HomeMy WebLinkAbout02-09-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cu 1Y\U>A-' lud
Estate of
also known as
/YJ1f~&1I1( Fi
5,. Vt)IVt:1)
COUNTY, PENNSYLVANIA -'
~ \ \) -1 0 l~")
l (d' ~4 i' ~&"
File Number
, Deceased
Social Security Number
/(pl -"11J) /l]ljlJ
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
D A. Probate and Grant of Let ers Tes amentary and aver that Petitioner(s) i~he C, h\ ld f{Cr'l
last Will ofthe Decedent dated 1-\ - 0,3 and codicil(s) dated
named in the
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(State relevant circumstances, e.g., renunciation, death of executor, etc.)
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ofth~j~en~ offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
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D B. Grant of Letters of Administration
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(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durantetrlilidritatej
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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: (If
Administration, c.t.a. or db.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
I
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Name
Relationship
Residence
(COMPLETE IN ALL CASES:) Attach ~onal sheets ifnecessary.
Decedept w~fomiciled at death in ' 'Ja~ County, Pennsylvania with his
~ ~ ~. L
(List street address, town/city, t
tl!rincipal residence at
'--I \,\C:,SC:
Decedent, then ecq
years of age, died o~ uz:bu
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\ \ U\O'l at -\' ~'l Am
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Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(Ifnot domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
$ 8..100
)
$
$
$
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate ofthe last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
T d or rinted name and residence
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Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF G.v-I"\W ~ol..
SS
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 ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
before me the
<1
day of
Sworn to or affirmed and subscribed
.~
Signature of Personal Representative
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Social Security Number: \ UJ \: 9. S 2:;&D Date of Death:
AND NOW, C\ ~ e. b fl..,lCUU , (l00/, in consideration ofthel~regoing Petition, satisfactory proof
having been presented before me, IT IS D~ED that Letters ' 0 en 1R
are hereby granted to d,-O\. L f\{\cu.A 8 0 i
File Number:
Estate of
, Deceased
FEES
Letters .............. . $ Lt-~-d:>
Short Certificate( s) . . . . . . . . $ \ dcO Attorney Signature:
Renunciation( s) ......... . $
\ D~\\ $ (C' cO Attorney Name:
~~
~p $ I () .cC Supreme Court I.D. No.:
~ -00
$ ~
$ Address:
$
$
$
$ Telephone:
$
TOTAL ............. . $ blOO
in the above estate
and that the instrument(s) dated Hr" \
described in the Petition be admitted to probate and filed of reco d as the last Will
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Form RW.02 rev. 10. /3.06
Page 2 of2
HI05,805 REV 1105
This is to certify that the information 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 permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No,
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Local Registrar
Fee for this certificate. $6.00
P 13104586
JAN 0 8 2n07
Date
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3 REV. 0212006
E/PRtNT IN
RMANENT
ACK INK
1, Name of Decedenl (Fiffil. middle, last SuffiK)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
Dauphin
STATE FILE NUMBER
4
5. Age (lasIBirthday)
89 Y~
Bb. County of Death
Harrisburg Hospital
o Res"ence 0 0,"", Speci~
10. Race; American Indiirl, Blrl, While, ele
(Specify)
Whi te
1,. QecedenfsUsualOccu ion Kindofwor\l;donedurin moslofwork' ~le.Donolstaleretired
Kind of Work Kind of Business I Industry
Sales Clerk Bowmans Dept.
. 16 Decedenfs Mai~ng Address (Street. city I town, slate. zip code)
335 Wesley Dr. Apt. 321
Mechanicsbur . PA 17055
18. Falher's Narne (Firnl,middle, lasl.suffix)
Robert Borthwick
12. Was Decildenleverinlhe
U,S. Armed Forces?
DYes DNa
Decedenl's
Actual Residence 17a, Stale
13 Decedenfs Education ISped~ only h~t'es19'ade compleled)
Ele121CWY I Secondary (0-12) College (1-4 or 5+)
14. Marital Slatus: Married, Never Married,
WKlowed, O""'oced (Speci~)
Widowed
17b Coun~
PA
Cumberland
Did Decedenl
Uveina
Township?
He, m Yes, Decedent lived in
17d.D NO,DecedentUvedwithin
Acluallimilsof
Allen
Twp
City I 80m
2OB. Informant's Name (TypeIPrint)
Hu h Jones.III
,'.~ 19. Mother's Name (First. middle, maiden surname)
Margeret McCracken
2!ll. Infonnatll's Mailing Address (S~l, city llown, slale, zip code)
2 A mattox Ct. Mechanicsbur PA 17050
21b. Dale of Disposilion (Month, day, yew) 21c, Place of Disposilion (Name of cemetery. r::rematory or other place) 21d. Location (City Ilown, slale. zip code)
RollingCr~en M~mbrial Park
22c. NameandAdd'esso1Fd~ Myers- rner Funeral Home
1903 Market St... earn HilLPA 17011
Lower Allen Twp.
Complete Ue'''' 230-<: only when ce<1llyirg
physicilll is not available at ~me ofdealh to
certify cause of dealh.
Items 24-26 must be completed by person
who pronounces death.
238. To \he best of my knowledge, death occurred at \he time, dale and place slated. (Signature and title)
01-1" LIOlVYl em ]t'()U(l~ lO'It-}ZOC'l AO..AA''-C'-i7,'iW
24, Time of Death 25, Dale Prooounced Dead (Month, day, year)
23b, license Number
WlD
yy\Q,4'2..i'iw
23c. Dale Signed (Moolh. day. year)
:iCmUC'lt'\"J'1.j Cf-lt, '2..:/c..'-'
4:27
q.
6. 2007
26. Was Case Referred 10 Medical Examiner I Coroner for a Reason Other than Cremalion or Donation?
o Yes ~ Na
CAUSE OF DEATH (See Instruction. 8nd examples)
Item 27 PART I: Enter the ~gt~. diseases, inlUrles, or complications . thai directly caused the death, 00 NOT enter terminal evenls such as cardiac arrest.
respiratory arres!. or venbicular fibr~lation without showing the etiology, list only one cause on each line
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5 Lien"",
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P e z-} p ~1 co,/ l)CA;) u-< \a Y
disco>,
cmpnCj<:X'Yl C\
28. DidTobac:co~~tribuleIoDeath?
DYes ~obably
o No 0 Unknown
29. If Female'
~pregnant wilhinpasl year
o Pregnant allime of dealh
o Not pregnant, but pregnanl within 42 days
01 death
o Nol pregnant, but pregnatll 43 days 10 1 year
of death
o Unknown II pregnan1 within the pasl year
32c, Place of InJI.KY: Home, Farm, Streel, Factory,
Office Building, elc. (Specify)
: Approximateinlerval
: Qnset10Death
Part 11: Enler other sianilicanl conditions conlributina 10 deattl,
but 001 resulting in \he underlying cause given in Part I
=tiaIIy list conditions,. il an,Y,
Ie k:l cause listed on line a
Enter UNOERt. YING CAUSE
(diseaseorinJUf)' that initiated the
events resulling m death) LAST.
Due 10 (or as a consequence of)
f\ CO l2.T I C V A LVE
Due 10 (or as 8 consequence of)
iN<;uFFiCifNCY
Due to (or as a consequern:e of)
DYes rn-C
DYes DNa
31 Manner 01 Death
~",a1 0 Homickle
o Ac6denl 0 PerKlirg """"-
o Suicide 0 Could Nol be Determined
32d. Time of Injury
321. If Transportation Injury (SpecifyJ
o cmer I 0peraI0r 0 Passenger 0 Pedeslrian
o O\he" Sped'"
33b, Signature and Tille 01 Certifier
32g. location of Injury (Slreet. city I town. stale)
30&. Was.., Autopsy
Performed?
3Ob. Were Autopsy Findings
Available Prior to Com~
01 Cause 01 Death1
33a. Certifier (check only one)
Certlfytng physician (Physician cenifying cause of death when anolher physician has pronounced death and compleled lIem 23)
To the belt of my Imowtedge, death occurred due to the caUle(I).nd mlnner II stltejl_.. .... _ _ _ .... _ _ _.. _ _.. .. _.... .. _ ........ _.. .. _ _.. ..
~=:~:,.;; :==8~~=: ~t=,n:n~:::I:~ :t~~::Uo::f:~d manner n lt8ttd_ _ .. _.. _.... .. _ .... _.... .. .... .D
~:::~~":~;rn= and '.or investigation, in my opinion, dnth occurred lit lhe Orne, dete, end plaee,.nd due to the eaule(l) Ind l'I\InlMK" ItetflL_.D
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33d. Dale Signed (Month. day, year)
MO 421 <1 S-O ji:,nu(n"j Colt.
34. Name and AcXtress olPfnOn Who Completed Cause of Death (lIem 27) Type I Print
NA'>I~A'ffi V HAi...OI eUR I H<1mpd",v>
'5l,<;(, ',...t'f1(11 e fCc.cd ("m ~ Ihll e(1
2c'01
('h&\",'C.,'Glf' .A S,CU e;/.e,1
1'1011
0160226
LAST WILL AND TESTAMENT
BE IT REMEMBERED THAT
I, MARGARET S. JONES, a resident of Cumberland County,
Pennsylvania, being of sound mind, memory and understanding, do make,
publish and declare this to be my LAST WILL AND TESTAMENT, hereby
revoking any and all Wills and Codicils previously made by me.
I
I declare that I am not married, my beloved husband having predeceased
me, and that I have two (2) children, HUGH R. JONES and LINDA LEE
TROUTMAN.
II
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I direct that all my just debts and funeral expenses shall be p~ct?rr<?m IW
residuary estate as soon as practicable after my decease.
.
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III
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I direct that all taxes that may be assessed in consequence of my death,N
of whatever nature and by whatever jurisdiction imposed, shall be paid from
my residuary estate as a part of the expense of the administration of my estate.
IV
I give, devise and bequeath, all of my property, whether real or personal,
wherever situate, including any property over which I may have a power of
appointment, to my son, HUGH R. JONES and my daughter, LINDA LEE
TROUTMAN, in equal shares, per stirpes.
V
I nominate, constitute and appoint my son, HUGH R. JONES and my
daughter, LINDA LEE TROUTMAN, as Co-Executors of this LAST WILL, to serve
without bond. If either is unwilling or unable to act as Executor, then the other
may act alone.
IN WITNESS WHEREOF, I, MARGARET S. JONES, have set my hand to
this LAST WILL this
;l;L
day of
a 'L
~
,2003.
1J;4&)AOI J{],o-rUL-L/
MAR "RET S. JONES"
Signed, sealed, published and declared by the above-named MARGARET S.
JONES, as and for her Last Will and Testament, in the presence of us, who, at
her request and in her presence, and in the presence of each o!W, have
hereunto subscribed our names as witnesses. r/c(~ ..'
(~d.Jf
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, MARGARET S. JONES, Testatrix, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my LAST WILL; that I
signed it as my free and voluntary act for the purposes therein expressed.
rl~'4;'r;(~i.;"-;~
Sworn or affirmed tOJI1d acknowledged before me by MARGARET S. JONES,
Testatrix, this Jd.-JY \ day of ~~ , 2003.
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Notary Public
NOTARIAL SEAL
DEBORAH L. RYAN, NOTARY PUBLIC
CITY OF MECHANICSBURG, CUMBERLAND COUNTY
Wf( COMMISSION EXPIRES JUNE 11, 2006
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
sSG
COUNTY OF CUMBERLAND
Wel4i/:,?el~ R. tAlA Lr::d?1J'Wand l/t;a. J...4-daJ~ ,
the witnesses whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we were present
and saw Testatrix sign and execute the instrument as her LAST WILL, that
MARGARET S. JONES signed willingly and that she executed it as her free and
voluntary act for the purposes therein expressed; that each of us in the hearing
and sight of the Testatrix signed the Will as witnesses; and that to the best of our
knowledge, the Testatrix was at the time 18 years 0 age or more, of sound mind
and under no constraint or undue influence. tf' ~/
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Sworn or q.ffirmed to and a~knowledged before me
this d;)~ay of~. , 2003.
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Notary Public
NOTARIAL SEAL
DEBORAH L. RYAN, NOTARY PUBLIC
CITY OF MECHANICSBURG, CUMBERLAND COUNTY
Wf( COMMISSION EXPIRES JUNE 11, 2006