HomeMy WebLinkAbout06-04-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of Mildred E. Davis
also known as
CUMBERLAND
COUNTY, PENNSYLVANIA
File Number 21 - 07 - t)~,-\ ~
, Deceased
Social Security Number
195-32.2653
Albert L. Comer III
Petitioner(s), who islare 18 years of age or older, apply(ies) for:
(COMPLETE~' or 'B' BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) islare the
last Will of the Decedent dated and codicil(s) dated
named in the
(Slate reIev8nt c/IcUIII8t8nC8I 8.g., I8IIUncieIioI1, dNt/I d executor. etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom 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:
I!I B. Grant of Letters of Administration
fir appiIC8DI8. enter: c.l.a.; CI.IJ.n.c.t.a.; "..,.1118; 0lI181H8 aoaenue; ClUI8Iffe ~}
Petitioner(s) after a proper search has I have ascertained that Oe<:edent left no Will and was survived by the following spouse (if any) and heirs: (If
Administration, c.ta. or d.b.n.c.ta., enter date of Will In Section A abow and complete list of heirs.)
Name
Tinamarle M. Wojciechowski
Relationship
Daughter
Residence
Albert L. Comer III
Son
1013 Main Street ~,~~
Oberlin, PA 17113-:2
1240 Highsplre Road
Ha u PA 17111
---'
(COMPLETE IN ALL CASES:) Attach additional sheets If necessary. I
Decedent was domiciled at death in Cumberland County, Pennsylvania with his I her last principal residel'l~1 at
514 North Front Street, Wonnleyaburg, PA 17043 Co)
(Ust sl18et sdd/8$S, 1owM:ity, township, county, state, zip code)
Decedent, then 65 years of age, died on 05120/2007 at
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) 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 $
situat8cl as follows:
14,000.00
Wherefore, Petitioner(s) respectfully request(s) the probate fA the last WIll and Codicll(s) presented with this Petition and the grant of Letl.er8 in the appropriate form to
the undersigned:
Signature Typed or printed name and residence
Albert L. Comer III 1240 Highspire Road
Harrisburg, PA 17111
//',..
Fonn
Rev. f()'f3-2D06
CopylIQhl (c) 2006 form solIw8nt any The Lackner Group, Inc.
Page 1 of2
Oath of Personal Representative
lss
l
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
The Pelitioner(s) above-named swear(s) or aftirm(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. , /4
Swomto.._and- {,\ ~~.:;(,(/--
'if&,ture Personal Albert L. Comer III
before me this
U:
!
day of
~~AO ,;b5l-
~
-, - .. l
For the R . .
Signature of Penronal Representative
Signature of Personal ReptesentatiVe
File Number:
21 - 07 OS-\lp
Estate of Mildred E. Davis
, Deceased
Social Security Number:
195-32-2653
Date of Death: 05120/2007
ANONOW. 9:'''. '4 . .;lCDI .;0_....._...-.__
having been presented e. IT IS DECREED that Letters of Administration
are hereby granttl;tto Ai~L. Comer III
In the above estate
~>= ',..-.
and that the instl'dment(st #ted
desCribed in the-PtMltionbe admitted to probate and filled of record as the last Will (and Codicil(s)) of Decedent.
I '. ..
J
f.;,~_:
(-,
-,
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Short Certificate(s)........................ $
~.~
60.00
..28.00
5.00
5.00
10.00
,~~~f1IJ~
~d~ fU~
FEES
Letters............................................ $
Attorney Signature:
Attorney Name:
Nora F. Blair
Supreme Court 1.0. No.: 45513
Nora F. Blair and Associates
Address: 5440 Jon_own Road
PO Box 6216
Harrisburg, PA 17112-0216
Telephone: 717/541-1428
Fonn RIIl'02 Aev. 10-13-2006
CapyrtghI (el 2006 form IClIIwWe only The Lackner Group, Inc.
Page 2 of2
1105.805 REV 1105 .' h ., tly copied from an original certificate of death duly filed with me as
This is to ~ertifYTthhat t~e .mflormrta~filocnateewreilr~:nf~~~~~~ to the State Vital Records Office for permanent filing.
Local RegIstrar. e ongma ce I I .
WARNING: It is mega; to duplicate this copy by photostat or photograph.
No.
tf~~'Rt:L
Fee for this certificate, $6.00
p
13524525
J1(k y J, ~-I ~ (j 01
Date
---~_._-_._---~
( ~',.:;)
-....J
---~------
u
li
(..,)
Hl06.144 REV 11/2006
TYPE I PRINT IN
PERMANENT
BlACK INK
#31-019
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FIlE NUMBER
J. \ D -, \j ~l..\: lc
c
~
~
~ 221.
1. NamocA_(Fil1I._...........)
MILDRED
S.Ago(laIIllirttIday)
65
E
DAVIS
C' and stale or
lb. CounIy cA Oedl
III FadIly Name IN "'" _. gNo _ and """"')
514 N. Front Street
12.WuDeced8nl:everr.1he
u.s. Armed Forces?
o Ves [iN.
_-.... 11. Stale PENNS\.luJ/tNl A
11b eo.my C.U lY\ p., E. jOt..L.A IV 0
17e. 0 Yea, Decederi lived il Twp.
17c1Iia:... o.:-.r""-WOIiU'I\ Le"tS~ueo Cly
.....24-26_.._.."""" 24T....oIlJeal11 prx. 2S.DallI_DeodI_.dlly.yeot)
................- 1:00 P. M May 21, 2007
CAUSE OF DEATll (Soo ""'_..., 0_1
""27, Partl: Enlerlle~ -lIseases, ",orromplicalions-1haI<hctI>tcauaedlhedeath. OONOTanlerlermilalevenlssucha5catdiacarresl,
respiratory Illest, or WIl'llril:tW ft:lriIaIion wi1hoU: showing 1he etiok:Igy, list QO/y one cause on NCh h
~~=)"":; End StaRe Renal Failure
Due lo (Of IS a consequeoce 01):
AppI'OUnats inltMI:
Onse11o DeaSh
26, ~ Case Referred to MecIicIII Ellaffliner I Coroner lor. ANIon Ohr Ihan CtemaIion 01' 00nIIi0n?
2S!Ves DNa
Part I: Enw oaher ~ condition&~ 10 dulh, 28. OidTollea:o UsI Cottidtlo 0uIh?
"''''''r''''"''9~Iho~causo.....~''''' 0 Vol D~
DNa 0-
2ON_,
D.....__paII_
o _.....cA_
0..._....__....,.
cA_
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32<:. PlococA"i"Y'_.F....-.F_.
~1loting;1Ic(Sp<<:ly1
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IHditw;atolhecaustllsledonlintl
EnIIr hi UNDERLYING CAUSE
~~w:.."tmf.'"
b.
OuetolOl'Ulc::on&eqIJeOC8of):
[Ale to (or as a con&equenc8 01):
3Oa. Was an AWlpsy
1'0010""""
d.
3lN>.Wer._FIldingo
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of CalIle 01 Death?
Dves DNa
31. Wamer 01 0eaIh
Ja.NaIural D_
0- Dp"""'9_
o Suicide 0 c.... No<" 01,,,.,,*,
32d. TIII'I8 of Injury
o V.. pl.Na
II.
331. Coo1IiIr_alIyOlll)
. CoIIIfy1ng _IPhy- """'"" causo cA del"'.... """"" physWl....".....,..,ced del'" and ~"" '10m 23)
T. .......aI.. "-"dgo. __......"" CIUIo('1 end _.. __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
. ~=:.:=."'=".::.:=:~":.":".::::.Io==_..___mm_mmm 0
MIdIc8I ~ I Coroner
Oft, 1M... at IUIIl6nIUoR eAd I 0I1nvMtiption.1n my opinion. duIh occurm II lie lIMe, ",lAd ....,1Ad duI to Iht AUM(I) lAd 1DIMIIt. III&IcL
Coroner
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e
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l5
i
3S
~
33d _Sipd_....._)
May 24, 2007
34. NiIrne and MhsI 01 Person Who ~ Cause of 0IIII (..... 2n Tpl PrinI:
Michael L. Norris, Coroner
6375 Basehore Road Suite #1
~\ ~l D~'-\~
RENUNCIATION
REGISTER OF WILLS
tIAI11I!EA'tA-r10 COUNTY, PENNSYLVANIA
Estate of
M ltRffJ
,-
J~I
OAtJ/j
, Deceased
I, \.\r\A~NC: f\\ \0ci~le.Lho~h "
~ (Print Name)
:\ Cl. ~ ""'~Q of the above Decedent, hereby renounce the right to
, in my capacity/relationship as
administer the Estate of the Decedent and respectfully request that Letters be issued to
-t1l~ (2 -t L (})ffi (> r n.J-
~ ~\,~I
(Date)
, c.ff1
,/011 FbI/) LPk~t
(Street Address)
/!2!t!filfJrA/'tf/3
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunc~i~ and c~ified
that he or she executed the re~ciatio:ri:-for the
purposes stated within on this .~..~ (~\ ::2 day
Of~ ,~(X}-~-
-fl ry Public - -,~~:, ~:
My Commission Expires: (....;J
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this '('(\Qu day
of '~, , '200\.
Deputy for Register of Wills
8) NOTARIAL SEAL
. LLOYD P. SCHROEDER, NOTARY PUBlIC
LOWER PAXTON TOWNSHIp, DAUPHIN COUNTY, PA
COM/!!SSION EXPIRES MAY 2, 2009
(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