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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
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Estate of KATHRYN A. WALSH
also known as
File Number
. Deceased
Social Security Number 174-40-9388
JAMES L. WALSH
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ofti;~~ment(S~ered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: )-"7 CF'<
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
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
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o B. Grant of Letters of Administration
(If applicable, enter: c.t.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.)
I Name Relationship Residence I
JAMES L. WALSH HUSBAND 43 GOLFVIEW ROAD, CAMP HILL, P A 17011
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in CUMBERLAND
43 GOLFVIEW ROAD. CAMP HILL. P A 17011
(List street address, town/city, township, county, state, zip code)
County, Pennsylvania with his / her last principal residence at
Decedent, then 59
years of age, died on MAY 29, 2007
at CAMP HILL, PENNSYLVANIA
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(Ifnot domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value ofreat estate in Pennsylvania
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$
$
$
$
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
JAMES L. WALSH
43 GOLFVIEW ROAD
CAMP HILL, PA 17011
Form RW-02 rev. 10.13.06
Page lof2
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Oath of Personal RepresetitatiVe t:.
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COMMONWEALTH OF PENNSYL VANIA
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COUNTY OF CUMBERLAND : OJ'_?;v... 9~\ \R\
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The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the f~mg~P~ition~fte.tfl1e and correct to the best of
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the knowledge and belief ofPetitioner(s) and that, as personal representative(s) of\h~~D~ceden~, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~day of
J;1Jit ~
1j!1 e -~st
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Signature of Personal Representative
Signature of Personal Representative
File Number:
J(~tJ?- &/:f 6
Estate of KATHRYN A. WALSH
, Deceased
Date of Death:-J:11 A Y # 1, #- 007
, .-..A1d 7 (J;)derati~n of the ~regoin&.p3.tition, satisfactory proof
~EC~tha~lrsA. (--f n t7U morrtL-H n
AND NOW,
having been presented beti
are hereby granted to
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as t
Letters ..........~~~~ $ ~PO
Short Certificate(s) . . . . . . . . $ ~
Renuncia~. . . . . :. :. '.' $$$ 10 : ~~
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.. . $
.. . $
.., $
.. . $
.. . $
.. . $
. .. $
TOTAL .... . . . . . . . . . . $ 0.00
Fonn RW-02 rev. 10.13.06
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Attorney Signature:
Attorney Name:
STEVE C. NICHOLAS, ESQ.
Supreme Court I.D. No.: 6845
Address:
2215 FOREST HILLS DRIVE, SUITE 37
HARRISBURG, P A 17112-1099
Telephone:
(717)540-77 46
Page 2 of2
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.
ikn- frl~-
Local Registrar
Fee for this certificate, $6.00
p
13355843
MAY 3 1 2007
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REV 1112006
, PRINT IN
~ENT
CI( INK
COMMONWEALTH OF PENNSVLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
12. Was Decedent ever in the
U.S. Armed Forces?
o Ves [XNo
Decedent's
Acluai Residence 17a. Slate
4. Date of Death (Mont~)i.Flr) /'\ r'a
rnOLt 0'1 0.00' J
Othar:
June 21, 1947
Bel FacIlly Name (If not instlMlan, ~ street and runber)
HOIL\ S?\nr \-\o~p\b\
o Other . Specify:
10. Race:.American indan. lllack, White. etc.
I Specil}'l
white
. 11. llecederts Usual lion Kild 01_ done
Kind of WOfk
Teacher Education
. 16. lJec:edenI's MaIlIng Adl!ress (Sreet, city Ilown, slate, zip code)
43 Golfview Road
Cam Hill, PA 17011
18. FaIh8r's Name (Finll, mlddIe. 1aBl, suIlIx)
Jacob L. Endrizzi
20L InfonnanI's Name (Type I Pr1nl)
James 1. Walsh
21.. IolelIlod of DIsposIIIon ~ CrImeIIon 0 Oonallon
o Burial 0 R8moYaI from Slate I w.. c-tton or DonItIon AuthorizlId
o 0lheI. Sp8cify: by IIIdIcIl EumInIr 1 c-.?
~ 22a.' F (or person acting as such)
13. Decedent's Education (Specify only highest grade completed)
Elementary 1 Secondary (0-12) COllege (104 or 5+)
12 6
Pennsvlvania
Cumberland
Married
James L. Walsh
East Pennsboro
TW!>.
17b. Counly
17e. ~ Yes, Decedent Uved In
17d. 0 No, Decedent Uved wllhln
Acluai UmIIs of
City I Bora
19. Mother's Name (FiI11, midcIII, malden surname)
Beatrice R. Miles
2Ob. Inlonnent's MoiIng AddrMe ISlreet, city 1Iown, sIa., zip code)
43 Golfview Road, Carn Hill,
21e. PIIce 01 DlIpoctlIon (Name of _ry, eremotory or oIhor place)
Evans Crematory
17011
21d. Location (City ftown, slate, zip code)
Schaefferstown, PA 17088
22c. Name and Address 01 FaciUly
Parthemore FH & CS, Inc.. P.O. Box 431, New Cumberland, PA 17070
23b. License Number
23c. Date SIgned (MonlI1, day, yea~
. ===:m~byptl'SOl1 24.TImeolDeath q:?j:) P M. 25.~Daada~,daY,.YlJ.II~ ()
CAUSE OF DEATH (See Instructlona and examples)
IItm 27. Pelt I: Enter Iht ~ -~, Injuries, or ccmpIealIons -Ihtt cheIIy caustd Ihe dealt DO NOT enlIlr tenninaI events such as cardac arrest,
IlllIPirlIlOrY arrest, or ventric:Uar ItlriIIaIlon wlthOIA 8IIMing Iht eIioIogy. Ual only one eeUllt on eech Int.
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26. Was Case Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation?
o Ves ijJ No
Approximate irterveI: Part II: Enter other oionIflcant ..,,-.. C<lI'btloJiM to death 28. Did ToIlaoco Use Conhllute to Oesth?
Oneet 10 Oeslh but not resulting in the undeItyIng cause giYen In Part I. 0 Yes 0 Probably
o No nknown
a.
LiVf- (' ~l ; I III (-e
Due to (or 81 ~ ~ 01):
b. '. {C" jt'S L,~
Dueto(or~~S
e. . I
Due to (or as a 01):
d.
o Veo ,}if No
:n. Were fdDpay Rndngs
AveIIebIe Prior \0 CompIe4ion
01 Cause 01 DeaIh?
DYes ~No
31. Manner of Oeslh
~ Natunli D Homicido
o AceIdIInt 0 Pending InvatIgalion
D Suicide D CoI*l Not be Del8rm1ned
29.~:
Not ~t witIlln past year
Pregnant at lime 01 death
o Not pregnanl, but pregnant within 42 days
of dellth
o Not pregnant, but pregnant 43 days 10 1 year
before death
o Unknown N ~t wtttm Ihe past year
32c. PIece of Injl.vy: Home, FIrm, SlnIel, FlIeIOIy,
0fIIce BuildIng, lltc. (SpecIfy)
=151 ooncIlIonI,lI any,
to cause IsIed onlne a.
EnlII UIIlERLVIIG CAUSE
. =:-re:>>:n~~~
3011. Was 111 Autopsy
Perlormed'I
32d. TIme of II$lry
320. LOCIIion 01 Injury ISlreet, city 1 town, slate)
M.
331. Cartlfier (chedt only one)
. CIrlIIVlnll phyIidIn (Physician 0IItifyIng cause of death WIlen another pl1yIlcian heI pronounced dealh and ~ Item 23) ,
To the bell 01 lIlY 1oMMledgI, dMlII ClCCUtIlId ulo lhe ClUM(I) IIld _ II lilted.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - - ~
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. lIedlcIl EumIIw 1 eo.-
On Iht bail oleumtna1ion lIIId 1 or Invesllglllon, In my opinion, dee1h oeeuned eI the time, dele, end plIce, lIIId due to the eellll(l) II1llIlllllIler as alII8cL 0
35. Registrar's .
.
I oa / I C1 / I /1 36'~-7J'~yeI)
Disposition Permit No. ("1 II '7 15<1