HomeMy WebLinkAbout02-28-07 (2)
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Helen M. MacDonald No. 21-- Dlo - 001 j
also known as
, Deceased
Social Security No. 216-01-1884
June A. Pecukonis
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:
(c.t.a; d.b.n.c.t.a; pedente hte; durante absentia; durante mlnontate)
Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs:
[!] B. Grant of Letters of Administration
ame
Pecukonis, June A.
e atJonshlp
Daughter
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with hislher family
or principal residence at Cumberland Crossings, 1 Lon
610 Hilda Court
Mechanicsburg, PA 17055
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Decedent, then
96
years of age, died
09/04/2005
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at Cumberland Crossings, 1 LongsdorfWay, Carllse, PA 170d3
(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
situated as follows:
16,000.00
$
$
$
$
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 appropnate form to the undersigned:
ignature ype or pnnted name and resl ence
June A. Pecukonls 610 Hilda Court
Mechanlcsburg, PA 17055
Prepared by the Pennsylvania Bar Association
Copyright (e) 2004 fann software only The Lackner Group, Inc.
Fann 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 estate according to law.
Sworn to or affirmed and subscribed
before me this At#, day of
y ~t2 ;1~
Ju A. Pecukonis
'"'<,
No.
21- {)(D - /1
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Estate of Helen M. MacDonald
also known as
-0
09/0412005
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AND NOW, ,c;)(XJ7 , in coniid~~ation
of the Petition on the reverse side hereon, satisfacto roof having been presented before me,
IT IS DECREED that Letters DTestamentary 00 of Administration
f'.)
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(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to June A. Pecukonis, Administrator
in the above estate and that the instrument(s) dated
described in the Petition be admitted to probate and filled of record as the last Will of Decedent.
Short Certificate(s)...................... $
16.00
J:JiLndfL 1.921/1/JrL)tu. ~
. R . er of Wills "Y.pt-1
FEES
Letters..... ................ ......... ............ $
60.00
Codicil.......................................... $
Attorney: Marielle F. Hazen
1.0. No: 68003
Marielle F. Hazen
Address: 2000 Linglestown Rd
Harrisburg, PA 17110
10.00 Telephone: 717-540-4332
E-Mail: MFHazen@Hazenelderlaw.com
Renunciation............................... $
Affidavits ( )...........................$
Extra Pages ( )......................$
JCP Fee.......................................$
Inventory...................................... $
Other... ...... ................. .................. $
5.00
TOT AL... ... ...... ................ $
91.00
Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner Group, Inc.
Form RW-1(1991)
HIO,.RO, REV I/O,
This is to certify that the information here given is correctly copied from an original certificate of death d~l~. filed with me as
Local Reg~st1:'ar. The original certificate will be forwarded to the State Vital Records Office for permanent fllmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~JC4
Local Registrar
Fee for this certificate, $6.00
p
11878783
Se?.km~~.. g, 2M$'
Date
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fll~ H1OS.143ReY 2/87
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BLACK INK
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
..
AGE (last Blnhday)
SEX
2.female
STATE FILE NUMBER
SOClAL SECURITY NUMBER
3.216 01-
I. 96 VI'I.
COUNTY OF DEATH
BIRTHPLACE (CIIy end
S1ato ... Fcnlgn CO<lnlry) ...,
paltinDre,MD ::- 0
FACILITY NAME (n not Inolilullon. gIvo _ end n...-)
-- 0 ::::.., 0
RACE ._1ndIon. -._.
(Sc>oI;ify)
'0. white
SURVIVING SPOUSE
(.......,....... -)
.... Cuntler land
DECEDENrS USUAl. OCCUPATION
(c:r~or~':r~""
KlNO OF BUSINESS I INDUSTRY
Id. Cuntler land Crossings
AS DECEDENT EVER IN DECEDENrS EDUCATION
U.S. ARMED FORCES?
VelD Noil
PA317055
11
. Clty/Town. SIalo. ZIp Codo) OECEDEN'Ml
ACTUAL
RESIDENCE
(--
",,_olde)
17.. State
PA
rt[:lJ"'T All..n ""'l['
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'lb. CounIv
c:ilyIboro.
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DUE TO (OR.... A CONSEQUENCE Of):
~Iitl_ {b.
. 011)'. lood1no Io_to
COON. E_ UNOEIll VING
CAUSE (Disease or Injury c.
...... kllu-Ied e'W8flll
nMUIbng on death ) L.AST d:'
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
DUE TO (OR AS ACON$EClUeNCE Of):
DUE TO (
MANNER OF DEAl1i
o
Pondlng InveolJgation 0 V.. 0 No 0
Could not be de'ermined 0 3Oe. -- t.I. :lO..
PLACE OF INJURV . A' home. f...... _. 1edoIy. .....
building. etc. (Spedfyl
... ZIb. ZI. ...
CERTIFIER (~ only....) SIGNA
l~~G~~~d':::t:"'~~rn\'=:''=c:t'~~.~~.~.~~~.~~.~~)................. 0 SIb.
UC
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DATE OF INJURV
(MDnII'I,o.y. v....)
TIME OF INJURY
INJURV AT WORK? DESCRIBE HOW INJURV OCCURRED.
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