HomeMy WebLinkAbout07-13-06
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
~l?A-N
I\-. ~D t:
\)E'A.N ~.
No.
, "
,j
t' ;
j
also known as
G.oK
, Deceased
Social Security No.
511-36 - ~).t2-
Petitioner/51, who is/are 18 years of age or older, apply(ies) for:
(COMPLETE "A" OR "B" BELOW:)
El
A. Probate and ,Grant of Letters and aver that Petitioners are the executors named in the Last Will of the
Decedent, dated \ (1-k. :Thi0~ . d-OO~ and codicil(s) dated
,
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:
o
B. Grant of Letters of Administration
ld.b.n.c.t.a : pendente lite; durante absentia; durante mlnontatel
Petitioner{5} after a proper search has/have ascertained that Decedent left no Will and was survived by the folloWinq spouse)(if
anv} and heirs; '-,
I Name Relationshio Residence -
'-
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in e.-u.'^-~~b
~...).o T<.t:?Nc sr FWrL
New Lu~ClL.-L-mVD f.A- /'/07'0
Decedent then B I ears of a e died
..
Countv, Pennsvlvania, with he&last family or principal residence at
(list street, number and municipalitv)
J() f
~
200
eA:M.fJ I-H l(.
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl
(If not domiciled in PAl
(If not domiciled in PAl
Value of real estate in Pennsylvania
All personal property ...................................................................... $
Personal property in Pennsylvania .................................................... $
Personal propertv in County ............................................................ $
$
$
o
I ...........
Real Estate situate as 0 ows:
Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the qrant of letters in the appropriate form
to the undersiqned:
17/l0- "Ii
Form RW-l Page 1 of 2 (Dauphin County) - Rev. 9/92
615209.1
Oath of Personal Representative
Commonwealth of Pennsvlvania
County of
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foreqoinq Petition are true
and correct to the best of the knowledqe and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s) will well and trulv administer the estate accordinq to law.
Sworn to and affirmed and subscribed
before me this
L))
day of
\ \ ' 20 i\ I~
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Estate of
r,
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tl:)'c~,
Deceased
Social Security No:
AND NOW,
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Date of Death:
, 20 [, lc ,in consideration of the Petition
are hereby qranted to
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d.b.n.c.t.; pendente lite; durante absentia; durante minoritate
\ \ ,\,,;:....,<')<_f--'~
in the above estate and that the instrumentls) dated
described in the Petition be admitted to robate and filed of record as the last Will of Decedent.
FEES
Letters........................... $
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ReQister of Wills
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Short Certificate(s)....ll..'...
Renunciation................. .
Affidavit ( ).................
Extra Paqes ( )............
("~"';~a. '..', \ \
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JCP Fee...:;.. L~.l'.(:.........
Inventorv............. ..........
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Attornev:
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Address:
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Wt,RN1NG: it is illega! to dupHcate this cOP'!
.Jnotostat or
12625058
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JUL 032006
Re\l_01106
:>RINT IN
iANENT
:::KINK
1 r.'ame of Decedent (First. mKJdle.last)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
STATE FILE NUMBER
81
2-23-1925
3, Social Securrty Number
v"
'571
36
4 Dale of Death (Monlh, day~~
De.an Alan Cool<.
5 Age (lastbinhday)
7_ Dateo/Binh Monlh.da . ear
8_ Birth lace C
HCVlJr.i-6bWtg, P A
2, 2006
o ERlOut alienl
9
Other
o DOA 0 Nursin Home 0 Residence 0 Other. S ci
Was Decedent of Hispanic Origin? 10_ Race: American Indian. Black, White, etc
1si No 0 Yes (lfyes,specityCubarl, (Specify)
Mexicarl. Puerlo Ricarl, etc,)
whae.
Ea-6t Pe.nn-6boJr.o Twp. Ho.e.y Sp.(J[it HO-6pita.e.
most of werkin life: do nol slale retired 12 Was Decedenl ever In the US 13. Decedent's Education S eci
Kind of Business/Industry Armed Forces? Elementary/Secondary (0-12)
PO-6ta.e. Se.Jr.vic.e. 16 V" 0 No 12
16 Decedent's Mailing Address (Street. cilyAown. stille, zip code) Decedent's pO'
520 Re.no StJr.e.e.t Apt. 2 kl,,'Res;dence 17, 51", e.nYl-6t.{.(.van~a
New CUmbC0't.e.and, P A 17070 lib Co""~ Cumb0.e.and
hihest radeco leled
College (1-4 or 5+l
2
14 Marital SlalUs Married. Never maffled 15_ Surviving Spouse (If wife, give maiden name)
Widowed, Divorced (Specify)
DivOJr.c.e.d
Did Decedent
liveina
Township?
17c_ 0
Yes, Decedent lived in
__Twp
17d.lli
No, Decedenl Lived within
Actual Limits of
Ea-6t Pe.nYl-6bOJr.O
CityiBoro
18 Fathei's Name (FirSl.middle, last)
19. Molher's Name (Fits!. middle. maiden surname)
Robe.Jr.t K. Cool<.
Le.ah F. LU-61<.
208_ Informant's Name (TypeJprinl)
20b. Informanl"s Mailing Address (Street. cityll.own, stale. zip code)
De.an A. Cool<., JJr..
3810 DOJr.a DJr.ive., HaJr.Jr.i-6bu.Jr.g, PA
17112
FD013376L
21d. Location (Ci1y!l.own, stale, zip code)
o ReroovalfromStale
o DonaHon
21b_ Date of Disposition (Monlh. day. year)
7-3-c2dO&
22h_ License Number
22c. Name and Address of Facility
Inc..
To the best of my knowledge. death occurred at the time, dale and place staled_ (Signature and tille)
23b_ License Number
23c_ Dale Signed (Month,day, year)
00
26 Was Case Referred 10 a Medical ExaminerlCoroner'l
Ilems 24-26 musl becompleled by person
who prooounces death
24 Time of Death
OIl Yes 0 No J L
Item 27_ Pan I: Enter the chain of events - diseases, injuries, or complications -[hat direclty caused the death. 00 NOT enter terminal events such as cardiac arrest
'esPI"'o~ "',,', 01 ,enl,'oul" fit,,;I!,';oe "lha~"' ,hawleg Ih, "olagy. DO NOT ,bb'''~I, Eel" ocly a", '"u'" oc a I;"" k:. rL
IMME~IATECAUSE(Finaldiseaseor 1.1'~ ...:). 1 ~ /OJ _/ ~'1." ~ \f_L" : ., Itt"'~. 't
cocdrtoe"wl,;ng;ndealhl -3> a. ';~'Y'.LJ/~/<-<<-9/:j'LPlr/ '/1"_" LILIT-r'?_"V'>!<. A,_
!~0(9'asacon{equenceo0: ,- '.'l- ,. I / ./' iJ. I
SeQuentiallylislcondilions,ifa~y, b. U"l1?.>>t--t' obs-JV.,//-h.'-'!'r (t/~ ~___~ :y:;;t'i:.i'~T
leading to Ihe cause listed on line a Due 10 (or as a onsequence oQ , :(J ,
Enler the UNDERLYING CAUSE , ~"A r~<'-
(diseaseorinju~thatiniljaledlhe :., ~
evenls resu~mg In death} LAST ,
I Approximaleinterval'
; onset to dealh
Part II: Enter other sianificantcondiHonsconlribulinoto dealh.
butnotresul1ingintheunderlyingcausegiveninParll
28 Did Tobacco Use Contribute to Death?
.g-yes 0 Probabtv
o No 0 Unknown
o .
!Q.t/;-T/I/('.Kf 0/
{m ;/1(} fJ ~J.l:h
/
~;l t" rP'J
' ()
29 If Female
o Not pregnant wrthin 08St year
o Pregnantattimeofdeath
o Not pregnanl. but pregnant within 42 days
of death
o NOlpregnanl.butpregnan143dayst01 year
before death
o Unknown ifpregnanl wrthin the past year
32c, Place of Injury: Home, Farm. Street, Factory. Office
Buikling, elc_ (Specify)
DYes 0 No
30b. Were Aulopsy Findings
Available Prior to Complelion
otCause of Dealh?
DYes 0 No
31 Manner of Dealh
o Natural 0 Homicide
o Accident 0 Pending Investigation
o Suicide 0 Could Not 8e Delermined
32a. Dale of Injury (Month,day,year)
32b_ Describe how Injury Occurred
30a. Was an Autopsy
Performed?
32d. Time of Injury
321
32g_ localion {Slreel, cityllown, state)
M
33a_ Certifier (check only one)
Certifying physician (Physician certifying cause of death when anolher physician has pronounced death and completed Item 23)
To the best 01 my knOwledge, death occurred due to the cauSe{S) and manner as stated ......._................ .. ........................... .............................. .................~
Pronouncing and certifying physician (Physician both pronouncing death and certifying to cause 01 death)
To the best 01 my knowledge, death occurred at the time, date, and place, and due to the cause{s) and manner as stated ..................................................... ...............0
Medical examiner/coroner
On the basis of examination and/or investigation, in my opinion, death occurred at the time, date., and place, and due 10 the cause{s) and manner as stated ........0
33d Date Signed (Month. day. year)
35 Regislrars Si~~e and Dislricl ~eJt rr.--'
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(See instructions and examples on reverse)
Register of Wills of Cumberland County, Pennsylvania
RENUNCIA TION
Estate of be f\N f\.. ~ K
also known as )~ .1\-., ~o tc.
No.
~\ 't
~ ~ i
l'
i ....,.--~ ~/
~
, Deceased
The undersigned,
,At- t; ()1~1 ~. < 6x t
:5 c f~
of
(Relationship) (Capacity)
the above Decedent, hereby renounces the right to administer the estate and respectfully requests that
Witness my hand this
day of
~, CmKnL-
--.\)t- i ,2006.
.- . . /l I
([fUr {(T~
Letters Testamentary be issued to
u lic
ission Expires: f1tv I~l ZISDf.t;
\ NOTARIAL SEAL
I Megan T. McClain, Notary Public
City of Harrisburg, Dauphin County
l My commission expires November 18.2006
!---.-. "'-'.__..~
(Signature and seal of Notary or other otficial
NOTE: Renunciations executed outside the Office of Register of
Wills are required in some counties to be notarized.
Qualified to administer oaths. Show date of
expiration of Notary's commission,)
~-.-..j
6 \ 5208.\
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--.J
LAST WILL AND TEST AMENT
OF
DEAN A COOK
I, DEAN A COOK, of the Borough of New Cumberland, Cumberland County,
Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and
declare this as and for my Last Will and Testament hereby revoking and making void any and all
other Wills by me at any time heretofore made.
I.
I direct my Executor hereinafter named, shall pay all my debts and funeral
expenses as soon as conveniently may be done after my decease.
II.
I direct my Executor, hereinafter named to sell at public or private sale, or redeem,
or convert into cash, all the rest, residue and remainder of my estate, whether real, personal or
mixed, and wheresoever situate, and I give and bequeath the net proceeds derived therefrom in
equal shares, per stirpes, to my son, ALBERT E. COOK, my son, DEAN ACOOK, JR and my:
daughter, JACAL YN E. CLARK
III.
I hereby nominate, constitute and appoint my son, ALBERT E. COOK,.as - 1
I
Executor of this my Last Will and Testament. If he should predecease me, not qualify or not -
accept the position of Executor, then I hereby nominate, constitute and appoint my son, DEAN
A COOK, JR., as Executor.
IV.
I direct that my fiduciaries, herein named, shall not have to post bond for the
faithful performance of their duties.
IN WITNESS, WHEREOF, I, DEAN A. COOK, the Testator, have unto this my
Last Will and Testament, set my hand and seal this ~ day of
r, ~
,2002.
~(,J;~JQ---
(SEAL)
SIGNED, SEALED, PUBLISHED and DECLARED by DEAN A. COOK, the
above named Testator, as and for his Last Will and Testament in the presence of us who have
hereunto subscribed our names as witnesses at his request, in the presence of the said Testator
and of each other.
fA 2
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ACKNOWLEDGMENT AND AFFIDAVIT
STATE OF PENNSYLVANIA )
) SS
COUNTY OF CUMBERLAND )
We, DEAN A. COOK,
:.-: J }/h I~ ,I); 5"f'A J
and
Page 2 of 3
f /) t' It
jj;(( )", 5 I; () '-/
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, the Testator and the witnesses, respectively,
whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to
the undersigned authority that the Testator signed and executed the instrument as his Last Will
and that he signed, willingly, and that he executed it as his free and voluntary act for the purpose
therein expressed, and that each of the witnesses, in the presence and hearing of the Testator
signed the Will as witness and that to the best of their knowledge the Testator was at that time
eighteen years of age or older, of sound mind and under no constraint or undue influence.
/1). /f'. .!-
!of~~ ~l t~/
Testa or
(SEAL)
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. t4i{~/ a-i4 ~YlttJ./
Witness
(SEAL)
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(I!fci"
Witness
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j/{r{.l(fj)'j
(SEAL)
Subscribed, sworn to and acknowledged before me by DEAN A. COOK,
f / Ie h ;7/ (-{ ~}tl S I; (/ ~
/
I j i1,
, witnesses, this ~ day of
17r 5,'A)
'J'1 I, f
and
the Executor, and subscribed and sworn to before me by E ( J J I) t!
2002.
1 "
,', //fi;~h...
Notary Public
1-1.
Page 3 of 3
NOT!~R1AL SEAL
WILL1/,~!' !\. V\JCiJi'vI, Notary Public
I Carr:,; hi'! Ec.J. ' l.wlcerland County
M',! C:O,,:r11iS::'" June 27, 2004
L..............
Marjorie A. Wevodau
First Deputy
One Courthouse Square
Carlisle, Pa. 17013
Glenda Farner Strasbaugh
Register of Wills &
Clerk of the Orphans' Court
Kirk S. Sohonage, Esquire
Solicitor
(717) 240-6345
FAX (717) 240-7797
OFFICES OF
l\rgis'trr of awills' anb ((lrrk of tbr ~rpbans" ((ourt
ClCountp of ClCumberlanlJ
July 13,2006
Dean A Cook J1'.
3810 Dora Drive
Harrisburg, P A 17110
Dear Mr. Cook:
Before I can complete the grant of letters I will need you to complete the Estate
Information Sheet attached. Please complete the estate sheet attached and send back in to
the Register of Wills Department, 1 Courthouse Square, Carlisle, P A 17013.
Thank YOll for your cooperation in this matter.
Sincerely,
&~~~
Register of Wills