HomeMy WebLinkAbout03-02-07
PETITION FOR PROBA TE AND GRANT OF LETTERS
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYL VANIA
Estate of
also known as
Vplma A. Jones
File Number
~J ,~(j()',7-,//,1
, Deceased
Social Security Number
007-07-2587
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE ~' or 'B I BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated and codicil(s) dated
named in the
(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 ofihe instrumeI1l(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
~ B. Grant of Letters of Administration
~'" \
(fj applicable, enter: c,t.a... d b.n.c. t. a., pendente lite; durante absentia; durante nllnoritate)
"_.r
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if any)" ~nd heirs: (If
Administration, c. t.a or d b.n. c.t.a., enter date of Will in Section A above and complete list of heirs.) :~j
I Name Relationship Residence I
Lee A. Jones Son ??lq Peonv Court. Jamison, PA
18729
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in Cumberland
rt Ham den Townshi
(List street address. town/city, township, county, state, zip code)
Decedent,then RS vearsofage,diedonFebruary 19,2007at Holy Spirit Hospital,
Pennsboro TownShip, Curnberlana coun~y, Pennsy~vanla.
County. Pennsylyania with his / h\;rla:i.t..pB'ncipaJ residenGe.at~ )
(Mechanlcsburg, ~7U5 , Post UIL~~e
East
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
$20.000.00
$
$
$ None
situated as follows:
Wherefore, Pctitioner(s) respectfully rcquest(s) the probate of the last Will and CodiciI(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Lee A. Jones,
2219 Peony Court, Jamison, PA 18729
Ty ed or rinted name and residence
Form RW-02 rev. jOj3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA •
: SS
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 ,
cqSignature of Personal Representative L e A. Jones
before me the day of
March 2007
Signature of Personal Representative
tee/. , i �J.ZL�.AL.. ..
or For the 'egis'r Signature of Personal Representative
',==,' � -
1?/-,20-67- /7 ^�
File Number: n
Estate of Velma A. Jones ,Deceased' .., -
;
)
Social Security Number: 007-07-2587 Date of Death: February i ,,
9 �2007W ,
AND NOW, March 12 , 2007 ,in consideration of the foregoing Petitidxi,satisfactory proof
having been presented before me,IT IS DECREED that Letters of Administration
are hereby granted to Lee A. Jones
in the above estate
3cf fl Batitbstitbtottr WSIMPO li3E SIMI S WREPW [l d .,..EISSX. r _Ffili,
/
FEES /i_'l/, ‘—..17., L_ , `����� .J./ '�y
Letters $ S 57fEMAN, P.�C.
Short Certificate(s) °Z $ Attorney Signature: B : , a=t
Renungiatio s) $
J $ /0--61P Attorney Name: Richard C. Snelbaker
• . • $ 5.Q) Supreme Court I.D.No.: #06355
$ Address: 44 West Main Street
$ Mechanicsburg, PA 17055-0318
Telephone: (717) 697-8528
TOTAL $ g500_0.00--
Form RW-02 rev. 10.13.06 Page 2 of 2
H 1(1" i..:(l"- PF\
This is to certifv 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 ~~1!-1~ /Cj'l
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for thiS certificate. $6.00
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Local Registrar U IJ
P 13378162
No.
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II J..J'vJ. tI 'u..-~\ ~-.l. GI~
ale
HhJSlnRtV 11'2()li6
T'r'PE. ' PRIrH IN
f'fRMANfNT
Bl ACK INK
I Name 01 Deced..nt (Fir~l. middle Idst 5l;HI~)
COMMONWEALTH OF PENNSYlVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
C.~1
. 16 n,"c~nl'~ Mdll,r'Q AdJless (SII,"8! city 11<JWfI, slale, llJ-' code)
513 Bar.ry Court
Mechanicsburg PA 17050
85
Y"
Oct
29, 1921
Bangor Maine
ti(] tnpiilient 0 EA / OlJll>dlleot [J DOA (] NUlslng H0il1e 0 A~'sldl:nc~ CJOI ler . Speclty
9 ~::~:~:~:t~l ~:J:~dnIC Ongm? ~ No 0 Yes 10. ~;~;.,~~lerican tflOldrJ Btack, White elc
Me~lcan, PUer1oRlcan. elC) Whi te
14, Mi::1II1at Slalus, Mi:lflled. NeVel MaHled.
Widowed, Div(j((;ed /SpeClf}1
Widowed
Velma
A.
Jones
3 Social Security Number
5 Age (Last BlrthdaYI
6 Date 01 Birth (Monlh, ddj. year)
7.6111hptacelCi
J-ClC
Bb, County 01 Dealh
Cumberland
KirooiJtWurk
Homemaker
Kind of Bu,u'e,~ I tnduslry
Own Home
Dyeo ~o
lib County
17cgYl:5[}eCE:dC(IIl.lvedlfl
17d 0 No. Decedent LNE:d wlttllrl
AcliJdt Limits ul
Hampdl~n
T.p
Decedwt's
AclualRbiullnee 17a SlalE:
18 Father's N.-Inl':: (First nuddt,:, I",~l, 5ul1i~1
Roscoe Arnold
19 Molher's Name (First, middte, maiden surname)
Anna Belle
CIIy.'Bow
20a tnlormanlS N,lIne (Type I Pnlil)
Buchanan
"
"
~
:t
Lee A. Jones
20b Intorrnan!'5 Maltmg Address (Slreel, City I town, Slale, lip code)
2219 Peony Court Jamison PA 18729
21c Place 01 Dtsposllion (Name of ceml;llery, crBmalory Of olh"r pldce)
Rolling Green Memorial Pa k
21d Locallon jelly i lown slale, ll~' code)
22c Namo and Address of Faclhty
MYERS FUNERAL HOME 37E MAIN ST MECHANICSBURG PA 17055
Camp HIll PA 17011
23b License NlJmber
23c Dale SIGned (Mm,th day, yeas)
ttcnI52--l26I1lustlJ€ct~ltll:dby~t!fSOJl
...huprofloUnceSdE:dlh
25 Ddte Pronounc.ed Dead (Muolh, day, yea/)
~....\,,,,(( \9 ;lMI
CAUSE OF DEATH (See Instructions and examples)
01 complICJlIOI,S' 1I13l rjlredly cilused the dealh DO NOT el1t~IIt:ln,illat events ~uch a~ Cd((Jlac allest
I.I~t t..llty one Cdl;St: on each Ime
d !1, :eu. [;..1 (.,~t I t'.-....
~fO,,;~q'''''''UII L:'/ _
1...-1 \/t' ,-- L,;,1 it.' .....<<.
Due 10 (or as a:OIl~equence 011
26. Wa5 Case Referred 10 MedKal E~aminer I Coronm lor a Reason Omer Ihan CremallOn or DOflalton?
D Yeo jiifWo
Il",n, 27. Part t: Elller It", Uh.!!uuf liu:!l\~
leSpllalOlY,iflest
Appr{mmateinler..at
Ollsel to Dedltl
Pall n filler other ~!killll !<Qilljdill[l~ !<Q01nb!.illD9JQ ~mn
bul rJotW~I,l!inglnll1eundellYlngcau$egiven rn Part I
28 Did Tobacco U~e Cuntnbule to Dealh?
o Ye~ [J pl(.()at;
[J No J:}tfr1knuwn
29.lfF~ale_--
[~I'le9(liilll"llt;lfoPd51~lJdS
o Pregnrinlalllllli:lold<:JIn
[J tlulpro:glo"nt l)ulf,Jreyn",r,I"'11I11fl42d':'tS
OldealtJ
o NorrJlvgnalllhutpregn,:lIl1--l3ddY5101year
betO/edealh
[J UII~llown II pregnant wilr'in me pdSI year
32c Place of jlltU1Y Hume Farm Stri::CL Fac,tory
OHlCe BWldlng, ele (Spoo!y!
~~Jt~A;e~~tn~s; ~~~:hll d'*':;'
SequtJlIllaltyllslC0rldlliwns IIJny
~1~1~;lal~O JNhER~~I~~e~~~~Ee a
idlsecise 01 lfI)ury U-,,,I 1lIllJ<ltcd the
e>.enls rtsunlflglrl J€,,,ltl) lAST.
Due toloras a GunseqlJenel: 01)
LJ'" ~
LJ'" l~
J...j.n:;lt,r;;1 C_J H"{fllClde
1_-1 A',d\MlI [] PtJllJllIg In~e~IIQdlIOIl 32d TlrtlE: ul IfltUly
[J SUluLl,. [J C0t,la riot lit, [)(;t",II!;lra;:,j
32S1I.OCJhOllol tlllluylStreet, ellyilown, slillBI
30" VI." an AutopSy 30b
PfrtlJrrn,"d?
31 Mdnn"ll,' Dt"dlh
ot C"I,~e ,jf D~",ltli
JJa CtJ!1llter (~Il...'(k Ul1ly Drill)
'Hb Sll:iI'dtUl~ <tIllJ r
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Pronouncing and certifying physician iPhyslCl,JIl bU', PIOIOU"lldlly ltt;all, cillO ([>1111\,lllg I" C<luse ul d~",lIi) ['J 33(; llCl:rl~<l N lber _
To the be" 01 my knowledge, death occurred althe lime. date, and place, dnd due tu the cause(sI and manner as staled_ - - - - - - - - - - - - - - - - _ _ 1 lO' .. I , io) /\ Q/ /
MedlcalE.amrnerlColoner __ v,Vl" ",l.{I u ILL/f..--'
On the baSIS 01 uami;Jahon dnd I or IIweshgallon, in m~ opUJion uedl!i OCCIJrred i1llhe tune. dale, and pt<Jce and dUt: 10 the cause(s) and manner as :>lilled_ L
33d. Diltt::31 ,Ull (M011Ihda~ Yt:dl)
2 2, ( c. "J.-.
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34 Nan:e and AdrJft,s 9 f'el,GI1 W~ CUfl1plek'd C<lu~e 01 PlJdl~, (llem 27) lype I Prlnl
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