HomeMy WebLinkAbout08-30-07
REGISTER OF WILLS OF
PETITION FOR PROBA TE AND GRANT OF LETTERS
C fA ~ Bt= J2.Uf A)J) COUNTY, PENNSYL VANIA
File Number dl -{J/ ~ gDS-
/H. /? ru1g
Estate of F/ortnc~
also known as
, Deceased
Social Security Number
J 91, -/Lf- ;{SbO
Petitioner(s), who is/are l8 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /.-e the E)<eclLiror
last Will of the Decedent dated rnm.a-;r,1 I CfY,/ aRB eeeieil(91 e1llted
~ RenllnciQ,kon n~ D~~&Jd Da..vis Cc.~et.c.c.hr i'~ {;/eJ IAa-r.w;te..
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
named in the
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instmment(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: NoNtF
o B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d.b.n.c.l.a.; pendente lite; durante absentia; durante minoritate)
Petitioner(s) atier a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
Administratioll, c.t.a. or d.b.ll.c.t.a., elller date of Will in Section A above and complete list of heirs.) ,
( . ~ !
Name
Relationship
---"\
Residence)
____2
>~
c...)
(COMPLETE IN ALL CASES:) Attach additiollal sheets ifllecessary.
--.-.-"
Decedent was domiciled at death in
~J
County, Pennsylvania wit~her last principal ~~iaehce at
{.......l
Decedent, then
gtJ
years of age, died on ~./~, 2txJ7 at Hot SI'/rd
I!llSp,'fal
.
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
$ /,000.80
.
$
$
$ :L'. oco_ 410
situated as follows: ~ / :!> 5" La Jlci,s ~ 1&./ EhtI/O (1Itz~dM1 7Utp.) (1~uB &t.u,-$
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:
bDlI tv.
&#w1.
Typed or printed name and residence
Sha.dIf t.~
7jf h02S"
Forll/ RW-OJ rei' 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COVNTYOF CU-IVle>EJU.^NJ)
The Petitionerl)l1 above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and conect to the best of
the knowledge and belief of Petitione~ and that, as personal representativej;81 of the Decedent, Petitioner~ will well and truly
administer the estate according to law.
· aM~~L~ ~
Signat e of Personal Rep ltatlve :De-NAllS 1)A VIS
Sworn to or affirn1ed and subscribed
~~j~l-/ day of
,Jet'') [
\Y-i Ckfu-l,v1
For the Register ()
Signatllre of Personal Representative
Signature of Personal Representative
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File Number: aU - v I - LJ (,) U
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Estate of Flor~nc.e m. Ru..d~
Social Security Number: 11u-I'f-2Sf4o Date of Death: Au4UU /i,,'ZtJ07 ~::~
(/
AND NowrL . % ill ~ ,.;)co I , ;n con,;d,,,rinn of tho fnregn;ng Poririnn, ,,",['Olney pmn[
having been presented be e me, IT IS DECREED that Letters 7e.s fIJhJenh""
are hereby granted to Dennis tJIJ y/.s -
, Deceased~J
,
in the above estate
and that the instrument(s) dated /YID..j ~7.. 1''19
described in the Petition be admitted to probate and filed of record as the last Will €eRQ C'Qdi-;-il(E)) of Decedent.
-1d~~ l^1l\.(),~A MD~,-16Q"JYLud~ f'J~' ), t
Register of Wills ~
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Attorney Signature: ~ t!": ~ Z!f ,
Ch4r/e.s e: SA, e./q"S 7F
Supreme Court LD. No.: 38$;/3
, Clouser it7d.
/J1ec.hanicSbu7' 1111 170SS
FEES
Letters ............... $ 00.(Xl
Sh011 Certificate(s) . . . . . . . . $34. dO
Renunciation(s) .......... $ -5 .ct)
Lu; I / .. . $ 15'". 00
.....JeP . . . $ 10. cD
o 1 A T~ >YYxJ UO'('-' . .. $ 5. 0:")
.. . $
. .. $
$
.. . $
.. . $
. .. $
TOTAL.. .. .. . .. .. .. . $ 14q .00
Attomey Name:
Address:
Telephone:
7/7- 7/.f# -tJ Zt9'!
Furl/l RW-02 rev /0.13.06
Page 2 0[2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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3 REV 11/2006
I PRINT IN
lMANENT
ACK INK
1, Name 01 Decedent (First. middle, last. suffj~)
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
89
y"
12/23/1917
STATE FilE NUMBER
5. Age (Last Birthday)
Florence M. Rudy
6, Dale 01 Birth (Month, day, year)
3. Social Security Number
196-14
Cumberland
Pennsboro Tw
~palient 0 ER ! Outpatient 0 DCA 0 Nursing Home 0 Residence
9. ~~~~~=~~t~~~~~~anic Origin? ~ No 0 Yes
Mexican, Puerto Rican, elc,)
8b County of Death
11, Decedent's Usual Occu tion Kind of work done durin mosl of workin life. 00 rlOt state retired
Kind of Work Kind of Business !Industry
Domestic
Housekee er
DYes ~No
Decedent's
Actual Residence 17a. State
14. Marital S1atus: Married, Never Married,
Widowed, Divorced (Specify)
Widow
DOther. Specify
10, Race American Indian, Black, White, elc
(Specify)
White
. 16, Decedent's Mailing Address (Street, city I town, state, zip code)
2135 Lambs Gap Rd.
Enola Pa 17025
17b. County
17c. [&: Yes, Decedent Uved in
17d.D No, Decedent Uved within
Actual limits 01
Hrtmpclpn
Twp
18, Father's Name (Firs!, middle, last. suffix)
James H. Davis
19. Mother's Name {First, middle, maiden surname}
Edna M. Forney
20b. Informant's Mailing Address (S1reel, city / tOWfl, slate, zip code)
604 W. Shady Lane, Enola, Pa 17025
21c. Place of Dispos~ion (Name of cemetery, crematory 01 other place)
City/Bora
20a. Informant's Name (Type I Print)
Dennis J. Davis
21a, Method 01 Disposition
23a. To the best ot my knowledge, death occurred at the lime, date and place stated, (Signature and title)
Stone Church Cemeter
22o.N,mea"'Add",ssofF'ciJi~ Sullivan Funeral
51 N Enola Dr Enola
Pa
Home
Pa 17025
23b.license Number
23c. Date Signed (Month, day, year)
26. Was Case Referred/tO Medical Examiner j Coroner for a Reason Other than Cremation or Donation?
oy" ONo
Sequentially Itst conditions, if any
.. ~;t~~~~o ti~eD~a~t~i~~~~~~~e a
! (dissase oriryjury that initiated the
.. even!s resultmg Ifldeath) lAST.
-
..
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ApprOl{imate interval Part II: Enter other i n t it nt 'b i t 28 Ok! Tobacco Use Contribute to Dealh?
Onset 10 Death but nol resulting in the underiying cause given in Part I 0 Yes 0 Probably
ONo OUnknoWfl
29. If Femakr
o NOlpregnanlwithinpaslyear
o Pregnantattimeofdeath
o Not pregnanl,butpregnantwilhin 42 days
of death
o Not pregnant but pregnant 43 days to I year
beforedealh
o Unknownilpregnanlwilhm the past year
32c, Piace of Injury: Home, Farm, Street, Faclory
Off~ Building, etc. (Specify)
Due to (or
I~ 30aWasanAulopsy
.. Performed?
'!JI
30b. Were Autopsy Findings
Available Prior 10 Completion
01 Cause of Death?
o y" [tfNo
Dy" DNo
o Accident 0 Pending Invesligation
o Suicide 0 Could Not be Determined
32d, lime oflnlury
321, If Transportation Injury (Specify)
o Driver I Operator 0 Pas
o Other. Specify
33a Certifier (check only one) 3;J~ Signat~ and Titl
Certifying. physician (P. hysician certrlymg caus. e of death when an.olher Physician has pronounced death and completed Item 23) r7i'" ... /"
To the best 01 mv knowledge, death occurred due to the causels) and manner as slated_ - - - - - - - - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ -r /"', j,.1.- ''-'''t
P"n,"no;ng and c.rt'~ing physioian (Phys<<," bolh P"""",,ng dealh and certi~,"g 10 ""se 01 dealh) 330 ""nse m~r'
Toth. be" of my knowl.dg., dealh 0"""" allh. 11m., dal., and pi"., and d""o Ih. ""se(s) and mann" as stal.d_ - - - - - - - - - - - - - - _ _ _ 0 'rIr 1) (i ' J f} J I
Medical Examiner / Coroner I _" I '
On the basis of examination and I or Investigation, In my opinion, death occurred at lhe lime, date, and place, and due to the cause(s) and manner as slated_ 0
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36. Date Filed (Month,day, year)
I ,xl I I ~ I II I
Disposition Permit No G? L) .5't1 /7-.5"'3
34, Name and Address of Person Who Completed Cause of Death (Ilem 27) Type I Prinl
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RENUNCIATION
REGISTER OF WILLS
C. u m 13 8!LI/-JVj) COUNTY PENNSYL VANIA
,
en
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Estate of
F 10 re.nce /J1. I? u. d 'I
,
, Deceased
I, unalcl ])111//S
(Print Name)
&- execufor
, in my capacity/n~latiom;hip as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
j)el1l1is .lJOJl/S a{,. Sole e--y.ew/z:;r
XCO~~,~
(Signature) ]:)Dna J)ayiS
:l ~ 3 S .sh~rman.s J1:t II,.. /(/)lU/
(Street Address)
E///tdfSbu7.'?A /7o~1f -1 b!S-
(City, State, Zip)
r'1w~ 58;1- ~ 13'1
Executed in Register's Office
Sworn to or affirmed aod subscribed
-:Z,',i.... ~
bef91f me this, o.J'J day
of U~Kj .l.0T , (:J..[)D 1
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this ;Z 1 It day
of 17a91- , .;u:o 7-
t%Utb I? ~dv :zzr
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.06
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Member. PeJ1.:ns-'~:"v;:::;".i'8> J\s,:)c~
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OATH OF NON-SUBSCRIBING WITNESS(ES)
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REGISTER OF WILLS
C.Utnr3FJeLI'rNJ) COUNTY PENNSYLVANIA
,
.,\
c...n
N
Estate of
FloFence M. 1?u.d!:J
, Deceased
1)~nni5 PMiS
and
~ being duly qualified according to law, depose(s) and say(s) that ~he /~ was,l v.'€r~ well-
acquainted with Floretla 111. Rl.l~ and a~ familiar
with the handwriting and signature of the decedent, and that the signature of FIDrenu. m. V?~
to the foregoing instrument purporting to be the Last Will and TestamentlCodieil of Florf;1\Gt. }1t1. Ru.d!j
is in ~her own proper handwriting.
x~~
(Signa re) Pe.Yl t\ is IS
(S~~ jdres~' '5hatJ.;} L041t
Enola) pfr f10').5"
(City. Slale, Zip)
(Signature)
(Slreel Address)
(City, Slale. Zip)
Executed ill Register's Office
Sworn to or affirmed and subscribed
before me this ~() I..:. L day
of Q~'v'J.)-t , doOi
I,
~CQ~~ ~-+
uty for Reg ter of Wills
Farm R W.04 rev. 10. 13. 06
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OATH OF SUBSCRIBING WITNESS(ES)
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REGISTER OF WILLS
C U WI IJEllLA-AlJ) COUNTY, PENNSYLVANIA
r.Il
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Estate of
F/r;rena I'vl. RI..t~
, Deceased
ChlL"/es r, Sn,'eJds 1JL
, ~ a subscribing witness to
(Print Name/s)
the r&l Will 0 Coclieil(:y) presented herewith, ~ being duly qualified according to law, depose(s) and
say(s) that ~/ he /~ was ~ present and saw the above J:~~tator~/ Testatrix sign the same
and that ~ he ~ signed the same and that -Bfte / he ,4hey signed as a witness at the request of
the .408ttlt<Jr/ Testatrix m her /-ffi.&. presence and in the presence of each other.
(S~,~ {~~~
Co C)t>u5>er Ad.
(Signature)
(Street A ddres;)
(Street Address)
/Jl~4n;es'1/)"~1 fA- /1()5~
(City, State, Zip)
(City, State, Zip)
Swam to or affirmed and subscribed
:), ~ \---'
before me this Y
Executed out of Register's Office
Swam to or affirmed and subscribed
Executed in Register's Office
day
before me this
day
of ~~-+
,:')...OJ{
of
Notary Public
My Conunission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.
Form RW-03 rev. /0./3.06
LAST WilL AND TESTAMENT OF FLORENCE M. RUDY
I, FLORENCE M. RUDY, of Hampden Township, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding, do make, publish and declare this
my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at
any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
I hereby give and bequeath to the Cumberland County Office of Aging the sum of Two
Thousand ($2,000.00) Dollars.
3.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, is to be converted into cash and distributed to the following persons: Marion
Duncan; Joseph Davis; Ruth Radabaugh; Catherine Yeager; Wilbur Davis; G. James Davis; Ronald
Davis; Michael Davis; Donald Davis; Dennis Davis; Gary Radabaugh; Russell Radabaugh, Jr.
Each of the above-named persons who survive me shall have an equal share. In the event any of
the above-named persons fails to survive me, his or her share shall be proportionally divided
amongst those above-named persons who do survive me.
4.
I nominate, constitute and appoint my nephews, Dennis Davis and Donald Davis, to be the
Co-Executors of this my Last Will and Testament. I further direct that they shall not be required to
file bond or other security in the Office of the Register of Wills for the purpose of administering
my Estate.
~ss ":7:~:;. have hereunto set my hand and seal this
:J~ L-1A AJ '-m' K ~k
FLORENCE M. RUDY - U
.;2710 day of
(SEAL)
Signed, sealed, published and declared by the above-named FLORENCE M. RUDY as and
for her Last Will and Testament, in the presence of us, who at her request and in her presence, and
in ilie~~CleOfe~h~,~ve h=E~ft-
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