HomeMy WebLinkAbout03-29-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Lv.\M~ ~~ COUNTY, PENNSYLVANIA
Estate of
L 0 v.. ,\..t.... (2.
<;~f{e'f'l.-.
File Number
d-\ Ot 03D\
also known as
, Deceased
Social Security Number I q t..-( -1 1../ - 6 D 1 ">
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
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Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
, ." ....~......
:;:v named 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 executio;~f the instru~t(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: (..r;
(State relevant circumstances, e.g.. renunciation, death of executor. etc.)
~ant of Letters of Administration
(If applicable. enter.' c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
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.)
L.
r.u!Jl\. 91.
l ~~lt'
\)"(' \ ,U-
PIJ..'{OlO
Z \ \
",(Th S+.
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in c..,^lM.~I.a.~ County, Pennsylvania with his / her last principal residence at 1 t..l '3
[c;-1h 9"t. -A(r:. 9- <;" . lh.1.U (u\AAbu'lL..dIVL I pAr- \ "1 C L 0 .
(List street address. town/city. townshIp. county, state, zip code)
Decedent, then ~ ~ years of age, died on ., I } '6 {zex;1 at A Y'-"\
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 P A) Personal property in County
Value of real estate in Pennsylvania
$ 5; oDO C':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:
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L'Ik
'10'1
Form RW-02 rev, /0,/3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
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.
furnhPrfMd
before me the ~ q
day of
'-.......,"'
Sworn to or affirmed and subscribed
Signature of Personal Representative
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(~:~~;)
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Signature of Personal Representative
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File Number:
N
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Social Security Number:
~\ c..:.~l D3c>\
LO{J-}-VJ ~ <5checc!kr
/q ~ 3Y 0073
(jCf mtlrCh , d067
Estate of
Date of Death:
, Deceased
~ /1 ~/()7
AND NOW,
having been presented before mjT IS DECREED that Letters I '1 AJ I IA , ,~~
are hereby granted to flSSI { C,- /2 - S c he a (? r
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record
Letters ............... $
ShortCertificate(s) .(~).. $
Renunciation(s) .. (. I). . ., $
.-JL\> ... $
C\\A-~~ ... $
." $
.,. $
.. . $
.. . $
... $
.. . $
.., $
TOTAL ........... . . . $
60.8J
g.OO
5_00
'0-00
5.oD
FEES
Attorney Signature:
.-'
&ar\A ( ~~M.L)
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\ ') 1.\ C;~ ~ -A.;e.-
t\v..",^1M \ e) ~ V\.. . ~ A
.
Attorney Name:
Supreme Court J.D. No.:
I Address:
\lo1(P
Telephone:
il,l -S-J') J2~O
5'6.00
Page 20f2
Form RW-02 rev. 10.13.06
H105.805 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.
Fee for this certificate, $6.00
p
13352315
No.
thn.- /p ~
Local Re~
M~Al 2007~
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
~ev 11/2006
PRINT IN
IANENT
;KINK
1/30-477
1. Name<l-"(Rrst._.Iast.suIIIx)
Louise
5./<qe(l.aslBlI1hdoy)
62
R
Scheaffer
6. Date of BIr1h (Monlh. . ~
May 4, 1944
y".
12. Was 0eced8nt ever in the
U.S. Armed Forces?
DYes IKlNo
7. BirthPace( . andstateOf
Shenandoah,
6b. County <l1Jea1h
Cumberland
Bd. FllCiity Name (I' noIinslMon. give _.nd numbe<)
143 15th Street
"._,UauaI _<I ".Oonol_
KindofWol'< Kindof_flndus1Jy
Clerical State Government
. 16.0ec0dent"~A_(SIroot,ciIy/town.-.Z\lcode)
143 Fifteenth Street, Apt. 5
New Cumberland, PA 17070
16. F_, Name (RIst, _.Iast. suIf.)
Mirco Ricci
201. Informanl" Name (Type 1 Print)
John M. Scheaffer
. I 0 CIematIoo 0 Donalion 21b Dote ofllispooition (Monlh. day. year)
IXI Bunel 0 RemoYaI horn Slate ! - CromeIIon '" - A_ 0 0 March
o Olher. Specify. . by Uedlcel ExImineI' 1 Coronef? Yes No
_ Ucensee (or p8I$OIl ac:tilg.. such) 221>. Ucenee -
FS 012 849 L
Decedent',
ActueI_11..S1ate
Pennsylvania
Cumberland
17b.CotrlIy
STATE FILE NUMBER
~ \
0\ Q3D~
OOlher - SpecIfy:
10. Race: _,-' Black, While,'"
(~
Old Decedent
Uveina
TownsI;p?
11e. 0 Yes, -.. u..d in
17d. [)g No. -..u..dwlltin
ActueILimIlsof
Twp.
New Cumberland
CIty/Bom
19. MoItIe~, Name (Fk1I. _. meiden sumeme)
Lena Simonetti
201>. ,_, Melfng Add.... (SIroot, ciIy 1 town. _. Z\l code)
80 Green Street, Apt. A-1,
21e. Place of llispooition (Name of cemaIety. _ or olher piece)
Gate of Heaven Cemetery
PA 1705
22<:. Name end Add.... of FecIIty
Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
23b. Ucense Numbe, 23<. Dete Signed (Month. day. year)
2.. TII118 oflJea1h 25. Dele Pronounc:od Deed (Monlh. dey. year)
1:00 March 18, 2007
CAUSE OF DEATH 1_'_ and examples)
Itam Z7. Pert I: Enterlhe~--......... orcompllcations-lheIdIeclIyceusedlhedeelh.llONOT-.- _such as cardiac .-
'..pinll"" aneeI. or _, _ _ showing lhe etiology. Us! only one cauee on _line.
I ApproKimate inletYal:
I Onset to Death
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
=,~~)dseese~
Pendin~ Investi~ation
DIl8to(or..ecoosoquenceol):
~i81_.iany.
10 CIUIt listed on Ine a.
Eroer UHllEALYlNG CAUSE
=-~a:.~
b.
DIl8 to (or as e coosoquence 01):
e.
Due to (or as a consequence ot):
308. Was '"'~
Performed?
d.
3Ob.W...~Flndings
A_PrlortoCompletion
<I Cause of Deelt1?
Dyes ONe
32<1. Tmeoflnjuly
31.MaMeroflleelh
ONatutel D-
O _ ~Pendng hweetigellon
o Suldde 0 CaJd NcI be Oatenrined
OY" ~No
M.
33a. CetlIlIer (chock only one)
. CartIlytngpllylltlen(PttysidenC8ftilying""""<ldeeIh__physicien has""""",,*,deelhendCCfl'4lleled Item 23)
Tolllebeelol my --..__duelolhecouee(.)end _..-. _ __ _ __ _ _ _ _ _ - - - - -- - - - - - - - - - - -- -- - 0
==:=~'::::::~enddee,::.=.tlo==_..___________________ 0
. _ _, Coroner
Onllle_of_ end I", InveetIgeIIon, lit my opinion, _ __ etlhe__, end ~endduetolllecauee(e) end -..-..
35. Rog;sIta'e
~
1.9-(/(?t/(/1
Disoositlon Pennit No.
26. We Case Referred 10 MecicaI ExarTiner I Coroner lor a Reason Other than Cremation 01' Donation?
Yes 0 No
Part II: Enter other!limifieant rnvIiIiM!; MnIrh.m In dMttt 28. Did TobIcco Use ContrIbute to Death?
lNIno1resullinginlheundel1yingcausegiYoninPertI. 0 Y.. OP.-y
o Ne 0 Unknown
29. i Female:
o NcIP"Pn1"""'pastyear
OPregnantetllmeofdeelh
o NcI~,butpregnenlwlhin42day1
ofdeeltl
o NcIpregnenl, but pregnenl 43 dayllO 1 year
beforedeelh
o Unknotm i pregnenl wlhinlhe past yea,
320. b:: ~= :ts:.;i - Fec\oly.
Coroner
33d. Dote sqI8d (Monlh. day. yea,)
March 20, 2007
3-I'l.irf~oflt~~e8'f!Hm Type/Print
6375 Basehore Road! Syite 1/1
Mechanicsburg, PA 70~0
a \ c')-,- 030l
RENUNCIATION
REGISTER OF WILLS
Cv.1M1..&r~ COUNTY, PENNSYL VANIA
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Estate of
Lou.~ ~~UL-
N
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;-:Oeceas(:d_ .'
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I, ~~'^ ~v-~
r' (Print Name)
2611\..
, 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
~c; iCA.. c;G~~~
1 ! 2-t:t I 'ZO:/{
(Date)
~~
0o~M,Q ~
(Signature)
8D G.r~ <;'""1. ~\. A \
(Street Address)
(~~~)lLl'^ l D~
~~
Deputy for Register W.lls
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 day
of
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this ~ day
of fna.r L-~ , dbD \
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.06