HomeMy WebLinkAbout08-28-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF (luh} IoFp //1,. Jd COUNTY, PENNSYLVANIA
Estate of t' -4 R M € J...l
also known as
,/u IJE ~~ttrl5)
File Number
0\ \ () '\. () "&) t
, Deceased
Social Security Number .;La :l - d....O - ~ 83 I
Petttioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
o A. Probate and Grant of Lette
last Will of the Decedent dated
Testamentary and aver that Petitioner(s) is / are the~>> I (
and codicil(s) dated
M . n~{famedinthe
(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 instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
o B. Grant of Letters of Administration
"'-:>
o ~
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; dur~ l!!!Joritate) -.J
'.,:::J:J > ,
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following s~@f:jiny) ~heirs: (Jf'
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will ill Sectioll A above and complete list of heirs.)' .~ :?:' F;::; N ':::-;
': '''co::u r :
::0
Name
Relationshi
Residence-
_~;Q n
-J:=;
w
(CO,\;/PLETE IN ALL CASES:) Attach additiollal sheets ifllecessary.
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c: tJ )J~ Y I V -II-~ I It- I ?a:.s-- 0-'. ~
11'1 ULJ~tt6-tEf( i!J LvJ, - A1.E(l{.,~)J,e-66l./~
7A V.-
(List street address, townleity, township, county, state, zip code)(!pf..L.
/
Decedent, then B 3 years of age, died on '8 -/.3 - 0 7 at
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 Pennsylvani~
$
$
$
$ .;lOI!:> oc>rn ,.<:r>
/
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:
Fonn RW.02 rev, 10./3.06
Page 10f2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF t!~ ht..h ~ R./.4 ILl d
The Petitioner(s) above-named swear(s) or affirn1(s) that the statements in the foregoing Petition are tme and con-ect to the best of
the knowledge and belief ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and tmly
administer the estate according to law.
Social Security Number: .;:t,oQ
AND NOW, ~~v.b \ .;) 8;- , .;:;:J::J::J"" ,in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Le~rs "\" eS~~0-\~
are hereby granted to "'l)o...u.:>{\ \(\ \:)e-\-~-e,
and that the instmment(s) dated ~~b:> \ f/ \~
described in the Petition be admitted to probate and filed of record as the last Will and Codicil(s)) of Decedent.
Sworn to or affirmed and subscribed
C)
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~~- III
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8~
before me the
day of
Signature of Personal Representative
Signature of Personal Representative
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Estate of
File Number: :A \ 0 l O)ffi I
Ca...rrc'Rf"'\ " J.,.l.f'\c? f< r-oor1.s.
;;) <:) ~~3\
, Deceased
g ~C)I
Date of Death:
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in the above estate
FEES
Letters . .aOD /)f::P. . . $ ::J loD 00
5 "000
Short Certificate(s) .. ..... $ ~
Renunciation(s) .......... $
L..)\\\ ." $
..:)L? ...$
~\o ...$
.. . $
.. . $
.., $
. .. $
... $
... $
TOTAL ..... . . . . . . . . . $ 3\ Dov
Attorney Signature:
\ SloP
\000
~
Attomey Name:
Supreme Court I.D. No.:
Address:
Telephone:
Form R ;+'-01 rev. l O. j 3.06
Page 2 of2
HIOS.80S REV (01107)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
Certification Number
This is to certify that the information here given i:
correctly copied from an original Certificate of Deatl
duly filed with me as Local Registrar. The origina
certificate will be forwarded to the State Vita
Records Office for permanent filing.
P 13671184
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HI~143AEV 11'lOO6
n PE. PRINT iN
PERMANENT
BlACK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
ad. Facility Name (U not institullOll, 'life street and numbel')
114 Lancaster Blvd.
STATE FILE NUMBER
a. \ Dl 02b{
I. Nome c4 Decedent (First middle, lasl, suffixl
Carmen J. Rhoads
5 Age (las' _,I
83
6. Dale of Birth (MorIth, day. year)
4. Date " Ooath (Monttl. da,. _I
August 13, 2007
VIS
October 3,1923
11. Oecedenrs Usual Occ 1100 Kind 01 work done
Kind of Work
Clerical
most 01 life. Do not slale retired
KindofBusinessllndlJSlry
Health Care
12. Was Oecedeol ever in the
U.S. Armed fOl'CEls?
oVos ~
Oocedent',
Actual Residence 17a Slale
13 Decodent', Educa1ion (Specify only tughos' grade """.'eled)
Elementary I Secondary (0-12) COllege (1-4 or 5+1
Unknown
14. Marital Status: Married, Never Married,
_,ilMl<ced(~
Widowed
. 16. Decedent's Mai!ingAddfess (Street city flown, state, lip code)
114 Lancaster Blvd.
Mechanicsburg. PA 17055
17b. Counly
PA
Cumberland
17c. ~es, Deced&ntlMld in
17d. 0 No, Decedent UYed.......
AcluafLimitsol
en
T..
18. Father's Name (First, milidle, Ias~ suffix)
ClIyI-
Fred Delbaugh
19. Mother's Name (First, lTlil*Ie, maiden surname)
Bessie Kulp
20a lnfotmanI's Name (Type I Print)
Dawn Defuge
2Gb Informant's Ma~inv Address lS1t881, ~ I town, &late, lip cadi&...
114 Lancaster Blvd. Mechanicsburg, PA 17055
~
~
21c. Place ol Disposilioo (Name or oemetefy, aernitory or oltIer place)
Mechanlcsburg Cemetery
21d, loca&ioo (CIIy I town, staae, Zip code,
Mechanicsburg, Pa. 17055
22c, NamI and Address of Facility
Myers Funeral Home, 'nc. 37 East Main Street Mechanlc.burg, PA 17055
23b. Liceoie Number
~~~~ldise~
e.
~^ J..cll1'll21.~
Due 10 (01 as a consequence ol):
C lLf'A-.D ..
----
Approximate interval; Part II: Enter oIher siMifir.aot conditions conI1iluIiM 10 dealt\. 28. Did Td:I8c:co Use ContribuIt 10 0eaIh?
Onset 10 Dee" buI no! <esultJng m Ihe _ cause gNen . Pal1 I. 0 Ves 0 P-.
oNo 0""""'""
29. . fem8le:
0"""'_........,..,
o "'''''''''''''de''''
o Nol",_,buI"..gnant_42deys
"de""
o ""_,..."'_43de"Io'....
o ="'~__"""""_
32<:. Place" "*"'t. Home. FlUlll, 51.... Faday
0lIlce BuOing, "" ISllecilyI
=:tlialconditioos,ifil'lY,
=: UNOEca;:;=rut- a
~~e::rWlu:a~re
b.
Due to (or as a consequence ol):
Due 10 (or as a consequence of):
n. Was an Autopsy
P.-
d,
3lI>. W........., F_
Available Prior 10 CompIeIion
d Cause at DeaIh?
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u
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<>
o
i
1 d 1 lid I (I.), 1
Olsposition PerfTlll No 0 0 y (!) s fl 3
32d. Tlm8olm;ury
32g. location at "*"'t (51""", '" 1_,_1
OVos~
oVes oNo
31.~Oeaitl
Il?"""Nawral 0 HomIcide
o Accident 0 Pendil1glnvesllgaliol"l
o Suicide 0 Coold Not be Determined
M
33a CeMlef (check only one)
Ctrtifring physician iPhysician ceMVIOg cause 01 death when anothel physician has pronouoced death and completed lIem 23)
Tothtbettoflly know.., dlalhoccwred due 10 the cauM('land manntfU latteL _ __ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ __...... _.. _ _ _.. _ _ 0
;=::':~1.~~~~j:=.:.~~~;::c~.:~:~~a::~::mlllnlf" ."led_ _.. _ _ _ _ _ _ _ _ _ _.. _ _ _ _ 0
::'~=~oe: and I Of lnYuligltion, In my opinion, death occurred II tlllUme, date, and place, and due to the CluM(11 and mannlf ill ataled_ 0
CH~~
ep\wills\rhoads.cj\12-98
LAST WILL AND TESTAMENT
OF
CARMEN J. RHOADS
I, CARMEN J. RHOADS, of the Mechanicsburg, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM I:
I direct that my Executor hereinafter named shall pay
all my just debts and funeral expenses as soon as conveniently may be
done after my decease.
ITEM II: I devise and bequeath all the rest, residue and
remainder of my estate of every nature and wherever situate to my
daughter, DAWN M. DEFUGE. Should my daughter, DAWN M. DEFUGE, fail to
survive me, I devise and bequeath all the rest, residue and remainder
of my estate, of every nature and wherever situate, to my granddaugh-
ter, WENDY DEFUGE.
ITEM III: I appoint my daughter, DAWN M. DEFUGE, Executrix of
this my last will. Should my daughter, DAWN M. DEFUGE, fail to
qualify or cease to act as Executrix, I appoint my granddaughter,
WENDY DEFUGE, Executrix of this my last will.
'.' <j
~. ,_ , ~ "r 11 ~ "-
., ". ,-/. Ct.,; '.,vO
:u"".\I' , ". ,\,"""".'w
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SZ :2 \:.!d 8Z ~iW LDOZ
Page 1 of 4
ITEM IV: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of her duties in
any jurisdiction.
IN WITNESS WHEREOF, I, CARMEN J. RHOADS, have hereunto set my
hand and seal this ~ day of ---Dot.Q""~ , 1998.
~~/~ i~^~
CARMEN P.f. RHOADS
SIGNED, SEALED, PUBLISHED and DECLARED by CARMEN J. RHOADS, the
Testatrix above named, as and for her Last Will and Testament, and in
the presence of us, who at her request, in her presence and in the
have subscribed our names as witnesses.
/1~ J ~~ 1~() ,.K
Address
~r &4K~LdJ~/:d
Address
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND
I, CARMEN J. RHOADS, the Testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according
Page 2 of 4
to law do hereby acknowledge that I signed and executed this instru-
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
c.~Jc~~Q
CARMEN 5'. RHOADS
Sworn to or affirmed to and acknowledged before me by CARMEN J.
RHOADS, the Testatrix, this
~
e::l:=~ ;8.
Notary Public ~
NOTARIAL SEAL
CONSTANCE L KARlI. Nolary Public
New Cumberland, PA Cumberland Co.
My Commission Expires April 13, 1999
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
and~~~_
witnesses whose names are signed to the attached or foregoing
We,
~4
~e
the
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as
her last will; that Testatrix signed willingly and that she executed
it as her free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testatrix signed the
Page 3 of 4
will as witnesses; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, of sound mind and
under no constraint or undue influence.
00--4 ~~
Wit
Ifkk/~
Witness
Sworn to or affirmed to and acknowledged before me by
~h.~ t-l ~
and
witnesses, this ~
day of
()er~~. , 1998.
~~Y:K~
Notary Public
NOTARIAL SEAL
CONSTANCE l. KARU, Notary Public
New Cumberland, PA Cumberland Co.
My Commission expires April 13. 1999
Page 4 of 4