HomeMy WebLinkAbout09-07-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Qvm68UAtJD COUNTY, PENNSYLVANIA
Estateof~LJ) e,
also known as
Hoo v'Gt-
J"f-.
File Number ~)
D 1 Dl~L\
}&,O r'-j:J-1D I f'l
, Deceased
Social Security Number
Petltioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
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
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aiamed 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~~~rumeTI$) offJred
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person: --; ~ ::
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...........
(State relevant circumstances, e.g, renunciation, death oj executor, etc.)
o B. Grant of Letters of Administration
c.n
o
(If applicable, enter: c.t.a.; d;b.n.c.t.a.; pendente lite; durante absentia; durante minori/ate)
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
AdministratiolJ, c.t.a. or d.b.ll.c.l.a., enter date of Will ill Section A above and complete list of heirs.) _.
s
Residence
Name
(COMPLETE IN ALL CASES:) Attach additiollal sheets ifllecessary.
Decedent was domiciled at death in ~~~unty, AennSYlVania with his / her last principal residence at
I bOO S w 1tf'l.11I1n~~ {iJ . . ::aA j) 'It (7/170
(List street address, townleity, townsllip, county, state, zip code)
Decedent, then 5c{ years of age, died on f')30 I b'1
at
R.ES, J)evC6
)lX>O ~1h<-~1lG I!-b. /J~ I III- )'/070
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) V All personal property .,..- 1_...1!!
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania ~S.Q..
~ ?@'''-. 5
f ,..~ ~o
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situated as follows: e~\~ c.-6
Wherefore, Petitioner(s) respectfully requesl(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in Ihe appropriate form to
the undersigned:
T ed or rinted name and residence
t,,~ X H:vVt:fL
Form RW-02 rev. 10./3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
fAA r?l86at-R tV tJ
The Petitioner(s) 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 ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
SigM,",,"/~~
Signature of Personal Representative
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Signature of Personal Representative
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File Number:
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Estate of
, Deceased
Social Security Number:
Date of Death:
AND NOW, ~~l
having been presented before me, IT IS DECREED that Letters
are hereby granted to --to. f\-n (0... S \-\otN~('
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codic"1(s)) of Decedent.
FEES
I 0 Dob -
Letters ....... ( . . L .~ $
Short Certificate(s) . . .'.C?). . $
Renunciation(s) .......... $
0C~ $
~~ $
$
$
$
... $
'" $
... $
... $
TOTAL .............. $
is ,bC>
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Attomey Signature:
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Attomey Name:
Supreme Court I.D. No.:
Address:
Telephone:
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Form RW.O] rev~ fO.13.06
Page 2 0[2
H105.80S REV (01/07)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 13857726
Certification Number
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
R;.)OfdS Off~fr.~anent filing. SEP 0 1 Z007
~/'~ ~-/ /
Local Registrar Date Issued
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REV 1112006
I PRINT IN
\!ANENT
,CK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(see Instructions and examplas on reverse)
\ \) t O~ f().Y..
Anne B. Schell
2Ob. Inlom1anfs MaHilg Addnlss jSlreat, ctty I town, _, Z\> codel
1000 Swarthmore Rd. New Cumberland PA 17070
21c. Place of Disposition (Name of _, CI8ITIllloly or oIher pIaca) 21d.localion (CiIy 1_, stala, zip code)
ower Allen Twp., PA
Cumberland! PA 17070
Serv:l.ces, nc.
23<:. Dala Signad (Month, dily, yollf)
1. Name oIlJecadant (F"", _,last, sutllx)
'c.t.rdd C
5./lqe(Last BlI1hday)
'J.-,
54
9/18/1952
Harrisburg, PA
VIt.
Bb. County 01 Peath
8d. Facility Name (If noI_,1jie st.... and nunmj
Cumberland
New Cumberland
1000 Swarthmore Rd.
12. Was Decedent ever In the
U.S. Armed Forces?
ov.. IlClNo
Decedlnt's
ActuatRIlSidence 17a.Stale
13. Decadenf' Education (Speci~ on~ highest grade complolad)
Elementary I Secondary (0-12) College (1-4 or 5+)
12 4
PA
17070
17b. County Cumberland
18. Father's Name (FIrSt mickIe,~, suffix)
19. Mother's Name (First, middIa; maiden surname)
208. Inlonnanl', Name (Type I Print)
Harold C. Hoover, Sr.
Barbara J. Hoover
21a.MatrodolDi8posilion
. Ql BurtaI 0 Remov~_S1a1a
o Other,
~ 22a,Signature
. ~
25, Oala Pronounc:ed Dead (Month, day, yea<)
~-30,';2007
CAUSE OF DEA'fH <see~. _ o""mpla)
Item 27. Par1!: Enllrthe ~ -liseases, Injurie&, or compicationI- tha1 chc:tty C8USId Jhe.d8ath. DONOr enter termlnal events such as cardac arrest,
respiratory 1IIT8It, or ventrict.dar fIbrlIlation wIthoot showing the eticiogy. . UsI only OI'l&CIUH on "lllne,
=~~~)--.;. a, ()flJ,'.A.J~~ m./Ltff:-'l,nM4
0Il0"~ ~
=t,lISlcondtlons, I 'ny, b.
=: ~:rJ"us~ I. Due 10 (Of as a consequence of):
='"~.~~~
I Approximate interval:
t Onset 10 0eIIh
.
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c.
Due 10 (or as a consequence of):
d.
3Oa. Was an AlJlopSy
perfonnOd?
3Ob. Were Au\OjlSy FIndings
A_bOll Prior" COmpIotIon
01 Causa 01 Peath?
OV.. ONo
31. Mannar 01 Doa1h
~I D-
o- oPandlnglnvestigatlon
o Suicida 0 Could Not ba Oelarminod
M
32d.1lmeollnjury
OV.. CjNo
331. Ce<tifie< (check "'~ one)
Cor1I1yIng phyOlc1on (PhysCian cat1iIytng cause oi dilath when anolha, phyojcian has pronounced dila" and..."platod Item 23)
To the best of my knowtedge, dnthoccumddut to 1t1ecauae(1) and manner nltlted. __... -.. --.......;........................................... --..........
;== ~ =~: !=:hti~.-.I~~':':1o"'::~= mannor.. s1atId.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
:u.: == and I or Inveotlgot1on, In my opinion, daath occurrad at tho lime. dalo, ,nd pIoca, and duo to tho coUla(s) and mannet a, atatad_ 0
:Rogialra"ssignatunl~r
Disposition Permit No.
oOthe' . Speciiy:
10. Race:.Americ8n Indian, Black. White, etc.
(SpecifYJ
white
14. Marital SIaM: Married. Never Mal'!ied,
Widowed, Otvorced (SpecifYJ
married
Old Oecedont
Uve ina
Township?
t7e. 0 Ves, Decedent Uved ~
17d. ~ No,lJecadant Uved wi1hin
ActualUrnltsof
r"".
New Cumberland
IBoro
23b. License- Number
:26. Was Case Referred to MedIcal Examiner I Coroner for a Reason Other than Cremation or Donation?
OVa, OClNo
Part n: Enter other unflcBnI: l:MlItD"lI ctlnIrtlutinrJ to dMsh, 28. Old Tob8cco Use ContrIbote to Death?
butnolrosulllng.lheundattiingcausogivon.PaI1l 0 Yes oProbabIy
o No 0 Unknown
29. I Famell;
o NotplO9ll8nlwitOOpaslyear
oP_allimeoldealh
o Not Pf8lI18Ili, but pregnant within 42 days
oldaalh
o Not ~', but pl'9glBnt 43 days 10 1 year
1la1<n_
o Unknown H _t within the past yasr
32c. Place 01 kVf Home, Farm, Slreel. Factory,
0fIica Building, e~. (SpecHy)
32g. Location of Intury (Street, city Ilown, !tate)
33d. Dale Signed (Month, day, year)
8.30- 2 CltJ7
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