HomeMy WebLinkAbout04-12-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF fJ.Jf\'J:X' f \C~
COUNTY, PENNSYLVANIA
Estateof !hart( 5, Rvl(:~~
also known as
, Deceased
File Number ~ \ D 'l O~ ~'
Social Security Number 5'4..f - 8 1- ~ I.{ 4 4
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
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 of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person;
~ B. Grant of Letters of Administration
(If applicable, enter: C.I.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.)
Name
/tv K ~ }
~1
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary. 0
f _ Decedent was domiciled at 4eath in, ~Io-Vlk nJ . . County, Pennsylvania with his / her last principal res~~ at
lV~O(P <;~ ~l>frl ~O-.l./+ f1'!e.r.J/lo >11t'J. bJrb \ fA lid ro.. '~
(LISI street address, townlclty, townslllp, county, state, ZIp code) . > :':',
/ ,
Decedent, then 3(P yearSOfage,diedon!lfr'l (7., 2 {)iJl at ~,,/'I..(rbWV1S.h~p I P A ":~.
c.=)
--.; .
:::-.,
'-,J
:::c
r'0
~
UJ
, I 1.
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
$ t (Jib
$ ~ ~O^
$ I DO'\)
. ,
$
4=-
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
1 vn D. Rv \(q,j '$1 r SN
FormRW-02 rev. 10.13.06 Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF 0, .mbU( (J
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 beliefofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
SS
before me the
/{J,
administer the estate according to law.
Sworn to or affirmed and subscribed
SigfUlture of Personal Representative
,.-......
~-~U
>"1
":';{)
1--.)
)
!::::a
"'r'~
:.,.";:,
?J
, )
," 1"--....
1'.)
Signature of Personal Representative
~~
."
--r
~.
U':'
\ \
<9 \ 0'1 03'04
Estate of ~ (h S. R IJ... W ' Deceased
Social Security Number: 5 L.\ ~ '6 \ ~Y:~ Date of Death: 01..:\ (j 'a. 'dl')t) l
AND NOW, ~ ~n \ \ l Q , ~Obl ,in consideration ~e f~regoing Petition, satisfact~ry proof
having been presented before me, IT IS DECREED that Letters A:~ \\\\,:s, c-.::\i6n
are hereby granted to \~ \ 'N'\ \~.__\ \ l.~ D Rs~ \<...... c..S,
_r:"
File Number:
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of rec rd as the I
Letters ............ "\ $
Short Certificate(s) . (t.il) . . $
Renunciation(s) .......... $
<- \cN .. . $
~m .., $
.. . $
.. . $
.. . $
.. . $
,.. $
. .. $
.. . $
TOTAL ........... . . . $
80.00
d'-t.OO
5- DO
/O.()O
S.QU
::::::ru<" f~.N" 2,Ba~kor1/'
Supreme Court I.D. No.: 4 ) 7 Z 7
sS"}O T fl vJ.u f.oO^-c1
(b vnp bhJl1 fA 1/(1)
FEES
Address:
Telephone:
( 7)'-)') 7(PO-- 7S-0 1
74. 00
Page 2 of2
Form RW.02 rev. /0.13.06
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.
No.
~~&~
Local R gistrar () .
Fee for this certificate, $6.00
p
13523746
a~~ ;2dO r
Date
._,)
':::..:)
c::;')
~
o
-""
l ~~,~:~ CJ
^....,,-~
'C.' ~
-.::_ ,--r,
~
:::n
7,J
N
~
\..0
.r:-
It.
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions and examples on fe-I
2.S. 1_SocuriIy_
STATE FILE NUMIlEA
~ \ CYl (j~
Ht06.144 REV UI2CI06
TYPE I PAM IN
pf~NT
IUCI( lNI<
I. _.._IF..._..........,
October 24,1970
'._"_\*lllh.dIrov-l
April 2. 2007
..AglllM~
36 v..
. CounIy"-
Dauphin
7.
"'_or
California
1d.~_(lI"'_''''_'''....-)
..
_ot 110 Do"
_"_1-
Food Service
11.___"''''
U.a_~1
0.,.. lONG
_.
__17.._
17b. CounIy
PA
Cumberland
Ilid_
LIloo"'.
-"""7
17c:.{] __livIdil
17d.O No. _livId_
_LillIII..
Hampelen
T..,
-..-
Chef
l&_.-.g_I_dltl-.-....-,
6206 Stanford Court
Mechanicsburg, PA 17050
C1r1-
I11F_._IF....-..........l
19._._~_.__
Audrey J. Baltes
2IlI>._.IIIiIng-t-.dltl_-....coclo)
6388 29 Palms, CA. West Court
2'cPllcl..~(NImI.._.-,or-,...1 2ld.lacIian\Cllr/_.-....coclo)
Conolite Crematory Schaefferstown, Pa.17088
Charles E. Rukas
~
~
':1/
22l:._"'_rlF_
Myers Funeral Home, Inc. 37 East MaIn Street Mechanlcsburg, PA 17055
2311."- _ 23c - S9*' 1-. dIy. v-I
2OI._._tllPl1Pllol)
_24-ae.......llIlIlpIoIId"'.......
'"--
2I.nna.._
..1lI1o_OoId_".JII!l
02:50 PM. April 2. 2007
.._c.._Io__lc-"._0II.-_~or_1
lID"" ONG
CAllIE OF DEATIt 1_ _... .........1
_27.....t E.-...~__._............--....__.._OOHOT____.cIRioc-
....._-.or----.,..-."""""--...-liII.
=:.==~ .. Traumatic Brain Injury
DulIo(...._oI).
~ IntIrVIt. PIA I: ENIr............ tft'IdIiDM. mMb6lo ID..... .. DId TabIoco UII ~... 0IItl1
0nsII1o_ ......_il..........__ilPlllL 0..... 0""'"
0..0-
3lIa_1ll_
-
d.
3Oll.__F_
_Pdorlo~
.. Coull rI 011II11
IXI..... 0"
n_oI011111
0- 0-
11SI-01'onlling1lwltliglllon
0:- OCGoldN<l"~
32dllmlollr1ooY
=:=1o?i_''''''
to. caMlilaldCl1Iin1a.
_ __CAUIl
=-":=''L.!~
b.
DuI"lor..._ol):
c.
DulIo(or..._oI):
IXI..... 0"
12:30 Au.
:J3I ~_""CM)
. ~~"::::==:"~.."':::i":::''':~-~~~~~--------- n______ 0
. =:~~"=::::~....~=..Io~=_._____________n____ 0
. ==--=..../.~Io.,........__....._._..._IIllI....to..._I)IIllI_.-- IKI
PaIIy J. Garber. ChleI Depuly
_ S9IIlft\bllll...,..,
April 4. 2007
I
ill
~
I
9, \ D l 03S'+
RENUNCIATION
REGISTER OF WILLS
CfllO&-lqV}rJ COUNTY, PENNSYLVANIA
.~
l~,jC)
--0-"
....~.;.....
N
,. .-"\ (-....,
~=
Estate oC.n Ov {( s:- , R V ~ a ~
~ ~. :~~ d ; I
,='::\
t.o
.~"..Deceased
I, I)_x:). r e~ ~, Rv 'COt 5
-kh..o=\-~ fLr (Print Name)
, 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
-'<1m J), QUKa 5
112/ 07
(Da
9,.*J /
(Signa
(P sa-g /Iv es+ ('o.J(+
(Street Address)
1~-fy f)/M ,JJa YVfJi,. (P A qzz 77
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
be~~e this \ d. day
of pn \ , d,C1\)
~~
.W.~
Deputy ~ R~OfWillS
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
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