HomeMy WebLinkAbout09-07-07
PETITIO:\ FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ---L~' /11';& /!.. LA N2-_ COUNTY, PENNSYL VANIA
Estate of
fi)UlI1 H. G_~L6';K-
File Number :1.1 -01- Og 73
also known as
, Deceased
Social Security Number .;<. / () - ;;, 2 - 7 3 'I- 9
I\,I'!10ner(S), who is/ar~ I S years of age or older, apply(ies) for:
(COJIPLETE 'A' or 'B' BELOW:)
O.\.. Probate and Grant of Lc:tcr~ Testamentary and aver that Petitioner(s)(i9 are the if j. E' r.!.. U TO R-
1.1; WIll of the Decedent dated I-f -:) - / c: tf 0_ and codicil(s) dated
named in the
(Slute relevant circumstances. e.g.. rellunciatioll, 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
lor pr"b;lI~, W!" not the VICtIm of a killing and was never adjudicated an incapacitated person:
o B. Grant of Letters of Administl-ation
(lfapplicable. enter: c,t,a" d.b.n.c.t.a.: pendente lite: duranle absentia: durante lIlinoritate)
Petitioner(s) after a prop~1 search has / have ascertained that Decedent left no Will and was survived by the fOllowiItgypouse (if an~f1nd heirs: (If
Administration. C.I.a. or d !J.n C.I.(I.. cllier dale of Will in Section A above and complete /ist ofheirs.) ,',-. r) ::::;
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I
Name
Relationship
Residence)
(COllrI PLETE IN ALL CASES:) Attacll additional sheets if necessary.
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Decedent was domiciled at death in C (,./:-7 IJ E ~ L-,If tJ :)
+
County, Pennsylvania with his I her last principal residence aFO
(LiSI streel address, tOWI/,hl)', lownsl,,/), coulll)', Slale, zip code)
Decedent, th,~n
1'0
,
years of age, died on </- i - () '7
at (7 I-t () ~ t Ii tI r G 0 I)
HOMe'
Dl'ced~nt at death owned property with estimated values as follows:
(I r dOJ1llciled in P A) All personal property
(I f not domiciled in P A) Personal property in Pennsylvania
(If not domiciled In PAl Personal property in COllnty
Vallle of real estate in Pennsylvania
:;:> .OJ
.:> /,
S~l;t;
$
$
$
$
-0......
situated as follows:
Wherefore, Pellliol1er(s) rcspccltlllly rcquest(s) the probate orthe last Will and Codlcil(s) presented with this Petition and the grant of L.elters in the appropriate form to
the undersigned:
I
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ForI/I R W~02 rev 10.13 06
Page I 0[2
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
SS
COUNTY OF
The Petitioner(s) above-named swear(s) or affmn(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 Dece Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
+U
be me the ~7 day of
. - hI. Fo, eRe'-~
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(-)
5""1
C.'::':'-
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Signature of Personal Represetllative
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Signature of Pe("3onal Representative
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File Number: /J. j - [) 1- 06231
Estate of M l ,r:l~ 0'\ (~(J ; l ~Q.r , Deceased
Social Security Number: ")...\0. r'l.-"l- l ~ '-l q Date of Death: 4 - ~ - 0\
AND NOW, ~~~\.... l , ,-100"" ,in consideration of tile foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters \~ \ 1-, ~I;"~, "'R ~
are hereby granted to '\'<\r ) ,\ \ 'fY\e r G ~ ~ r:::
-Z":-
CO
in the above estate
and that the instrument(s) dated 4 - S . q 0
described in the Petition be admitted to probate and ftled ofreco as the last Will,(and Codicil(s)),pfDecedent.
L I
FEES
Letters ............... $ 90 .c.o
Short Certificate(s) . . . . . . . . $ 4- .C~O
Renunciation(s) .......... $
.JQj ... $10.00
L",")'\ \ \ .. . $ I ~ Of")
f'l A. ").::~"U Y\I"'Q. b l)"- ... $ S; (~
... $
...$
...$
... $
.. . $
... $
TOTAL. .. . . .. . .. . . .. $ I2-Ltoc.. 50
Attorney Signature:
~
~~
Attorney Name:
Supreme Court l.D. No.:
Address:
Telephone:
Form RW-02 r('V. JO.J3J)6
Page 2 of2
i'l Ii I' j1il\ lil<i! lilt: ,Pldl!iid[1l111 !1,:rl' ~i\l'11 i~ I.:orreetl) copied from an ori~inal certificate of death duly filed with me as
I ('I ,Ii 1<,','" ,ILll Illl' (lllC'll1;[1 ," I Jli'c'<ilC will he forwarded to the State Vital Records Office for permanent filing,
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Date
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'05-143 REv 11!'2006
TYPE i PRIN T IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
tD
STATE FILE NUMt\EA
~:--
sg amd H).
Rnla HI. 17fJ25
13_ Decedent's Education {Specify onty hqlest Qlade compIettd)
Elementary- I Secondary (0-12) CoIIege (1.... (l( S+l
11
IeT5ylVCllia
C1Irter1:rd
. Dale of Death (Month, day, 'fear)
7349 ril 8 2007
, ~ 01 DeCe6erll (F'fSl middle last suth)
j~uth McClurken Geiger
S'A,~Il..llsta.rtrlaaYI
Yo,
6 Date 01 &rth{MorlIh, oay, year)
7, Birthplace (City and slate 01 Iol
91
8/7/1915
Philadelphia, PA
Sa, Place 01 Death (Check only one)
Hospital Other
o Inpatient 0 ER I OJtpatient 0 00.4. []l.UlSUlg Home
S1, wu Decedent or HisparIIC CKigill?
(11 yea, specify Cuban,
Mexican, Puerto Rican, .Ie.)
8tl Covnty ol Death
ad Facility Name (II not II'Iilitulion. flY' street and ~)
CUmber land
Church of God Hane, Carlisle
16 Decedent's Mailing Moiress (Street, City !Iown, stale. zip code)
Iile, 00 noI slall rl!ired 12, Was DecedenI ~r in lhe
U,S, A.rmed FOl'taS?
rod. Dves KJNo
-',
ActUII~17a.S&at,
1. Mari1al StatUi: Married, Neller Marned,
w_, 0N0n:0d1$pedt)1
Married
11 Oecaoenfs Usual Occ lion KIflCI 01 woo Iione
I(lfldolWoo
Laborer
Twp
170, Cw1ty
Crty,Boro
lFaltler's~(Flrsl.mJddIe,ia.stsulhxJ
, Charles B. Johnston
19, MoCht(s N.ame (First. mid(Ie, IMidIn $Uff'IIlTII1
aret McClurken
2CtI. Infonnanh Il4aiIing Adchu (SPntl city flown, mil, Zip codel
86 Beard RD., Enola, PA 17025
2Oa, Inloonanl's Name (lype I Pnn\l
M:::>rtimer Geiger
- ~
21C. Place ol 0isp0IiIi0n (Name ol cemMll'Y. crttnIIOl'y or 0lI'l<<" placel
21d. Loc~hOfl (City I town, state, ~ codel
o
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Harrisburg,PA
t'; I 'fj ~OO/
1tem$24.2'6mos1tl8~I8dl7)'pel'$Oll
who pronounces Clealh
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CAUSE OF DEATH (See IMtructlons snet examp"s)
nem 27 Pilrll Enler the ~ - diseases, Itljunes. 01 complIcalions - ltIaI: direclly cau5ed!hl dealtl. 00 NOT ent...lem'lInaI ......,-u such as cardi.ac ilrresl.
fllspilalory arrllst, or ventncular librillatlOl'l WItI1o.4l showing Ihe elioloqv List 0It'f one cause on each line
Approlirnllt i'llervll'
Onset to Outh
Part II: Ent. othef squranl 00I"Iliti0ns c:cnmutino lD dealt!, 28 Did Tooacco Use Contribute 10 Deall'l?
butnolrnultinglfltheoo;ktf1yingcaustl1Yertl"lPartl 0 Yes OProcaoty
o No 8-0-
=;e~~S~ ~~~) dI~:;
c;;~ '"" LlA.vJ..&tr.. J~.<~ "^
Due 10(01' asa consequfN'lCaol)
;>'" \........
29ItFiffiaIe
ZNol.pr89NntWllhlnpaslYe.ilf
o Pre9f'li1ll alllme 01 death
ONolpr~nl.outpfec;1'\alllJ111'1ttli(1421a'fS
. dea~
o NoIpregnanl,outDfecy.anl4JoayslO I f8ilf
belore death
o Uokrownrl~nlwittwllh8pas1year
32l: Place 01 1rlf'HY Home, Farm, S1.rMl. Facloo'y
Olhee Buildiflg. ele (Speoty)
~nhallyllslcondlllOOs.l!any
~ ~~~~:h~ru~~ a
I~Slase or rvY thall/llllateo:J the
e"enlSrlsu/tinI;) lOc!6alh) LAST
Due 10 (or as i COIU8QU81"1Ce oil
Due to (Of as a c:onsequence of)
[J Yes rzr No
Oy" ONo
:llM41~oIDeJlIh
Q-Na'",. 0""""'"
D Acadenl D PenclIng IrNestigalion
o ""'" 0 Could No< '" Ot14m>oed
32d. Twneoflnjufy
329, Location at Injury (Street. ~ i town. slate)
))a ,Was' an ~lopsy
P8f1orme.-j1
n Were Autopsy FirnnQ$
A~ajlilbl8 Poor 10 CompletlClfl
01 Cause of Death"
M
JJ.> Cert/her I,chec~ Of1ly onel
;:7:I~si:J~~i~=.n =~~=:= :~:e~~::u::a':=r~ :~_ ~~ _~ ~~ :~ ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Ef .,.
Pronourt(;lng ~f'Id certifying phylic~n (phYSiCian boIh pl'onounc:lng death and C8rtitylng to cause at Cleathl 33c LlCeflSl Numbef 33d 0:11 f"""'( I' IO"""'7n Jay. year I
To lht but 01 my knowl8<lge. de.th occurred altl'lt lime, dale. and place, and due to tl'lt CJlUse(I) ancl manner aa stJIlecC - - - - - - - - - - - - - - - - - 0 l\..1 l\ 0 ? ~2. II{ r;t.- 't
Yediul Eummer! CQI'Oflef ' . V
On tlW bUls 01 euminJItion, and I or invutigalion. in my opinion, deelh occurred II the time. dati, and pl~e, Inti due 10 lhe cause(s) and mlnne. il$ stJIt8<l_ 0 34. Name and MOress of Person Who ~et8?,lCause 01 Deiltl'1 (Item 271 Type(. Print I }
. S 1. 7 S' (" _ [, J l e I:'.o{,. ,() . . 'c L. u./'" ""0' a - , H';
, w.(j.vjv<~vl- fA I 7~ ) 'I'
,SIO i 4101 bl
O"P''''',on p"m" No 0 I /':::, 5'" 2 'is'"