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Home My WebLink About06-21-07 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Linda J. Campbell No. ~ \ a I 0 <.no , also known as , Deceased Petitioner(s), who is/are 18 years of age or older, apply(ies)for: (COMPLETE "A" OR "B" BELOW) Social Security No. 274-46-0304 ~ c::::J n A. Probate and Grant of Letters and aver that Petitioner is the executrix named in t~~st Will ~he Decedent, dated and codicil(s) dated S:;6 <- LT' () :;z:: State relevant circumstances, e.g., renunciation, death of executor, etc. ;~'" -93 _ _>-, ...j Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of t~~nts off@fed fo~pi~e; was not the victim of a killing and was never adjudicated incompetent (;0 -n 3 }2 be ~~,~ ...........................................................................~....~......~ :;g c..> ....,. ; N B. Grant of Letters of Administration ~ Lb:.. ~ (c.t.a., db.n.c.t.a.: pendente lite; durante absentia; durante minoritate) rxl 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: I Name Relationship Residence 240 North 36'" Street Richard Campbell Husband Camp Hill, Pennsylvania 17011 1620 E. Jefferson Street, #127 James Campbell Son Rockville, MD 20852 719 N. Second Street, Apt. 5 Nichole Campbell DauQhter Harrisburg, Pennsylvania 17102 P.O. Box 9271 Corey Campbell Son Aspen, Colorado 81612 (COMPLETE IN ALL CASES:) Attach additional sheets If necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 1000 Claremont Road, Carlisle, Pennsvlvania 17013 (list street, number and murijGllity) thYw~ ",Wf' Decedent, then 59 years of age, died March 19, 2007, at Claremont Nursinq Home, 1000 Claremont Road. Carlisle, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property..............................oo............................oo............................00............................$ -0- (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania............................................................oo............................00....................................................$ -0- Total.......................................................................................... 00............................00.....................................................$ -0- Real Estate 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: Shaun E. O'Toole 2813 North Second Street Harrisburg, Pennsylvania 17110 Fonn RW-1 Page 1 of 2 tDauphin County). Rev. 9/92 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and 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. Sworn to and affirmed and subscribed before me this .;( \ day of C:\ \ -' f\. 0 20fl ~ ~ t" [J(Jnf2- ,/ ............................................................................................. DECREE OF REGISTER Estate of Linda J. CamDbell also known as Deceased No. ~ \ D L DloC) \ Social Security No: 274-46-0304 Date of Death: March 19. 2007 AND NOW, \,20 61 ,in consideration of the Petition on the reverse side hereon, satisfactory proof having bee presented before me, IT IS DECREED that Letters 0 Testamentary [&J of Administration - are hereby granted to Shaun E: O'Toole in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters......................... . Short Certificate(s)..(1)..... Renunciation................. . Affidavit ( )................. Extra Pages ( )............ Codicil.................. .~.... JCP Fee....t..Av.......... I""'" ,tdly.. ...ed:. L........ ettW':.... .Cl.tO:D0'\ TOTAL............... . Fonn RW.1 Page 2 of 2 (Dauphin Ccunty) . Rev. 9/92 $ ~D. 00 $~ $ $ $ $ $ is .DO $ IS .tlJ $ dO. 00 ~ ~~no~lIDrlYJ1~ ~~,~~ Attorney: Shaun E. O'Toole 1.0. No: 44797 Address: 2813 North Second Street Harrisbura. Pennsvlvania 17110 Telephone: (717) 213-6653 DATE FILED: $ lJf.OO H105.905 REV.(6/06) This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records m accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. /7 :A~d: It Is illegal to duplicate this copy by photostat or photograph. c-o ~ ~~ tr""f~ Frank Yeropoli State Registrar Calvin B. Johnson, M.D., M.P.H. Secretary of Health (2 ,JtJN i.~OOl C:O-OO m~h!. :P ~ -::0 Z(f)~ 000 82-01 ::::\ ~ 4084268 No. H105-143 REV 11/2006 TYPE { PRINT IN PERMANENT BLACK INK COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) 1. Name 01 Oec9dent (First, middle, last, suffix) Linda Jo 5. Age (Last Birthday) - 0304 ~ 12. Was Dececlentever in the u.s. Armed FOI'ces? Dyes ~No Did Decedent Uve in a Township? 17c. 0 Yes. Decedent Lived in 17d. ~ No, Decedent lived within Actuatlimitsof r...;) C') c:::3 --' (.... c::. :;I: r.a - ""0 :x ~ ~ N 7-1-1947 Darby, PA Sa. Place of Death (Check onl one) Hospital: Other: o Inpatient 0 ER (Outpatient 0 DCA Ii1 Nursing Home 0 Residence OOther - Specify: 9. Was Decedent of Hispanic Origin? eg No 0 Yes 10. Race: American Indian, Black, White. eIt (If yes, specify Cuban, (Specil}1 Mexican, Puerto Rican, etc.) Wh i t e 6. Date of Birth (Month, day, ear) 1. Birthplace City and state or for 59 Yrn Sb, County of Death ad, Facility Name (It not institution, give street and number) Claremont Nursing Home 14. Marital $latus: Married, Never Married, Wklowed. DI"",ced (SpecifY! ~..arried Cumberland 11. Decedent'sUSua! tion Kind of work dooe durin mostofworki lite.Doootstaterstired Kind of Woo Kind of Business f Industry Housewife . 16. Decedent's Mailing Address (Street, city (lown, slate, zip code) 1000 Claremont Road Carlisle, PA 17013 13. Decedent's Education (Specify only highest grade completed) Elementary I Secondary (0-12) College (1-4 or 5+) 12 =~ce 17a,State Pennsylvania 17b.Coun~ Cumberland 19. Mother's Name (First, middle. maiden sumame) Frances Williamson 1 B. Father's Name (First. middle, last, suffix) Charles Miller 2Ob. lnformanfs Mailing Address {Streel, city (town, state, zip cocle) 240 North 36th Street, Camp Hill, PA 17011 208. In!om\ant's Name (Type / Print) Richard Lee Campbell 21a. Method of Disposijion ~ ro << ;t RN 513144L 26. Was Case Referred to Medical Examiner / Coroner lor a Reason Olher than Cremation or Donation? D Yes iii No 23c. Date Signed (Month, day, year) March 19, 2007 Campbell Twp Carlisle CIyIBoro 21c. Place of Disposition (Name of cemetery, crematory Of other place) 21d. Location (Clyl_, slate, zip_I Cremation Society of PA Harrisburg, PA 17109 22c.NameandAddressolFeOl"l\.uer Memorial Home and Cremation Services, Inc. 4100 Jonestown Road, Harrisburg, PA 17109 23b. License Number 'ems 2""'''''' be <:<lIIlple1ed by person who pronounces death. Connie Strayor, R.N. 24. lime 01 Death 25, Date Pronounced Dead (Month, day, year) 12: 45 aM. March 19, 2007 ApproKimale interval Onset to Death Part II: Enter other sionificanl Mnditions r.nntributina to death. but not resufling in the underlying cause gMtn in Part 1. CAUSE OF DEATH (See Instructions end exemples) Item 27. Part I: Enter the ~ _ diseases, injuries, or complications - that (jrectly caused the death. 00 NOT enter terminal events such as cardiac arrest, resplratoly arrest. Of ventricular fibriUation without showing the etiology. List octy one cause on each line :=~=)dse:; Inanition Due to (or as a consequence of): Senile Dementia Due to (or as a consequence 01): _ Alzheimer's Type SequenlJaIIylist conditiOI1s, . '"', ~tothecause1istedOfllinea. En1er!he UIlIlEAI.'/1NCl CAUSE =:e~~n~~re b. c. Due to (or as a consequence of): 308. Was an Autopsy Perlorme(\? d. 3Qb. Were Autopsy Findings Available Prior to Completion 01 Cause of Death? DYes DNo 32g, LocatiOn of Injury (Street. city I town, slate) 31. Manner of DeatI1 ~NaMal D- O Accldent 0 Pending Investigation D Suicide D Cou1d N~ be Delennined 32d.Timeotln;ury 32t.lfTransportationlnjury(Specify) o Driver I Operator 0 Passenger Dpedestrian Other. Specify: 33b. Signature and Trtle olCert Dyes gg No 28. Did Tobacco Use Contribute to Death? DYes DP- IKl No D Unknown 29.1 Female: IK.1 Not pregnant within past year o Pregnant at time of d8ath D Nolpregnanl. but pregnanlwflllin 42 dayS 01 death o Not pregnant. bot pregnant 43 days to 1 year _edeath o Unknown n p4'eQnant within the past year 32c. ~ 01 Injury: Home, Farm, Street, Factory, Oftice Building, etc, (Spec!fy) ~ z ~ o " ~ o o ~ ~ 330. c.mlie< lcl1eck only onel =:rT~=:,n ===:~~W:u=~;::n:rh:~=~_~~ ~~ ~..m~j~~ ~e:~~........ _.............. _........ ~ ... ~~~=~~~i:::~~=~=~~rti=~~=~~a:m.nnerllltlle<L........_.._............_....- 0 = =.n::= lIIld J Of lnvntlgetlon, In my Of'lnlon, death occurred at the time, date, and place, .nd due kl the ClUae(S) and manner .s stated.. 0 M. 33c Li~nse Number 34 Name and Address 01 Person Who Completed C of Death (1Iem 27) Type I Prinl Ernest M. Josef, M.D. 1830 Good Hope Road, Enola, PA I~I/I.;(I/ 1/ I ~ rnspos"~n P"mil No 0 (~ ~ 11(" 3-19-2007 17025