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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYL VANIA
Estate of HELEN VIOLA YEATIS
also known as
FileNumber ;2/ -07- 07 J 7
, Deceased
Social Security Number 292-36-6584
Petitioner(s), who is/are 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) is I are the
last Will of the Decedent dated and codicil(s) dated
'Med in the
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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 ofth~i~ent(s~ered"
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: .)C-A
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(State relevant circumstances, e.g., renunciation, death of executor, etc.)
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(lfapplicable, enter: c.t.a.: db.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
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iii B. Grant of Letters of Administration
Petitioner(s) after a proper search has I 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 Relationshio Residence I
JOHNR. YEATIS SON 108 STONER DRIVE, MECHANICSBURG, P A 17055
(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
MESSIAH VILLAGE NURSING CARE CENTER
(List street address, tawn/city, township, county, state, zip code)
Decedent, then 87 years of age, died on MAY 14, 1997 at MESSIAH VILLAGE NURSING CARE CENTER,
UPPER ALLEN TOWNSHIP, PENNSYL VANIA
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) 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
$
$
$
$
25.00
0.00
0.00
0.00
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 d or rinted name and residence
JOHN R. YEATTS, 108 STONER DRIVE, MECHANICSBURG, P A 17055
Form RW-02 rev. 10.13.06
Page] of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
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 of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
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administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~ day of
Signature of Personal Representative
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Signature of Personal Representative
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File Number:
8--1-01- 0111
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Estate of HELEN VIOLA YEATTS
, Deceased
AND NOW,
having been presented before me, I
are hereby granted to JOHN R. YEATTS
Date of Death: May 14, 1997
()...(f)7 ' in consideration of the foregoing Petition, satisfactory proof
that Letters of Administration
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed ofr
FEES
Letters ............... $ ~,aJ
Short Certificate(s) . . . . . . .. $ .00
:\Cun~..on~ H :----10. ~
~ -' ...$ 8-
0" $
0.. $
...$
.. . $
... $
... $
...$ ~
TOTAL.. .. . .. .. .. ... $ '-fa. -
Attorney Signature:
Attorney Name:
PATRICK M_ CICERO
Supreme Court J.D. No.: 89039
Address:
108 STONER DRIVE
MECHANICSBURG, P A 17055
Telephone:
717-697-1181
Form RW-02 rev_ 10_13.06
Page 2 of2
Hl05.112 REV. 8-88
(FEE FOR THIS
CERTIFICATE $2.00)
.;J/-I]7 - 07/7
WARNING: IT IS ILLEGAL TO ALTER THIS COpy OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. 3441420
Date of Issue of This Certification
May 14, 1997
Name of Decedent
Female
Helen V. Yeatts
First
Last
May 14, 1997
Middle
292-36-6584
Date of Death
Social Security No.
Sex
Date of Birth
June 5,1.909
Springfield, OH
Place of Death
Wh ite
Birthplace
Messiah Village Nursing Care Center,Cumberland Co., Upper Allen Twp. Pennsylvania
Facility Name County City, Borough Of' Township
Occupation Reg; stered
Decedent's
Mailing Address
Nurse
Armed Forces? (Yes or No)
Race
Marital Status
Widowed
P.O. Box 2015 Mechancisburg, PA 17055
Number
Street
John R. Yeatts
Funeral Director
Scott D. Brenneman, F.D.
Informant
Name and Address of
Funeral Establishment
No
17019
State
COCKLIN FUNERAL HOME Dillsbufg, PA
Part I: Immediate Cause
Cardiac Arrest
Interval Between
Onset and Death
Immediate
(a)
(b)
Aortic Stenosis
Years
(c)
(d)
Part II: Other Significant Conditions
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Manner of ~~~th:
Natural 0
Accident 0
Suicide 0
Describe how injury occurred:
Homicide
Pending Investigation
Could not be Determined
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Name and Title of Certifier
L. Zimmerman, M.D.
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Address
108 Lowther St. Lemoyne, PA
17043
(M.D., D.O., Coroner, M.E.)
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.
May 14, 1997
Dale Received Ily Local Regilt'.'
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