HomeMy WebLinkAbout03-07-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C t.( IH (J~AN.!J
COUNTY, PENNSYLVANIA
Estate of lIIa/'t./ t. IJhrrdt(.)
also known as
File Number
JI-f)" - /6fD1
, Deceased
Social Security Number I 8 '(- D9 - If? $"0
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or fB' BELOW:)
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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
I
nllmCd in the.
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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 of the instmment(s) ~red
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
(State relevallt cirCU/Ilstallces, e.g.. rellullciatlon, death of executor, etc.)
-4
ZI B. Grant of Letters of Administration d bll ciil hi ':!I-bttlJlal ,,/ oItGuJt!A" ~eathv)( 4~ /It-ntrI4.
(if applicable, ellter: 'c.t.a.; d.b.ll.c.t.a.; pelldente lite; durallte abselltla; durallte /IlIIlOrl:ate) .
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
Admillistratioll, c.I.a. or d.b.ll.c.t.a., elller date of Will in Sectioll A above and complete list of heirs.)
(COMPLETE IN ALL CASES:) Attach additiollal sheets ifllecessary.
Decedent was domiciled at death in t! U IH k,,1'it' County, Pennsylvania with his / her last principal residence at 1 (!) 0 0
t"-/4Nm /),,1 D,.iye. {'~~/':r/,-. L;Uh- 7~A.J
(Ust street address, IOwlllcily, towllshlp. "cOUllty, state, zip code) .
Decedent, then 9~
years or age, died on ()d:2t:~t
e141'e/114n1 4/1.{ /'".11 -"" ~ R~.
(J'
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value ofreal estate in Pennsylvania
6D
$ /" {)()&J.
$
$
$
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:
Ty ed or printed name and residence
~b SI: JD/(AI$ A?A~
{)PU6t.A6 A,tKI/JJ pA /7'1/
Fo/'ll/ RW-02 reI'. /0./3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF C. Lt.. m 8 tal LkAj.{)
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and conect 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
,dmin"l" Ih, "I'" ",n,ding 10 mw. ~
Sworn 100' ,ffirn"d ,nd "b"rib,d l< r:;::)~ ~ ~~
Signature of Personal epresentallve
before me the "DDfIl6t,A-$ 1fUtxJ>
Signature of Personal Representative
Signature of Personal Representative
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File Number:
021- t) ftJ -/0" 7
c.)
Estate of /J1AiScL L, ~JcJ
Social Security Number: /'9- /)9,. 'If'S?'
AND NOW, m(\.v'ch I , ?J5t> 1- , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters D/ AttAI/A. dUll tfi.
are hereby granted to 6JDUt:~ ~p/...lj
, Dec~~e'd
0'1
v:,)
Date of Death:
oct. ~S; UJe6
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of re
FEES
~~~~ffiC";i~;;~~;). {~. :
Renunciation(s) .. (~) . . . . $
.. . $
...$
.. . $
. .. $
.. . $
. .. $
...$
.. . $
. .. $
TOTAL ............. . $
d. (j .00
(0.0D
! 0 .rlJ
Attomey Signature:
) of Decedent.
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RelsterofWills LJ. r~r
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{!,A'Ar/eS" €: 5/'1 et'U 7!K
39'5"/3
" C!.1o t( .s ~r Rr./.
lJIet!l7a/1/cs 6&t/f-, IK 17osS-
Attomey Name:
Supreme Court J.D. No.:
Address:
Telephone:
7/7-76" -t:;20?'
lfln .00
Form RW-02 rev. 10.13.06
Page 2 of2
6G~ 10&-7
RENUNCIA TION
REGISTER OF WILLS
C Luw!3ee/I.AAJiJ COUNTY, PENNSYLVANIA
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Estate of 1J1/t/JEt
1" ~R/l/)W
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, De~sed
I l>>/tIALiJ /</ r~
,
(Print r:z.
~"J 4/1erh.t~ eJtUI,tlir J,'nr/ 13c: 77Y AM'Pl.f))
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
])~t{r;t.ItJ /Uflt/). Al/SktI tll3G TT)d /IIfA/()L~" /Uti) dea&J~
,
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(Signature) DOIJII-t..D tflr71:!1f!!
~.:l I!/, F/L8€FlT S:.7:
(0!!;)
(Street Address)
/J!Et!II/!AI/(!.J ~ IIJf!6 /,tJ,,4 /70 s.s-
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this [) ,-I"....... day
of -At-\:UU_JAJ<A-Y- , ,,')VL'I
~'D q),j ~
\. tary Public ~
My Commission Expires: Ln~~ ;;}1, :;Xl/a
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
(Signature and Seal of Not my or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Laura R. Delaney, Nolaty PubIlc
Lower Allen Twp., CurnberIanct County
My CommIssion ElcpIres Nov. 'D. 2010
Member, Pennsylvania Association of Notaries
00 - /Ou-7
RENUN CIA TION
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REGISTER OF WILLS
eU"'6Ercl.AIJ.P COUNTY, PENNSYLVANIA
c'",
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en
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Estate of
)J1,48E L L. /J!OI'Uct!)W
, Deceased
. StfIYI~
I, K( /11 fJEH..l.Y J..EOAlPttJ/TZ. ~'",erly ~"J" kIIJ/JJB?LY , in my capacity/relationship as
(prilltN~ )
Y ",/fer/l"t! etleouhiX $erry /fI{Jpt){..~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
D()UGLIIS 4/?AlPLtJ) htlsJ4IIA' "f LitE 77}/ /Wf/fJIJLf)/ /lHV clect!4$~t/.
;) - & -0 7
(Date)
-
35 /e().!>slrEl( ApE.
(SWeel Address)
PNIJ/;IfIIX Y/LtE; J?A 19~bO
(Cil)', Slale, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciat~~or the
purpose~it~n this t1 Y day
of ~ d::U.~ ~ 00 rt
Nota!:rr~~
My Commission Expires: '
Deputy for Register of Wills
(Signature and Seal ofNotaT)' or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
<\'{Xfl2" ~:;:; , ~:; :c:".t.L
.' ~"!,.n.:H~.N, ;:'f',:)tary ~:;t(t,
.".");,rfJr Count"l
F D/"Ill R W-06 rel'. J 0.13. 06
d'3i:';;iU'il E>'T<n--:.::; l~prll i l 2C/~''"'
H 105.805 REV 1/05
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.
P 13105187
No.
t2wn-1?~
Local Registrar
Fee for this certificate, $6.00
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H105. i4J Rev_ 2187
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
tPRINT
N
ANENT
:KINK
NAME OF DECEDENT (flr51 Middle. laslJ
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
DATE OF DEATH IMcrwh. Oa't. '''1
2007
50
=.vI 0
..
COUNTY OF OERH
DECEDENT'S USUAL OCCUPATION
(~~":.":'~~~:retr~
RACE -American IndiM. 8blek. White. etc.
t_
,..whi te
SURVMNG SPOUSE
mWlle.QI\4lN1l>>'\namel
Cumberland
....
E. Arnold
17b.
Old
--
"ina
Cumberland _7 ,7..0 :""""=,,..'::'01
MOTHER'S NAME (First. Middle. M8Jden SurnarM)
It. Violet Fernbau h
INFORMANT'S MAIUHG AOORESS (Screel. CityfTown. sa., ZIP Codel
216.06 St. John's Church Rd.,Cam Hill,PA17011
PlACE OF 0lSP0SI110N. ~ of c.m.tery, CremMOry lOCRlON . CityITown, SIaM. Zip CodIi
otOl:,*~ '
2~olling Green Cem.
NAME AND ADDRESS OF FACILITY
sselman FH&Cs,324
lICENSE NUMBER
H"mprlpn
.....
206 St. John's Church
~ Camp Hill,PA17011
FR'HER'S NAME (First. Middle. Last)
1'.
INF'ORMANT'S NAME (TypelPrinll
eoy-...
HummelP~~~91temoyne
ORE SIGNED
(Monlh. Day. -"1
DATE PRONOUNCED DEAD (Monlh. Day, Year)
23b. Dc.
,"""S CASE REFERRED TO:O E......NEAiCOAONEl\7 ,.Jg..
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WERE AUlOPSY FINDINGS
A\AJLA8LE PRlOflllO
COMPLETION ~ CAUSE
OF OERH1
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DUE 10 (OR AS A CONSEOlJENCE Of),
Not3-
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DATE OF INJURY
(Month. Day, 'Mar)
TIMe OF INJURY
INJURY /i3 WORK?
DESCRIBe HOW INJURY OCCURRED.
MANNER OF DEATH
Pending Investigation
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o ~E OF INJURY. At home, tarm~,lactOfV. otfIce
buiklng."C,ISpec:lfv)
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SSlGNATU~~
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