HomeMy WebLinkAbout12-27-05
Thi' i~ to certify that the infomlation here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanen~ filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
p
1,06L14ll~~5
. 2 ~ " t
No.
H 105143 Rev '))67
~ ~~-,,,. ~.L, A.M
Local Registrar
(J rt -tLA/
it ;{{)o;;-
(
Date
NAME OF DECEDENT (First. Middle, la~l)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
DATE OF--OEATH (Monlh, Day,Year)
9 2005
TYPE./PRINT
'"
PERMA"E"T
.j!!.ACK INK
l',
\~~ :
STATE FilE NUM6ER
,
AGE (Last Birthday)
SEX SOCIAL SECURITY NUMBER
...i
2. Male 3 163 - 07
BIRTHPLAC~ (City and PLAC f A H Ch in
Slate or Foreign Counuy) HOSPITAl
Inpatlenl 0 OOA. 0
aa.
FACILITY NAME (If not inslilution, give street and number)
John
5. 92 Y,.
COUNTY OF DEATH
a..
Cumber land
DECEDENT'S USUAL OCCUPATION
t~f\/:::~I~tr;;~:o ~~all~~r~~rr:t
,.
FATHER'S NAME (Filst, Middle, la~l)
la Ferree Joel Trout
INFORMANrs NAME (Type/Print)
20a. Linda Hadcock
METHOD OF DISPOSITION
8uni:l1 0 Cremi:llior, ~tlmo\lal from Slate 0
Other (Specify)
RA ER
Hb. Coulll",
Cwnberland
Did
dacudent
live in a
township?
RII.Id8~e 0 ~;~tyl 0
RACE - American IndIan, B\ad., While, e\
(Specify)
10. ., White
SURVIVING SPOUSE
(lfw,le, glv. milldel111ame)
MARITAL STATUS. Married,
Ne...el Mimiea, Widowtld,
Divorced (Specify)
'4. Widowed
17<. 129 Yes. decedenll;''fl;n Upper Allen
Iwp
17d. 0 ~~~e~~~~~~:: of
city/boro
MOTHER'S NAME (First, Middle. Maiden Surname)
19. Naomi Ho
INFORMANTS MAILING ADDRESS (Street, CityfTown, Slate, Zip Code)
20b 2611 Brian Drive Panna OH 44134
PLACE OF DISPOSITION. Name of Cemetery, CremalOl"i
Of Other Place
}
2.
Z1. PA.RT I: EI\~.n. "'I......., Inj,HI.. Of eomp\IC.UOn. which el"..d Ih. d..th. Do nol.nUl' Ih. mod. Qf dyln". luch II e.rdlae or r..plratory an..1, Ihoek or hurt '.Uur..
Ult Qnly Qn. '.u.. on .Kh IIn.
,
1/.//,-
OUE TO (OR AS A CONSEQuENCE OF}
);/1. L~
DUE TO lOA AS A CONSeQUENCE Of)
-Iv --'h.;"" v'c....
//.-( ~, -1/ '
SeQucnllalty Ii:!ol conditions
It any, leading to immediale
. caU$e Ent.cr UNDERLYING
_ CAUS,~ (Disease or inlury
~ lhat Inltlaltod avenls
resulting on death) LAST
r
OUE TO (OA.AS A CONSeQUENCE. Of)
WERt: AUTOPSY FINDINGS MANNER OF DEA Tt
AVAILABLE PRIOR TO
CO lETiON OF CAUSE
OF. EATH?
DATE OF INJURY
(MGrlU\.Oilo'l. l'8Ilof}
Homicide
o
o
o :~~CE OF lNJURY
tlU~d,"g tllG. ,Speedy)
30a
l- I
Yes 0 No
Pending Investigation
Could nol be dt.:lcrrnJned
,al
o
o
Yo'O
No
f-
Z
UJ
Cl
UJ
o
UJ
Cl
o
:i
"-
z
28a 28b
CERTIFIE.R (Ct\ec~ only one}
.~~~~F:~~tGor~~\I~~~.~~~Sd~:th ~~g~i~i~~J: t~ 3.C:~iI~~I:~(:r~~~~r,g~X~i~a~sh:t~t:d~~~~~~~_~ .~~~~~, ~f.l~ ,~~~~.~:~~.~ .I~~.~~ .~~?..
29.
-PRONOUNCING AND CfRTIFYING PHYSICIAN (Physician both pronouncing death and Ctll1ifying tv Cduse of dE::slhl
To tt\. b...t of my "nowt.dB.. d6a\h occurTed at the tlmli, dale, and place, and due to the caul8s(s) and manner aa ..tahld..
.MEDICAl EXAMINER/CORONER
~:~~:rb::I:t::e~xamln.tlon and/or invQatlgatlon, In m~ opInion, ~eath occurred at the lime, date, and place. and due to the causrU(.) and 0
31a
REGIST
SIGNATURE AND NUMBER. l
. .:J./
A . '4! (' L~I\ /
jn~'rl' /;/,
~ { IJ..I IIJJ
PA
m 17055
,:,1J-
2..
; Approximal8
: interval between
. onslJl and death
ther signlficilnt conditions contributW1g 10 death, but
not resulting in the underlying cal.lse gillen in PART I
.:>
C.-,4 /-J
flVO
TiME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
Yes 0 No 0
;;\ (J (] rl
Register of Wills of
Cumberland
County, Pennsylvania
RENUNCIA liON
Estate of
John H. Trout
No. 21-05- \ tl S \
I
also known as
I Deceased
The undersigned, Robert Trout .
Son Named Co-Executor of
(Relattonshlp) (Capacity)
the above DecedelOt, hereby I'8nounce(s) the right to administer the estate and respectfUlly request(s) that Letters be Issued to
Unda Hadcock
WITNESS my/aur hancl(a) this
FIRS, ~~~OVEM8ER
(~..j ~
, .2Do 5.
Robert Trout
1720 Nahate Court
~\na. HI 96761
---R~ B 7un,t
(Signature)
L.~'
(Address)
(Signature)
Swam la or afftrmed and aubscribed
f st (Address)
before me this - day
of No~e'YlbeY zooS
~
NatelY PubllcLlSA N. FRANCIS
My Commission expires: Rhvutu~ '2.~, 1.008'
(SIgnatUte 8I1d 11881 Of NotaIy or oIher afIIclal
qUlllllled Ia admlnIsler oaths. Shaw date of
expIMtIon of NotlUy'I commission.)
Prepamll!l' \he PennaylYlll'llll Bar AlIlloclaUon
~ Ia) 2004 rllllll ea!IwInI Ol'llt 1lIe I.8cIu1er GnlIIp, 1m.
NOTE: Ranunclatlons executed outside the Office of Register ofWllls
In some counties are required la be notarized.
FlIIIII.RW-4(1B111)
Register of Wills of
Cumberland
County, Pennsylvania
RENUNCIATION
Estate of
John H. Trout
No. 21-06-
10 <; \
also known as
. Deceased
The undersigned, Robert Trout t
Son Named Co-Executor of
(RelatIOnship) (capaCIty)
the above Decedent, hereby IlInounce(s) the right to administer the estate and respectfully request{s) that Letters be Issued to
Unda Hadcock
WITNESS my/our hand{s) this
FIRS, ~~tDVEM8FR
(-J J.,J J
, ~Do5.
Robert Trout
1720 Nahale Court
(J~~~a. HI 96761
-R~B
(Signature)
---
h7VI~
t,~'
(Address)
(Signature)
Sworn to or affirmed and subscribed
f st (Address)
before me this - day
of No~e,..,,~ ZOOS
~
Notary PubllclfSA N. FRANCIS
My Commission Expires: ~Mj 'L.q,~o g
(Slgnatunllll1d seal Of HOIary or other oIIlclal
qtl8IIIIed 10 aatnInlslBr oaths. Show dale of
expIrallon of NoIaIy'I cammlsslDn.)
Pre~ I!Y the PennsYlvania Bar Association
CapjorIghl (e) 2004 rm. aa1lwtn anIy 11le I.RI:Icner Gfoup, lnc.
....)
c,
NOTE: Renunciations executed outslde the Office of Reglaler of Wills
In some counties are required to be notarized.
FU/IlI tlRW-4 (tllll1)
PROBATE COURT OF CUYAHOGA COUNTY
DIVISION OF THE COURT OF COMMON PLEAS
COURT HOUSE
CLEVELAND, OHIO 44113
JOHN J. DONNELLY
PRESIDING JUDGE
JOHN A. POLITO
COURT ADMINISTRATOR
MAGISTRATE
JOHN E. CORRIGAN
JUDGE
December 21, 2005
Glenda Farner Strasbaugh
Register of Wills and
Clerk of Orphans' Court
1 One Courthouse Square
Carlisle, P A 17013
In Re: Estate of John H. Trout, Deceased
Dear Ms. Strasbaugh:
Enclosed please find completed commission of Linda M. Hadcock, Petitioneril1 the
above-named estate.
Ms. Hadcock signed the commission in the presence of Magistrate John A. gglito.
C_.. _'
Very truly yours,
~
(~Li~tJ.('c/ l{;J {L~iL-
Barbara Wachs
Deputy Clerk
/bw
Enclosure
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Register of Wills of Cumberland County
State of Pennsylvania
SS:
,...!
C _
County of Cumberland
BE IT REMEMBERED, that I, Glenda Farner Strasbaugh, Register of Wills of
Cumberland County, Pennsylvania, do hereby commission you, John Polito, Court
Administrator of Cuyahoga County or one of your Deputies, to administer the Oath of
Personal Representative in the Estate of John H. Trout, late of Cumberland County,
Pennsylvania. Said Will bearing the date of May 20, 2003; a copy hereunto attached. By
virtue of the Act of Assembly approved July 11, 1917, P.L. 803.
IN TESTIMONY WHEREOF, I have here unto set my hand and affixed my seal
the 12th day of December, 2005.
Glenda Farner Strasbaugh/
Register of Wills
Cumberland County
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of John H. Trout
also known as
No. 21-05- / oS /
, Deceased
Social Security No. 163-07 -6580
Linda M. Hadcock
Petitioner(s), who is/are 18 years of age or older, appl(ies) for:
(COMPLETE 'A' or 'B' BELOW)
[!] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the Executrix
the Decedent, dated OS/20/2003 and codicils dated
Robert Trout has renounced
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:
D 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:
I Name Relationship Residence I
.
.
..
-
(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 325 Wesley Drive, Upper Allen Twp.
(list street, number, and mUnicipality)
\-.i-.
Decedent, then
92
years of age, died
10/09/2005
at Bethany Village Nursing Center, Mechanicsburg, PA 17055
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
66,000.00
$
$
$
$
situated as follows:
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:
I
Signature
Typed or printed name and residence
~inda . H'JdCO.Ck ... _ / /J ~. 11 Brian Drive
.-L~L",- /7J *- &C'~arma, OH 44134
4 -884-2639
I
Prepared by tha Pennsylvania Bar Association
Copyright (c) 2004 form software only The Lackner Group, Inc.
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 e~tate "xx> Ing,1o low. ~
Sworn to or affirmed and subscribed _ /7? _
Lin a M. Hadcock
day j)EC 2 1 2005
ri- ~
JOHN A. POLITO
COURT ~OMINI~TRATOR
PROBATE dJ{JMRegister
before me this
No.
21-05- 'D~I
Estate of
also known as
John H. Trout
, Decea$ed
Social Security No: 163-07 -6580
Date of Death:
10/09/2005
AND NOW,
. in consid~ration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 00 Testamentary 0 of Administration
(c.t.a.; d.b.n.c.la.; pendente lite; durante 'absentia; durante minoritate)
are hereby granted to Linda M. Hadcock, Executrix
:j1=G
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.~:::-~:)
(:.~'7
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," \'-~l
in the above estate and that the instrument(s) dated
5/20/2003
r:-J
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!"'...)
described in the Petition be admitted to probate and filled of record as the last Will of Decedent. 'Tf"/7 A , ('L.ol., t>1?tik.~ 0 --I
FEES t' -:; S D?\ ~~j l/VlflJ{U/ l "'1J_, " .... ~
Letters........................................$ <::J - u J~elltt.i f/l- /J1~: J2;.--c
. 2> /' ^), Register of Wi i:'" ~
Short Certificate(s).....................$ c7\ - V V co
Renunciation..............................$ 5- D () Attorney: Edward P. Seeber, Esq.
;
, ~ ""1
r:~'-')
(:~)
-ri
.n C)
. .'T-~
;-~I
Affidavits ( )...........................$
1.0. No: 76084
James, Smith, Dietterick & Corlnelly, LLP
Address: 134 Sipe Avenue
Extra Pages ( )....................$
~.....CA.n(\.n0................$
JCP Fee.....................................$
l/J. Do
10. DD
Inventory.. ........ ................. ..... .... $
other....... ..... .....lh1 to. ............$
Hummelstown, PA 17036
TeJephone1 717/533-3280
E-Mail: eps@jsdc.com
TOTAL........................... $
5.00
do~
Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner GrouP. Inc.
Form RW-1(1991)
]\\11'-"11111 ()111111(lll'l" (,"'dill Ill' 1 \11 (JIIIII' J.S.).(
November 23, 2005
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, P A 17013-3387
TH.
ESTATE
SECURITY
f-:")R1\ 1fT 'I /\
.-c,., .JVltJ ..r'."
Re: Estate of John H. Trout, deceased
Cheryl L. Baker, CP
Certified Paralegal
clb@jsdc.com
Dear Ms. Strasbaugh:
We represent the Estate of John H. Trout, who died on October 9, 2005 as a resident of
Upper Allen Township, Cumberland County, Pennsylvania. His daughter, Linda
Hadcock, is the named Executrix under the Will and is a resident of Ohio. We would ask
that you deputize the Court Administrator for Cuyahoga County, Ohio in order to
administer the oath of office to Mrs. Hadcock.
Enclosed are the following documents:
1. An original Death Certificate for Mr. Trout.
2. A copy of the Last Will and Testament of Mr. Trout dated May 20, 2003.
Mrs. Hadcock will provide the original Will to the Court Administrator in
Cuyahoga County.
3. An original and one (1) copy of the Renunciation executed by Robert
Trout.
4. An original and one (1) copy of the Petition for Grant of Letters
Testamentary.
5. An original and one (1) copy of the Estate Information Sheet.
The contact information for the Court Administrator in Cuyahoga County, Ohio is as
follows:
John Polito, Court Administrator
Cuyahoga County Courthouse
1 Lakeside Avenue
Cleveland, OH 44113
(216)443-8979
134 SIPE AVENUE
HUMMELSTOWN, PA 17036
MAILING ADDRESS
PO BOX 650
HERSHEY, PA 17033
TOLL FREE 1.800.942.3660
TEL. 717.533.3280
FAX 717.533.7771
www.jsdc.com
Glenda Farner Strasbaugh
November 23, 2005
Page 2 of 2
Thank you for your attention in this matter. If you have any questions, require any
additional information or documentation, or require a check prior to forwarding the
documents to Mr. Polito, please feel free to contact me.
Very truly yours,
C1r6{J L. Baker, CP
~-ed Paralegal
Enclosures
cc: Linda Hadcock, Executrix
11\1"'>\1'1"DII 1IIIU'I,,\c ((1",1,1 liP I III ()III,I' J.S.).(
November 30, 2005
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, P A 17013-3387
ESTATE
SECURITY
F{)H.lYILJL.i\ .
Re: Estate of John H. Trout, deceased
Cheryl L. Baker, CP
Certified Paralegal
clb@jsdc.com
Dear Ms. Strasbaugh:
Enclosed is check number 56167 made payable to the "Register of Wills" in the amount
of One Hundred Eight-seven Dollars ($187.00) representing the payment for probate fee
for the above-referenced Estate.
If you have any questions or require any additional information or documentation, please
feel free to contact me.
Very truly yours,
Cher I Baker, CP
Certified Paralegal
Enclosure
134 SIPE AVENUE
HUMMELSTOWN. PA 17036
MAILING ADDRESS
PO BOX 650
HERSHEY, PA 17033
TOLL FREE 1.800.9423660
TEL. 717533.3280
FAX 717533.7771
wwwjsdc.com
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
JOHN H. TROUT,
. P-te,t.~//'(!l./
k-/ l tal) eJh !J. Eel:
and
, the Testator and the witnesses, respectively, whose
na es are signed to the attached or foregoing instrument, being duly first sworn, do hereby
declare to the undersigned authority that we were present and saw the Testator sign and execute
the foregoing instrument as his Last Will; that the Testator signed it willingly, or directed another
to sign it for the Testator, that it was executed as his free and voluntary act for the purposes
therein expressed; that each subscribing witness in the presence and hearing of the Testator
signed the Last Will as a witness; and that to the best of our knowledge the Testator was at the
time of sound mind and memory, of lawful age, and under no constraint or undue influence.
JOflH~ II tf~
L~L xl Cld
~
..w;4 ;lJeJ1b
Itness
H. TROUT, the Testator, and
~S (~ /If. 11/ '()/Il.I2J (l,: Ie
SUBSCRIBED, SWORN TO and ACKNOWLEDGED before me, a notary public, by
El i WJJRfh ~ E.c J(
MAY 2 0 2003
and
, the witnesses, on this
r-t:~ (J,[
Notary Public
,~ J'ld 4/--P
.
(SEAL)