HomeMy WebLinkAbout08-06-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF 0-um bfJr-\a.o d
COUNTY, PENNSYL VANIA
Estate of
G \ 0 \'\ C\ .s .
~\("Ir' 0
i)c.s~e-f
~~<<er
File Number
cJ J - 67- 0733
~lo ?:> - I ~ - () 3Cf5
also known as
, Deceased
Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
~probate and Grant of Letters Testamentary and aver that Petitioner(s) is' are the .
last Will of the Decedent dated \ and codicil(s) dated I\J O(\--e
named in the
(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 instl1lment(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: C)~
c-; 0 -'
. (If applicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; duranJ I~ate) ~ . -
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following sp~u{e Etfany) and heirs;
Administration. c.t.a. or d.b.n.c.t.a., enter date o/Will in Section A above and complete list o/heirs.} . C.,? C) :::0>' .
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Resf~~
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D B. Grant of Letters of Administration
Name
Relationship
;
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Decedent, then ~ /p
pcod~ r
years of age, died on~oj ",-q..l~at 1)~(\\le...r ~ICe., Au 1'0 Ie , C.O
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 P A) Personal property in County
Value of real estate in Pennsylvania
$0
$
$
$ 0
situated as follows:
titioner(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
ed:
Form RW-02 rev. /0./3.06
Page 1 of2
Oath of Personal Representative
COMMONWEAL TH OF PENNSYLVANIA
COUNTY OF t\JM k\~
SS
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 repr ntative(s) of the Decedent, Petitioner(s) will well and truly
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administer the estate according to law. I
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Signature of Personal Representative
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Signature of Personal Representative
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AND NOW,
having been presented before m , IT I
are hereby granted to
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, Deceased
7/:24/07
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in consideration ofthe foregoing Petition, satisfactory proof
Date of Death:
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed ofrec
FEES
Letters ............... $:J./). t)O
Short Certificate(s) . . . . . . . . $ /J>.OO
~Re~unCiation(s) .......::: ~~
~...$ .
rnO U!lk:..,t. .. $ ,
$
$
$
$
$
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Attomey Signature:
Attomey Name:
Supreme Court I.D. No.:
Address:
Telephone:
TOTAL ..... . . . .
Form RW-IJ] rev 10.13.06
Page 2 of2
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STATE OF COLORA
COLORADO DEPARTMENT OF<PUBLlC HEALTH AND E
HOLD TO LIGHT TO VIEWWATERMARK
O~)I-C 7-733
VIRONMENT
STATE OF COLORADO
CERTIFICAtE OF DEATH
STATE FILE NUMBEFl
1. DECEDENT'S NAME (First. Middle, Last)
3 DATE OF DEATH (Month, Oal', Year)
Glori
4. SOCIAL SECURITY
NUMBER
5c, UNDER' DAY
6. DATE OF BIRTH
(Month, Day, Year)
June 24, 1921
263-12-0395
8 WAS DECEDENT EVER IN
u.s. ARMED FORCf.;S?
o Yes ~o Dlnpa_tie1lt 0 ER/Outpatl~nt
9b. FACILITY NAME (II not institution, give street and number)
Denver Hospice
H<s
.Mins
.
IN
o DOA
OUNTY OF DEATH
lOa. DECEDENT'S USUAL OCCUPATION lOb.
b~'~i~~::e~~~~~one duringrnost of working life,
BUSiNESS/INDUSTRY
11. MARITAL STATUS . Married, 12.
Never Married, Widowed,
Divorced (Specify)
13b. COUNTY
Divorced
13d. STREET AND NUMBER
Cumberl~d Mech~ni~sbur
l~ WASPE:CEDENT OF HiSPANIC ORil>IN?
{Specify N6 or ,Yes - If V9s;spedfvCuban,
Mexican; Puerto Rican,' ate;,
~No 0 yes
Sper;J1y:' ,
Drive 11211
16. DECEDENT'S EDUCATION (SpeCify only highest
fo~~~~~'J:~I~:6dJl~~0nd~~o"~:~~~n~~77+ )
17055
White
-J!;fAME (irs', fvliddJe;,Last{M~idtmName,t}
12
17. FATH R.NAME IFirst, MiddJe;Last)
FORMANT-NAME and relationship to deceased.
.
2Oc. LOCATION - City or Town, State
Daughter
PA
A~l)enMortuary l:tSO Simms Street
Lakewo9Q,.Colorado ZIP 80401
25. WAS CORONER NOTIFIED?
(Yes or No)
No
TO BE COMPLETED BY CORONER
1_
27. .On the basis of examination and/or investigation, in rnyopinion dEtath occurred a1 the
Um.. date:anc;lplace, and due to IIle cause(s) and manner as stated.
S;grtatufe:..... f"--..)
, fIJf" /c::.')
29. DATE SIGNED (Month, Day, Year) ~
2 .....-.-
3_
4_
33a. DATE OF INJURY
(Month, Day, Year)
5~
o Pending
Investigation
o Suicide
o lh1determined
Manner ~.
o Homicide
34. IMMEDIATE CAUS
PART
I
CONDITIONS
IFM,y WHICH
GAVE RISE TO
IMMEDIATE CAUSE
STATING THE
UNDERLYING CAUSE
LAST Ie)
(b)
DUE
(e)
PART OTHER SIGNIFICANT CONDITIONS - Conditions contribu1ing todea1h but not related to cause in
II PART t (e.g., alcohol abuse, obesity, smoker).
35, AUTOPSY :36. IF YES were findings conBldered
(Y.. or No) in determining cause of dea1h?
NO
)
JUL2 7 2007
~S~
RONALD S. HYMAN
STATE REGISTRAR
DATE ISSUED
THIS IS A TRUE CERTIFICATION OF NAME AND FACTS AS
RECORDED IN THIS OFFICE. Do not accept unless prepared on
security paper with engraved bOrclerdisplaying tlie Colorado state seal
and signature of the Registrar. PENALTY BY LAW, Section)25-2-J 18,
Colorado Revised Statutes, 1982, if a person alters, uses, attempts to
use or furnishes to another for deceptive use any Vital statistics record.
NOT VALID IF PHOTOCOPIED.
11l~ /11I1111I1111111111111 III 1I1I1 11111 ~ /111111111111
003 5 291 8 9
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...21 -07- 733
LAST WILL AND TESTAMENT OF GLORIA S. BESSER
I, Gloria S. Besser, of the Borough of Mechanicsburg,
County of Cumberland and State of Pennsylvania, being
of sound and disposing mind, memory 3nd understanding
do make, publish and declare this my Last Will and
Testament.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can
conveniently be done.
I give and bequeath all the rest, residue and remainder
of my estate, of whatsoever nature and wheresoever
situate, to my four children, share and share alike.
In this respect, I nominate, constitute and appoint
my daughter, Norma A. Munchel, Executrix of this my
last will and testament.
In witness whereof, I have hereunto set my hand and
sea I t his -i!...s.L day n f Ma y , A. D . 2007.
Signed, seared, published and declared by the above
named Gloria S. Besser, as and for her last Will and
Statement, in the presence of us who have subscribed
our names hereto as witnesses, at the request of said
testatrix, in her presence and in the presence of each
other.
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U _____~TH OF. PENNSYLVANIA
Notarial Seal
Judith M. Wenberg, Notary Public
echanicsburl} Boro, C....mberland Coun
My CommissIon Expires Sept 27, 2009
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