HomeMy WebLinkAbout03-07-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
~ / .~()()7.. d/?
Estate of Barbara J. Dietz
also known as N/ A
File Number
. Deceased
Social Security Number 175-40-9999
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' 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
r ~ named in the
c;') ,
...--... -' ~-
, --J ' I
,',~O ~ .'.
:'~9, ::".
'., l.. ~~
"i~i. I
, . ...J -.1
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution oftltli'ilffitrument(s) offeft~Q
"':.", -0
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: . ;' " ".,'., -,
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
III B. Grant of Letters of Administration
. J
,'-j
C,,)
..
, (,oJ'
(If applicable, enter: c.t.a.; d.b,n.c.t.a.; pendente lite; durante absentia; durant~ minoritate) 0"
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 d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
I Name Relationshin Residence I
Berniece B. Dietz Mother 70 Magaw Avenue, Carlisle, PA 17013
D. Stoner Deitz Father 70 Magaw Avenue, Carlisle, PA 17013
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his / her last principal residence at
Cumberland Crossings. 1 LongsdorfWav. Carlisle. South Middleton Township. Cumberland County. PA 17013
(List street address, townlcity, township, county, state, zip code)
Decedent, then 59
Dauphin County. PA
years of age, died on February 26,2007,
at Milton S. Hershey Medical Center, Derry Township,
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) 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
25,000.00
$
$
$
$
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:
T d or rinted name and residence
John E. Slike, Esquire, 2109 Market Street, Camp Hill, P A 170 II
Form RW-02 rev. 10.13.06
Page 1 of2
()"( _!) 1ft'
Oath of Personal Representative
ss
C)
c::; 0
" ::n
-,
- --f S:~]
t-_..1
.:;:::")
c::)
-..
COMMONWEALTH OF PENNSYLVANIA
-".;
I
-J
COUNTY OF CUMBERLAND
;~..r r-~-l
/-. , '
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are truea1l(tcorrect1J> the bestq{:
-,~.~)-.-.i-: == '
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitionet(s)~~i11 well ~9 truly
..-i .,
administer the estate according to law. U1
c:;;
Signature of Personal Representative
Signature of Personal Representative
File Number:
Estate of Barbara J. Dietz
, Deceased
Social Security Number: 175-40-9999
Date of Death: February 26, 2007
AND NOW,
having been presented before me, IT IS DECREED that Letters
are hereby granted to John E. Slike, Esquire
, in consideration of the foregoing Petition, satisfactory proof
of Administration
in the above estate
and that the instrument(s) dated N/A
described in the Petition be admitted to probate and filed ofrecor
FEES
Letters ............... $ if~CD
Short C'mfi"'to(,)........ ~~
Ronun'''"~fpH:. :-~i~
.. . $
.. . $
... $
... $
.. . $
.. . $
.. . $
TOTAL.............. ios wO.oo
/
Attorney Signature:
Attorney Name:
John E. Slike
Address:
2109 Market Street
Camp Hill, PA 17011
Telephone:
(717) 737-3405
Form RW-02 rev. 10.13.06
Page 2 of2
07,;J/~
-::0
.7.7
J"....)
e:-;)
=
--.
RENUNCIATION
I
-J
J
I
, .~.)
3?
y.)
en
Q')
REGISTER OF WILLS
Cl""'- \c...r- \..."r\ COUNTY, PENNSYLVANIA
Estate of
~(H ~o.r-o. ~ D',e\-,
, Deceased
I,
.-?) -e. 1\.. f) l -e. ( e.
(Print Name)
o
(
l~tl-
, in my capacity/relationship as
rrother
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
John E. Slike, ESquire
/ ~ "'-..z --1L A-. "'"ct:'_
(Signature)
~
~j
(Date)
70 H3.qaw Avenue
(Street Address)
Carlisle, FA 17013
(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 renunci~on for the
purp stat d within on this (~ day
of ( . tJ1J7.
Deputy for Register of Wills
Form RW-06 rev. /0.13.06
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
NaIarIeI Sell
Sera J. EnIinger, Notary Public
CIrIIIe Bolo. ClJnberIInd County
MyCcllnmllleion &pres Oct. 17,2009
Member, Pennaylvan/a Aa8OClatton of Notaries
67,c//?
o
(-
::~o
';~O
, -n
r~......)
,_c;~-::)
=
-..J
RENUNCIATION
I
-J
REGISTER OF WILLS
Cum \oe- \ tAf\ A COUNTY, PENNSYL VANIA
"
-.
; i
(.,.j
CJ1
CJ\
Estate of ~~ ~~ X 'Dl~
, Deceased
I,~4 .s.tD~ e.V-
(Print Name)
Di' e + 2
, in my capacity/relationship as
father
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
John E. Slike, Esquire
(Date)
'A2r;;Vl~_. ~~.
(Signature) ~
70 Maqaw Avenue
(Street Address)
Carlisle, FA 17013
(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 renunci~n for the
p~ s~ethin on thiS~. d~Y., ,
of t: , /~..
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA .
NolarI8I Seal
SIra J. EiWlger, Notary PWIic
CIrIIIIe Boro, Cumberland County
My Canlftlil8io.l Expires Oct 17,2009
Member. Pennaytvanla Assocl8llon of Notaries
',',:'(.1:
t.....
r1 ,.k.,.:.'t "~...:i.;t. 'j
t"..l.;,:.)u'.......
',,";.'
"" ! ~r~ ~ ~:~ .: V,.:
,... ~ ..'- .~."I-I
P:O).R05 RPV 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.
01-}1(,
No.
.~/J!~",
Local Registrar
Fee for this certificate, $6.00
p
13107298
FEB 1 ~ 1f\07
Date
r-,.u...')
ITEM , 2 () f5
SHOULD READ AS POLWWS:
s~- fI/{;'~ 77<.~/~ ,Mt:Z>!=d1U> t..RJ!c~ AIr
C)
':-;,0
. -'I
:::.:_~~
l---j-.-
r~--'
';:3
.--'
::0
I
-J
~M~
-v
c)
, I
(.n
(J'\
REV 1112006
. PRINT IN
AANENT
CKINK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
lTIOItof lie. Donotstaltre
Klnd 01 B_11lWs1Iy
State of PA
.S. Hershey Medical Center
12. _ Oocodenl 0Y0f ~ the 13. 0ec0denI'. E_ (~ only hIgI1elt QIodo """"'etedl
U.S. Armed Fon:es? Elementary I_ry (0-12) College (1-4 or 5+1
Ov.e IXlNo 1
ever Married
Old_
L.iYeina
Townstip?
17c. [X Yes._Uved.
17d. 0 No. 0ecIden1 Uved ......
Ac1ulllLinllsol
S. Middleton
Top.
l.Nemeol_(FIrsI,_.Iut,SlIIIlx)
Barbara J. Dietz
5. Age (Lest Birthdey) Ur* 1
-
6. o.teolBirth (MonIh, , 7.BIr1hpIece( . end_or
59
VIS.
October 21, 1947 Mechanicsburg, PA
!d. FeciIIy Nome (ff not_, gIw _ and"""'"
0ec0denI'.
Actual ResIdenct 17a. State
17b. County
PA
Cumber land
City/Bern
230. De.. Signed (MonlII, day. yoer)
Items 24-26 must......- by pelIorI
--_.
24. Tme of Death
3:1!7'
P M:
2.00 .~
26. Waf. Case RefelT8d 10 MedIcal ExamIner! Coroner for a Reason Other than Cremation or Donation?
o V.. IXI No
AppIoldlMIe inleMl:
OMM to 0ea1h
Part!I: EnlerolherlimllicantcordiMlcontJbJlino.todlRth
butnolreoUtingltlhell'odellyingC8U88given~PeI1I.
==~=~
e ~fra c. er-e..-Io I~tt./
Oueto(or..._oI):
,Q~n~l'"lll'('
28. Old Tobecco Use ConIrtluI.1O 0eeIh?
o Yes OProbellly
ONe ~Un_
28. II Female:
o NoIpIllQIlinI_paslyeer
o Pregnant.llimeoldeeffl
o NctplllQllinl,b<Jtpregnantwllhin42days
01 death
o Notpr8lJ'l8lll.butpregnant43daysIo1yeaf
beIole_
'6iI. Unknown! pregnenl """It the pelt yeer
32. Place oI..,ry' Home. FlIITI1, _ Fac1ory,
0lIIce Buikllng. ill:. (SpsdIy)
_UBl_, MillY.
IeldlnalOhClLal8lrHdonlnea.
EnllIr!he UMlEIILYING CAUSE
=-~":..,~Ihe
b.
Due to (or as a consequence of):
c.
Due to (01" 81 a consequence of):
3Oe. WI! en Autopey
-
d.
n. WeIe Autopey FIIllIngs
A_l'ltorto~
01 Cauae 01 o....?
31. Menner 01 0....
Dyes .I:!llNo
OVes DNo
I5lNeIUrel D-
o - 0 Pendng I.-gItian
o Suicida 0 CoIJd Not be Iletem*1ed
3211. line of Ir$rf
32g. Locallon of Injury (S1reel, 01y / _, state)
321. . Tronspct18ion 'r+rt {Sper:IIy}
o Orlvor / ()pmW 0 P....nger 0-
0Ihe< . SpeciIy:
33e. Cel1ffler(chocIc only one) 33b,~andll1loolCe_
. ~~"=:==:'~:"'1he"':.::"~~':~_~_~~~~n___nm_______ 0 ~
. PIonounctng end -,tng pllyeiclln (PhyaIcien both pronoUlCing du" end certIIy1rg 10 cause 01.....) .M 330. LIcense NtB11ber 33d. [)aI, Signed (MooIh. day, year)
. ==:=.__..1he.me,......and~,endd..lo1hecoueo(.land..........____u__n___n__n M[J-()'l1'7/~-L tJl-;<& - '<'00.
On the bI,1s of .umInet1on and I 01' Invnflgation, in my opinion. dHth occurred -' the time, dal',.nd pIKe, and M 10 the caUse(I) and 11WlIl8f.. atIted.. 0 304. Name and Address of Pefson 'Nho CompIeled Cause of Death {118m 27} Type! Print
35 Reg;st..r'. S' /) / I"} M.S. Hershey Medical Ctr.
~ I pr.. I I AI i I Hershey, PA 17033
M.
Disposition Permit No.