HomeMy WebLinkAbout05-24-07PETITION FOR PROBATE AND G NT OF LETTERS
REGISTER OF WILLS OF ~~~~~~~~~ CONY, PENNSYLVANIA
~ ~~~j,(/~ File Number ~ + ~ l ,~ ~ `~
Estate of ~ q v~..~r ~ ~ ` ~~~j
also known as ~" / V J
,Deceased Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:) .-. ,
a~yamed in the
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the _ _ ~ _
and codicil(s) dated ~~
last Will of the Decedent dated - --` _'„
(State relevant circumstances, e.g., renunciation, death of executor, etc.) .F-`
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the htstxitmettt{s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: _ _ . `:
~. ~
B. Grant of Letters of Administration l a hcable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante minoritate)
(I PP
Petitioner(s) after a proper search has / ha ~~ao of Will in SectD n A above and cotmplete list of heirs.) by ~e following spouse (if any) and heirs: (If
R
~ ~3
(List street address, town/city, township, co ,state, zip code) Q ~ G/L~ ~ S/~ ~ •T L
ears of a e died on ~ 9` ~ at
Decedent, then 38' Y g
Decedent at death owned property with estimated values as follows: $
All personal property
(If domiciled in PA) g
(If not domiciled in PA) Personal property in Pennsylvania
Personal property in County $
(If not domiciled in PA) $ _
Value of real estate in Pennsylvania
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
~tiP ~~ndersi¢ned:
Typed or pnntec
~Y 4m~w.
and
:~ ~Pr.~~
~ /`t1~3
Page 1 of 2
Form R6V-0? rev. 10.13.Ob
(COMPLETE IN ALL CASES:) Attach additional~sLheets if necessary.
necedent was domiciled at death in ~''" """" r ~~ ~ County, Pennsylvania with~hj1s /her las/t rincipal residence at
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA .
1 SS
A~Ij,Y~~9'n/ ~
COUNTY OF ~ ~ ~ ?
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing•Petition are true anthcon ect is-the best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well an~Wuly
administer the estate according to law.
~ , ~ ,~
V v li ~~ t ~.~
Sworn to or affirmed and subscribed
before me the ~ day of
~~
For the Register
~~
G.Gr L LLB }•
File Number:
/~G~~y~]-- l~~ ~ L G~~ ~ ,Deceased
Estate of ,1
"3 8- jZ' 7~7 / Date of Death: ~' ~ ~'Z~~~
Social Security Number: ~ ~`5
AND NOW, , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters y ~' L • l f~~
are hereby granted to /C/4' 7"/~ ~~ ~' ~~ ~"'L~ + ~~ ~~~~ C~ `
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. fl~n ^ t
~ i n _ ~
FEES grster of '1 ,.,~ _- ~ .
Letters ............... $
Short Certificate(s) ........ $ Attorney Signature• `
Renunciation(s) .......... $ ~/ G ~'' ~ ~~ ~` ~~ ~~~~~
Attorney Name: ---~-
... $ ,Z ~ ~ 3.5'
$ Supreme Court I.D. No.:
Address: a
... $ ~~.. s u.~, Ali / ~'~
... $
... $
... $
... $ Telephone: ~"~ ~ "" /~-y3 '~ ~ ~ ~
... $
TOTAL .............. $
Signature of Personal Representative ~~ ^•T ' /~. ~ 1.
Page 2 of 2
Signature of Personal Representative
105.805 REV 1/OS
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
/~~
Local Registrar
P 13354701
No.
MAY 1 ~ 2~7
Date
~ _-
..-~
_ -, _~,
-, r•..,
-~ :.
.,
REV 1112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
PRINT IN CERTIFICATE OF DEATH
'~yf~rvr rc~ Insrrur.Biens and examples on reverse)
CTCTF FII F NI IaaRFR
1. Nam d Decedent (FlrN, mitldN, lest. suMxl 2. Ses 3. Sodd Secunry Number 4. Date d Death (Modh, day, year)
Male 195- 38 -7744 9, 2007
Robert Harve Culls Jr.
Age (Left BIMMry) IAmer 1 d Untler t 8. Date d BIM Month. r) 7. BkIIMaa (CIA' and stele «fareign ca,m a. Place d Death (Check oa)
5
OU
.
mr
Monte OeYe Moles Mnutr ~
7-26-1948 Mechanicsburg, PA ®,^pe+~^t ^ERIOWpeBent ^DOA ^Nunkpffome ^Rasiderke ^Other-SpedN:
58 v
n.
• eb. Counry d Deem &. CiA, Boro, Twp. d Deets 9d. FrecBfA Name (ll rnt klatllutlan, gWe easel end menber) 9. W ~ ~~ nk Odgin? ~] No ^ Yes 10. ~M rkan NdMn, Bledc. yAae. ek.
York York York Hospital ~%~^~ P~eno R~^~ ~) flhite
Deaddn's Usual Ibn its d work dab du moat d Be. Dc nd amts re 12. Wes Decedent ever M Bw 13. Decedent's Education (Spedfy only highest grade completed) 11. MadW Smlw: Married, Never Marred, 15. Surviving Spouse (h wile, give makmn name)
Specny~
W
11
.
a~ d
Ketd d BlWrmmas I kdwq U.S. Armed F«ca? Eleman»ry / SeaMary (0-12) College4(1 J or 5f)
I(Md d work
Sales Retail ®Ya ^Na
• 78. Deadars MdTrlp Address (greet. MY I town, state. zip arm) oeaeem's Did Decedent _ -
4 Adual Raeldena ne. Bare pennsvlvania Live ins 17c.~Ya, oecedem LNedro inVP_T Allen Twp.
Township? 17d
123 November Drive, Apt.
Liaed Wolin
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Cih / Boo
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clua
Camp Hill, PA 17011 ,>b. coudv Cumberland
18. Famd'f Nerve (Kral middle. raft Mdfm) 19. MWmr's Noma (Rre+. ^~•~ maiden sumemel
therine E. O'Hara
Robert H. Culls
20b. In»mlenra Mamnp Addreac (gnat. cry / rown, state, zA code)
20a. 1domMd'c Name (TYPe I Pddl
4711 Cedar Avenue, Apt. 1R, Philadelphia, PA 19143
Jessica L Culley
iBa ®Creme9an ^ Donetlon 21b. Dan d Diepaitlon (Momh, day, Yar) 21c. Plea d Diapaitlon (Name d anlelery, aelnalaY a omd place) 21d. Loalion (Cry I town. sere. z4 code)
d d Dm
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o
21e.
^ Budd ^ Renavel from gore I Wes Cremation «DaMlen AWhonad
Cremation Societ of PA Harrisbur , PA 17109
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liarlwNMrter 22c NemeandAddreaeolFedhy Auer Memorial Home and Cremation Services, Inc.
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~ Fd 013376 -L 4100 Jonestown Road Harrisbur PA 17109
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23a<ady wfren oertllyYq . To the Eeet dAOy lotowkdpe, death aaunad M deb end Plea staled. (Sgahae did tltla) 23b. License NanMr Y.ie. Den Si9^~ (i•1^^M, ~Y, Yar)
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Time d Deam 25.Oere Pra1o«wed Dead (Modh, day, Yaer) 28. Wee Case Retenad ro Medal Foamier / Caoar for a Renal Other Men Cremelbn «Dowtron?
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CAUSE OP DEATH (Sae ilsrtruetlan and e,ampNs) , Appmeharo hnervd:
a ampRaYana - and dkecdy awed Bra deem. t>D NDT' emer urmind evend such es ardac aneN, i Onset ro DeeN
iryuriae
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lM not reedlirp in IM urldenyktg auae given In Pan 1. 28. Did Td7eao Use Coradda to Dam?
^ Yes ~ProbehlY
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Item 27. Pan 1: Eraer tlm pGBR~tl~Df6 -
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imDERLrINC cAtasE , d deMn
(dMmSe~Md Bdhted tlm c. r
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r ^ Not Prepmd~ but pregtmd 43 days to t year
•
Duero (« as a waequena o0:
r Oefan dam
^ Unknown B IaegrlaM wnhin me peat Year
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30a. Wa an Autapay 30b. Wen Auropsy Fhldrgs 31. Mdnd d Dam 92a. DMe d Irglxy (Momh, day, year) 32b. Dexnhe F»w Injury Oaurred 32c. Plea d Injury: Home, Farm. Shed, Factory,
OKce Blmd^9, IIIC. (Specify)
Performed? AvaAeda Prior to CampMicn ,cy(~,_~._, ^ Haatlde
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d Celme d Deem? ~
^ Aaldenl ^ Pending Imentigenon Sze. rme d injury 32e. Injury et Wark? 321. n Trasponatlon Inuy (Spedfy) 32g. Ldatbn d Iry«y (Street, cdY I town, sWe)
^ Ye6 ~ No ^ Ves ^ No ^ Drivd / Openta ^ Pasedger ^Pedamdl
^ Yes ^ No
^ gicitle ^ Callld Nd be Deternened M Omd Spea'ty.
33e. CarBfid (~ ody o^e) 330. Sign»re end iBe d certlfld 1~,
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• Certllyltlq phyfki,n (Phyeiden aMYi^9 alma d dam when dldlmr ptheiden ha praaamlced deem and arnpleted Nem 23) ~
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•
To the paldmy larowledge, deaUl arxlrrrad due»dmo,wa(s)did ma«mras
• thwwwroBq end arslyhq PhY~^ (PhY~m^+~ P^9 deem ant cernlykrg to alma d deem)
^ 33s. Lfceae 33d. Dan 5igled (MOnm, dari Yes')
~
To tint hat d my Brro•'Mdse, dent Doomed N Nra nra, dent, end P~• and dw» the ceuea(a) end manner u Mahd_ _ _ _ _ """"""' `) L)
• Aledloel Esarhmr I Caroar
6aNa d efemNntlon end I a Invsetigellon, In my opidon, deNh ocawed at Uu time, den, ant pMa, and due» the ousels) and manor as s4md_ ^
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~, Name ~ Address of Perem WM Completed Ceuae d Deem (item 271 Type / Prnt
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ggrle»»rea ~` - I~ /lal/ I~ ~ 35~ io~6a"~ ~~Er~ or hEOt<NC, yU~.ic H~S~ I TH ~ ,. ~Y(•1 1~'+OS
('~ Disposition Perms No. h ~ 1 1 y" G ~ _