HomeMy WebLinkAbout09-17-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
COUNTY, PENNSYLVANIA
Estate of
fJ /'I/)f.. C w Jo A^,
ft1 A fZ..tj /II € Y
File Number ~ 1- 01- D~ 4<J
also known as
, Deceased
Social Security Number 45-" ~ q 2 - Co ~ ::,- 7
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE j4' 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
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 instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ,AlIA- c.)
IX! B. Grant of Letters of Administration
C'
(lfapplicable, enter: c.t.a.: d.b.n.c.t.a.: pendente lite: durante absentia: durante minoritate)
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
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
I Name Relationship Residence I
5'.4 IV 6. ,. M A I?.c. IV €. V /V..o THE a.. '-/4 '7 <-/ Nol!...th FRASER. .5'1. Co. ~.R.G ~t
.5G. .:1. <:) <{ "
-C.,.ul~
o
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in ~ j I Y\.\.~t.r2..L Or(J ~ County, Pennsylvania with his / her last principal residence at 7~
l.€. SANT Vi€"vv ulZ... /ll\IZ-CHANiC5~u.R(.,. Sit...II~A. l'G'..-c...
(List street address, town/city, township, county, state, zip code)
Decedent. then
4'1
years of age, died on A U G
.;2 if, 2,()6 7
.
at
L./ 5 /<. ( N", /) ,'2. .
L4/L4 sL~
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
situated as follows: 7t.c. PLfrA.sANT VIU: w b,e.. /lA.<i.d,. P.a.-. 116:"c
SQ]. C)('
$
$
$
$
112 . DO 0 . 'C (~
Wherefore, PetitlOner(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:
J,'.', 1/"
'..-t..(..t(..er-A"<' ' /t./~L--
Tv ed or rinted name and residence
/i
IN. II, M lOb€:. r<..r Il (l(2.C LL '-IS k"vG
C 4r'2-Ll S L 'c
ItCJ{S-
Form RW-02 rev. /0.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cu II-\. 6 ~,u'b
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 representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
'1'+L-
before me the I . day of
~
~r\l fnh.-<."-.. . ~(',L\\
C~(("A-<\'r') QkC\,~j
\ For the Register
~~,[l t C{ L <L--..-,
I
/ <..----.-
/, r, ,
'-- ?L.C"'C L\
Signature of Personal Representative
J
Signature of Personal Representative
[1pu-b.t . .
U Signature of Personal Representative
~-,,;
C
I
File Number:--L &1- 01 - 'jq 8
- !
Estate of /+ NDt<.. tZw
-
JoAN
ft1 A- t2-b rJ E:. V
Date of Death: A U d
, Deceas~d
I
:2. </ I 2c c; 1 c".
~-
Social Security Number: 4-)" tv - (12 - (:,.~ S- 7
AND NOW, ~O'..N\.~'- \'1 , aOOl
having been presented before m~, IT IS DECREED that Letters
are hereby granted to " O\..
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 Codicil(s)) of Decedent.
FEES J:ik,~ ilLLill~~~~ 8,..~J: j~
Letters ....... 0 . . 0 0 . . 0 $(}.LxJ . ex:::-
Short Certificate(s) .. .. .... $ 3 ,DC) Attorney Signature:
Renunciation(s) .......... $ 50 00
~Q.P . . . $ If) .():::;
~'~'rC'l;\~ '" $ S .Ou
.. . $
.. . $
.. . $
.. . $
. .. $
.. . $
.. . $
TOTAL .............. $ ;A:?,~ .60 '9()
Attorney Name:
Jacqueline M. Verney, Esquire
Supreme Court I.Do No.: 23167
Address:
44 S. Hanover St
Carlisle, P A 17013
Telephone:
717243-9190
Form RW-02 rev. 10.13.06
Page 2 of2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING It IS illegal to duplicate this copy by photostat or photograph.
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1/31-076
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instrucllons and examples on reverse)
c2l
01- () ~ 'i y
I Name of D&:;edem (FirS!. middle, las!. sulli.j
Andrew
49
May 19. 1958
3 Social Security Number
456 _ 92_
STATE FilE NUMBER
J
Maroney
6 Dale of Birth (Monlh, day, year)
S Age (last BIrthday)
Yo>
Bb County 01 Deisth
Cumberland
11 DecedeMs Usual Occu \JofI (K~d of work done dun mosl 0' worki Ide Do not slllte retired
Kind 01 Worll Kind 01 Business I Industry
Printing Press Commercial Pri
12. Was Decedent aller in the
US Armed FOfces?
t Dyes ~o
Decedent's
Aclwl ReSidence 17a Stale
13 Decedent's Education (Specify only highest grade completed)
Elementdl/2econdary (0-121 COli, (1-4 or 5+)
- 16 De.:eddnfs Millllllg A<k1ress (Slrect City /Iown, slale, lip code)
76 Pleasant View Drive
Mechanicsburg PA 17050
PA
Cumberland
17b. County
19. Mother's Nall\tl (First, middle, maiden surname)
Billie Jane Tompson
18 Falhills Name {flrsl, middle, last sulll~l
JohnJames
Marone
20b Informant's Mal~ng Address (SlrelO!, elly !Iown, stale, zip code)
4474 Fraser st Georgetown SC 29440
21d, location (City Ilown, slale, zip code)
2O.d Inforrmnl's N;;IrJt: (Tvpe I Pflfll}
Jane T. Maroney
14. Marilal Status: Married. Never Married,
WIdowed, Divorced (Specrt'}')
ReSidence OOther. Specify
10 Race: American Indian, Black. 'Nhite, elC
ISpoc,~
White
Did Decedenl
Liveina
Township?
17c. if! Yes, Dacedent lIVed in
17d 0 No, D6cedentlivedwitt'lln
Acluallimilsol
Silver Sprinq
Twp
City! Bo.-o
21b Date 01 DispoSItion (Month, day, year) 21c. Place o! DispOSllion (Name 01 cemetery, cremalory or ottlef place)
Georgetown SC 29440
~ Elmwood Cemetery Annex
~
'"
:ii
Iteno" 24 26 nllJSI tItJ COlnp~!~d by ptjl')UlI
who prvllOlJnce~ oealh
24 Time 01 Dealh Aprx.
3:00 A. M
25. Dale PrOOOl.Jl1ced Dead (Month, day, year)
August 24. 2007
CAUSE OF DEATH (See instrucllons and examples)
It.::m;a Pdrll Enter tloe l.:..Ili1J1lQ/ i1'\'Wllii dlsed"es, IIIJulles, ur complications m lhal direclly caused lhe death DO NOT antellerminal iN6nls such as Cdrdiac arrest,
re:;plfdlory arrllsl or venlllCUl,lIllbnlJatlon wllhau! 5tl0...lng Ihe t;lidogy_ lis! only one cause on each hne
23c. Dale Sigrled (Uooth, day, year)
26 Was Ca~ Referred 10 Medical Examiner I Coroner lor iI ReaSO/l O1~,el than Cre<<ldlIOO ar Donation?
~es []No
Appro.l;irnatli inlerval: Pari 11: Enter other ~1&[}Qi1lQllHO:fll[lbu1lng.jQ.QfaI/) 28 Did Tol>acco Use Coolfibule 10 Death?
Onset to Death bu! not resulting In the underlymg cause given In Part I 0 Yes 0 Probably
o No [] Unknuwn
~~~~A~~~~~~~~~\~~~
Probable Myocardial Infarction
Due to (or as a consequence of)
Hypertensive Cardiovascular Disease
DUBio (01 dS a consuqllt!llce of)
SequlHlOally II.slcondiIKlflS, if any
~~~~)~o ~,tOEd;:YI~be~~~;~e a
1(jj~tl<I:'1I UIIIIIUlY tll..!l 1fI11li.llud the
U~tlllt" r,,~ul\lfIlIlll 0001111) lAST
Due 10 (OfIASacOlI!>6quel1C8ofl
3Gil Was an Aulopsy
Pelt()'I1""d?
JOb Welt! Autopsy FlI\dings
AVdlldllle pl[allOComl'ltitlOfl
O!Cilu:;e01 Dealh?
31 Manne! 01 D&alh
~r,ldJUlal o Horlll!:lde
[] ACCident 0 Pending Inve!>llgallon
[] SUlCllW D Could Not be Deternlllled
32d. Time 01 Injury
[] Yes ~No
[J Yo> [lNo
M
Renal Failure
29 II Female
o Nol pregnanl wlthlll past yeal
o Pregr1antaltimeoldeath
o Not prtll:jnanl, but pUlgnant wllnlfl 42 days
ollhldlh
[] Nul ~reYlldllt, but pltlOj'Illnl 43 ddys IQ 1 year
btttOle 0ea1l1
D Unknown it pre'1'anl wllhm \he past yeal
32c Place of InJUry: Home, Farm, Slreef, Faclory,
0tIice Building, ete (Speer"')
32g locallon of InJury (Sllellt, city f lown, state)
~
l'>
!
lla CellJ!lllr (cheCk ooly 0fI&)
Cel1ltying phYUcian (physlC,an (;ell/tying c.aUSIl 01 dedlh wherl dllolher phYSICian has pronoullced death aM compleltld Illlm 23i
To the belt of my ItnOW>>dge, de.th occurred due 10 the C'Use(l) .nd mannel AI IlIteeL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
PnJOouncing and certifying phvslclan lPhyslCldn bOlh pronounCing dealh and cer1tlYlfly to cause 01 dedtli) [1 33d Dale SIgf"led (Month, day, Y8ar)
::"":;~"'::i:::' 7:;'::,:"' <lee.. 0"""" .1 tho "mo, d.I., ,"d pl."" .nd d... to tho 00"><('1''''' moo",,, .. .tal.... - - - - - - - - - - - - - - - - - - Au g u s t 2 7. 200 7
On I" ..... ">uminotion .nd 1 '" in"'Ii".on, In my oplnjon, "'". "''"".. " I" tlmo, d..., .nd pl."" .nd d... 10 ,.. 00"><('1 ond mu,.,., .. ""..- ~ " 'P1"f'l':'I't.fl!"l 01 ~'."" '!'R5l"t'<!<1fj"" el'J'!"ij~i' Type 1 PMI
Idr'" Signature anuDio.1( Nu r 36 Date Filed (Month daYY8ar) 6375 Basehore Road1 Suite III
tv.. I ~I I I ~I \. I .:zJ Ti7' 00) Mechanicsburg. PA 17050
DISpill;,llon Permll No DOS- 0 -.5 8 %
Coroner
RENUNCIATION
I'
Cumberland
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
C",
Estate of
!t/llDtZ-Ew J~AA/ jt1/rt?-6f\/eY
I
, Deceased
I,
Slill[ E-- -J. fL1 If /LD II fi- Y
(Print Name)
, in my capacity/relationship as
Mother
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
V\.J Illl p..(v\
f-o 6 2..t2... T
i \/ {Z r<.. C. L L
.
9-/7- 01
.
(Date)
~~ :L-;
-(21(' / -
(Signatllre)
ma.ik~d
Ai /1 JUL4--f I() ~ St
~i 1 J-/-
{tet ddreSS)---;
/#:,-c,~:t---,.:,/(/ ( t I VL
(City, Stat, ip) I
~. C ;( r) 1J-J'{)
Executed in Register's Office
Sworn to or affirmed and subscribed
befors:e this., 11'"\ i---- ~ day
of \ptrl~'- ,6hXll.
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 day
of
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