
Extra Pages ( )....................$
Codicil........... '" ........ ... .., ..n...... ..$
Dillsburg, PA 17019
JCP Fee.....................................$ 10 . cC)
Telephone9717-432-9666
Inventory........... ........... ....... .n. ... $
E-Mail:
OtherG.M.'"'~.~:~~~........$ S. 00
TOTAL............................$ 330 . c0
Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner Group, Inc.
Form RW-1(1991)
In the Court of Common Pleas of
IN RE:
Estate of
Scott Ian
also known as
Name of Decedent:
Date of Death:
Scott Ian
10/16/2005
Name
DeCreney, Dennis M
DeCreny, B. Vesta
DeCreny, David A Sr
Purcell, Diane E
II
Cumberland County, Pennsylvania
ORPHANS' COURT DIVISION
NO.
I Deceased
Social Security No. 225-98-1279
Petition for Grant of Letters
(Continued)
Relationship
Brother
Residence
4301 Columbia Pike
Arlington, VA 22204
Mother
203 Wood Street
Camp Hill, PA 17011
205 Wood Street
Camp Hill, PA 17011
271 Crawford Drive
Churchville, VA 24421
Brother
Sister
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This is to certify that the information here given is correctly copied from an original certificatc of dcath dul filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for pcrmanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 11931,1.09
No.
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Fee for this certificate, $6.00
OCT 1 8 2p05
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
Rev. 1/91
Cumberland
203 Wood Street
N
AGE (Last Birthday)
UNDER 1 YEAR
Months Days
Ian
UNDER 1 DAY
Hours Minutes
SEX
2. Male
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
NAME OF DECEDENT (First. Middle, Last)
"
Scott
~. 225-98-1279
48
Yrs.
DATE OF BIRTH BIRTHPLACE (Cily and PLACE OF DEATH (Check only one see instruclions on other side)
(Month, Day. Year) SIale or Foreign Country) HOSPITAL
Inpatient 0
8..
FACILITY NAME (If not inslitulion, give street and number)
g=ifY)0
5.
. COUNTY OF DEATH
Mean Indian, Black, White. etc,
8b.
8c.
WAS DECEDENT EVER IN
U,S. ARMED FORCES?
Yes 0 NO)(
12
18,
FATHER'S NAME (Fits\, Middle, Last)
203 Wood Street
Camp Hill,PA 17011
178. Stale
P p n n ~ y 1 .", ~ '1 i;:tl ~edent 17C.O Yes, decedent lived in
flveina
Cumberland townohlp? 17d~~hi~e~~~7\;:::::'ot Camp Hill
MOTHER'S NAME (First, Middle, Maiden Surname)
~ B. Vesta Kimes
INFORMANT'S MAILING ADDRESS (Street. CitylTown. Stale, Zip Code)
.203 Wood St.,Cam Hill,PA17011
PLACE OF DISPOSITION - Name of Cemetery, Crematory LOCATION - CityfTown. State, ZIp
",Othe' "'ace 1 7 0 R 8
21$;on l<a:haefferstown, PA
Lemo PAl17043
IWp,
17b. Coun
citylboro.
18.
INFORMANT'S NAME (Type/Prinl)
Stanley Kenneth DaCreny
O.
METHOD OF DISPOSITION
Burial D. Crematlon~ RemovalfromStateD
Other (Specllyl
B.
Vesta
Items 24.26 must be completed by
person who pronounces death.
23a.
TIME OF DEATH
. DATE PRONOUNCED DEAD (Month, Day, Year)
October'16, 2005
23b. 23c.
WAS CASE REFERRED 10 MED~L EXAMINER/CORONER?
2&. Ves vx.. II., ~ IJ l-io 0
:~roxlmate PART II:
I ,nterval between
~ onset and death
:
,
,
24. 9: 00 A. M, 25.
27. PART 1: Enter the diseases, Injuri9S or complications which caused the death. Do not enter the mode of dying, such as cardiac or respiratory arrest, shock or heart failure.
List only one cause on each Une.
IMMEDIATE CAUSE (Final
disease or condition
resulting in death)-----'
.,
Autoerotic Asphyxia
DUE TO (OR AS A CONSEOUENCE OF):
'MEDICAL EXAMINEAlCORONER
On the b.sl. of examination and/or Investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and
manner ae etated.. . . . . , . . . . . . . . . . . .. ....,........................................................................
318.
REGISTRAR'S SIGNATURE AND NUMBER
1.)1 II oJ /ii'
INJURY 1IJ WORK?
Sequentially Us! condItions
If any, leading to immediate
cause. Enter UNDERLYING
CAUSE (Disease Of inJUry
thaI initiated events
resulting in death) LAST
DUE TO (OR AS A CONSEQUENCE OF):
c,
DUE TO (OR AS A CONSEQUENCE QF):
WAS AN AUTOPSY
PERFORMED?
d,
WERE AUTOPSY FINDINGS
AVAILABLE PRIOR 10
COMPLETION OF CAUSE
OF DEATH?
MANNER OF DEATH
Yes 0
NO~
Ves 0
No 0
Accident
Pending Investigation
DATE OF INJURY TIME OF INJURy
(Monlh. Day, Year) Aprx.
o Oct.16,2005
o 300. 3Gb. 9: 00 A. M.
o PLACE OF lNJURY - At hOme, tarm, street, factory, office
~~~ing, ate. (Specify) Home
Yes 0 NO~
~OC.
Natural
o
J8.
o
Homicide
281. 28b.
CERTIFIER (Check only one}
.CERTIFYING PHYSICIAN (PhYSician certifying cause of dealh when another physician has pronounced death and completed lIem 23)
To lhe best of my knowledge, dealhoe~U"edduetothecau..(s)andmannerIl8stated.................... _... _...."......
Suicide
29.
Could not be cfefermlned
Hill, PA
o
Coroner
.PRONOUNCING AND CERTIFYING PHYSICIAN (PhySician bOth pronouncing dealh and certifying 10 cause of death)
To the beet 01 my knowledge, death occurred al Itle time. date, and place, and due to the c8uee(s) and manner as stated...,.,.....
o
34.
RENUNCIATION
County, pennsy,vlnia
Register of Wills of
Estate of
Scott Ian
No.
also known as
, Deceased
The undersigned,
B. Vesta DeCreny ,
mother
of
(Relationship) (Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to
David A. DeCreny, Sr.
WITNESS my/our hand(s) this B . l(J;-l6...0 () ~ ~I day of J ()/ ;;;;:2-?-~ 5'"
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(Signat~ l
203 Wood Street
cam~ Hill. PA 17011
(Address
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Swom to or affirmed and subscribed
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before me this ~~ day
(Address)
My Commission Expires:
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission.)
COMMONWEALTH OF PENNSYLVANIA
NotariaJ Seal
S. Dawn Gladfelter, Notary Public
Dillsburg 80m, York County
My Coomission Expires May 17,2009
Member. PennsylvanilNOTtl<iat~emlrlllliatiOns executed outside the Office of Register ofiWills
in some counties are required to be notarized.
Prepared by the Pennsylvania Bar Association
Copyright (c) 2004 form software only The Lackner Group, Inc.
Form #R1II,-4(1991)
Register of Wills of
Estate of
Scott Ian
also known as
The undersigned,
Diane E. Purcell '
sister
County, Pennsylv nia
RENUNCIATION
No.
. Deceased
(Relationship) (Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to
David A. DeCreny, Sr.
WITNESS my/our hand(s) this
Sworn to or affirmed and subscribed
before me this
day
of
Notary Public
My Commission Expires:
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission.)
Prepared by the Pennsylvania Bar Association
Copyright (c) 2004 form software only The Lackner Group, Inc.
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271 Crawford Drive
churfhville. VA 24421
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NOTE: Renunciations executed outside the Office of Register o~ Wills
in some counties are required to be notarized.
Form #RW-4(1991)
Register of Wills of
Estate of
Scott Ian
also known as
The undersigned,
Dennis M. DeCreny
brother
County, Pennsylvania
RENUNCIATION
No.
, Deceased
(RelatIonship) (Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to
David A. DeCreny, Sr.
WITNESS my/our hand(s) this
Sworn to or affirmed and subscribed
before me this
day
of
Notary Public
My Commission Expires:
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission.)
Prepared by the Pennsylvania Bar Association
Copyright (c) 2004 form software only The Lackner Group. Inc.
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4301 Columbia Pike Apt. 632
Arlin~ton. VA 22204
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NOTE: Renunciations executed outside the Office of Register of Wills
in some counties are required to be notarized.
Form #RW-4(1991)
of
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STATE OF PENNSYLVANIA
SS
COUNTY OF YORK
On this the 31 ST day of OCTOBER, 2005, before me, S. Dawn Gladfe~ter, a Notary
Public, the undersigned officer, personally appeared DAVID J. LENOX, ESQUI~, known to
me (or satisfactorily proven) to be a member of the bar of the highest court of safd state and a
subscribing witness to the within instrument and certified that he was personally present when
DENNIS M. DeCRENEY and DIANE E. PURCELL, whose names are subs~ribed to the
attached Renunciation(s), executed the same; and that said persons acknowledged that they
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
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NOTARY PWBLIc
MY COMMISSION EXPIRES:
COMMONWEALTH OF PENNSYLVANIA
NaariaJ Seal
S. Dawn Gladfelter, Notary Public
DilIsburg Boro, York County
My Comnission Expires May 17, 2009
Member. Pennsylvania Association of Notaries
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