HomeMy WebLinkAbout06-04-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Estate of Ada B. Underkoftler a/k/a Ada Brandt Underkoftler
also known as Ada Brandt Underkoftler
File Number
~\
61 () 9-t~
. Deceased
Social Security Number 185-03-5439
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
Ii] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is I are the Executor named in the
last Will of the Decedent dated August 25,1994 and codicil(s) dated
Leroy H. Underkoffler was first appointed as Executor and died January 5. 2004
(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:
o B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante'ndnoritate)
-~ 5:".:) , .
Petitioner(s) after a proper search has I have ascertained that Decedent left no Will and was survived by the following spousti'\~t any) ang.'1i.-eirs: (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.) ::0'
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Name
Relationship
ResidenC~ -:",:
.~--;:0
~;C.
C-:-)
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
-
Decedent was domiciled at death in Cumberland County, Pennsylvania with his I her last principal residence at
Outlook Pointe. 129 Walnut Bottom Road. Shippensburg. Shippensburg Township. Cumberland County. P A 17257
(List street address, townlciiy, township, county, state, zip code)
Decedent, then 91
years of age, died on May 23, 2007
at Shippensburg Health Center, Shippensburg, PA
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 PA) Personal property in County
Value ofreal estate in Pennsylvania
$ 95,000.00
$
$
$
TOTAL
95,000.00
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 ed or rinted name and residence
Gerald L. Underkoffler
30 I North Prince Street, Shippensburg, P A 17257
717-552-7266
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF Cumberland
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 ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s)~ well an€uly
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administer the estate according to law. '
~'-,,-'--
before me the
4
day of
(i) '~~~
Signature 0 ersona Repres . e
r
"t::-
Sworn to or affirmed and subscribed
- ._~ ~'i
Signature of Personal Representative
(::-)
Signature of Personal Representative
File Number:
~\ ()"'l ()~
Estate of Ada B. Underkoffler aIkIa Ada Brandt Underkoffler
, Deceased
Social seCUrizsmber: 185-03-5439
AND NOW, l~~Q~
having been presented befo )he, I I D
are hereby granted to
Date of Death: May 23, 2007
FEES
_' in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate
~::~r~e~i~~~~~(~; : l~J. . ~
Renunciation(s) .......... $
L0\.\,\ ... $
~C_? ... $
~-\-G ... $
.. . $
... $
... $
... $
.. . $
.. . $
TOTAL.. .. ... . .. .. .. $ :)~
a \0 -00
%.OD
Attorney Signature:
\ OS - aD
10 . d:J
$_OD
Attorney Name:
Supreme Court I.D. No.: 41713
Address:
109 Locust Street
Harrisburg, PA 17101
Telephone:
717-236-9301
-e:ea.
Form RW-02 rev. 10.13.06
Page 2 of2
GERT. NO. T 6108646
H105.112 REV. 1/05
(FEE FOR THIS
CERTIFICATE $6.00)
Name of Decedent
Female
Sex
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
~ \ 0 1 o'&f4
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
May 24, 2007
Date of Issue of This Certification
Brandt
Underkoffler
Rrsf
Middle
Last
Social Security No.
185-03-5439
May 23,2007
Date of Death
Date of Birth
Place of Death
Race
White
Number
Street
State
Marital Status
Informant
Name and Address of
Funeral Establishment
Hershey, Penna.
Birthplace
Shippensburg Health Center
Cumberland Co. Shippensburg
Pennsylvania
Facility Name
County
City, _Borough or Township
NO
Chocolate Worker
Occupation
Decedent's
Mailing Address
Gerald L. Underkoffler
Widowed
Armed Forces? (Yes or No)
129 Walnut Bottom Road,Shippensburg, Pa. 17257
Clifford D. Forester,Sr.
Funeral Director
Rothermel F. H., 25 W. Pine St., Palmyra, Pa. 17078
Part I:
Immediate Cause
Aspiration Pneumonia
Interval Between
On~ and Death
:~~;
I
C) I
;=;0:
;~)I
-;~l2
:c~ J~
~,~ l11
,::;'J I
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,-,::,~
.-.
(a)
Coronl:1rY,Artery Disease
(b)
(c)
(d)
Part II: OtherSignificantConditions
\")
a
Diabetes Mellitus
Manner of Death
Describe how injury occurred:
Natural xW
Accident 0
Suicide 0
Homicide
Pending Investigation
Could not be Determined
Balhara
Name and Title of Certifier
Address
(M.D.,e:O:,'CSr ~..yr ,lvJ.E:.}
761 Fifth
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 wiUbeforwarded lothe
State Vital RecordS Office tor permanentfilinW~.,'12\.r~ '.. ,,38-357
Loc~ Hegistrar.of Vrtal Records. ' District -No.
May 24, 2007 159 N. Railroad ST., Palmyra, Pa. 17078
Date 'fieceived by Local Registrar
Street' Address
City, Borough, TownShip
KWDlOl
1finst ~iIl nub Wtsmmtut
of
ADA B. UNDERKOFFLER
~eing nf ~nuttb ~inb, over eighteen years of age, and a resident of the State of Florida, I make,
pub1tsh and declare this instrument to be my Last Will and Testament, hereby revoking all wills and codicils
previously made by me.
~ itst, the expenses of my funeral, burial, or other disposition of my remains I may have directed, my just
debts, and the costs of administering my estate shall be paid out of the residue of my estate.
~etl1ltb, I give and devise all the rest, residue, and remainder of my property of every kind and wherever
situated, as follows:
To my husband, LEROY
does not survive me,
LINDA CRIDER, JOANNE
UNDERKOFFLER, or to the
*
H. UNDERKOFFLER, or if he
then to my stepchildren,
M. LYTLE and GERALD L.
survivors of them.
* *
,
c.:'
r'_ c)
mqitb, My'Personal Representative has full power and authority to sell, transfer and convey any property
in my estate, real or personal, upon such terms and conditions as my Personal Representative deems best. No
bond shall be required of my Personal Representative.
My husband, LEROY H. UNDERKOFFLER,
shall be my Personal Representative.
My stepson, GERALD L. UNDERKOFFLER,
if the person first appointed fails to qualify or ceases to act.
shall be my Personal Representative
!-1Il! Itnn ~erein inbiading gmber .~aU inclube all genber. nub .ingular .~all inclube plural. a. tlye ronlexl requir...
~tt ~ittteSS ~qerenf, I have hereunto subscribed my name and affixed my seal on this date of
August
..., .c~
'--', )
1994.
(2/;" B t2J1~~~
ADA B. UNDERKOFFLE
Testator .
~e lIerehy ([edif~, that the foregoing instrument was, on the date thereof, signed, published and
declared'by the above named Testator, as said Testator's Will in our presence, and we, at Testator's request,
in Testator's presence and in the presence of each other, have signed our names as witnessess, on the same date.
ChJvlq;1/ (~ /-Ir;!e/C/;-r/
,
~c~VAf~d-LA-
, of Pinellas County, Florida.
, of Pinellas County, Florida.
6572 Seminole Boulevard, Suite 9
Seminole, Florida 34642
The !&gal Center
2300 Main Street, Suite A
Dunedin, Florida 34698
~\ C)\ ~9-N
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
~~ COUNTY, PENNSYLVANIA
Estate of
~/f~
, Deceased
and
/4ct( ~'J
(each) being duly qualified according to law, depose(s) and say(s) that she @/ they was / were well-
acquainted with ~ &//A~ ~. and am/are familiar
with the handwriting and signature of the decedent, and that the signature of M,. 4 ~
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of
;f/4. 6- t4.~ is in his/her own proper handwriting.
,",11 ~ ~
(Signature)
(Street Address)
(Street Address)
(City, State, Zip)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed ~ subscribed
before me this 3' day
of\'fyl~ ' Boo 1 .
! ,0 :! / ,:1(..:
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Form RW-04 rev. 10.13.06
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OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
Estate of a~ g ~
, Deceased
T&-N D- Se-~ be.-r-
and
(each) being duly qualified according to law, depose(s
acquainted with
with the handwriting and signature of the decedent, an
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of
she / he / they was / were well-
and am/are familiar
~bA'#~
is in his/her own proper handwriting.
~~
(52.
(Sl a;~ 9 ~Sr-
(Street Address)
Ib-r/~bu
(City, State, Zip)
(Signature)
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this ~
day
~
Of~
1:7 : I II.!
17 ~
j - /.//
Form RW-04 rev. 10.13.06