HomeMy WebLinkAbout09-18-07
PETITION FOR PROBATE Ac~D GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYL VANIA
Estate of GERALDINE A. SEIBERT
also known as
File Number d. / - () 7- ~
. Deceased
Social Security Number 202-20-3416
Petitioner(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
named in the
.-,
j
(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 instiument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: .;'
Ii] B. Grant of Letters of Administration
(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 completelist of heirs.)
I Name Relationshio Residence I
MARGARET LOUISE SEIBERT-KELLEY DAUGHTER 185 HAIR ROAD, NEWVILLE, PA 17241
ROY C. SEIBERT, JR. SON 175 HAIR ROAD, NEWVILLE, PA 17241
STEVE A. SEIBERT SON 179 HAIR ROAD, NEWVILLE, P A 17241
1 1 HAIR ROAD NEWVILLE PA T7L4
MELVIN L. SEIBERT SON
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his / her last principal residence at
195 HAIR ROAD. PENN TOWNSHIP. NEWVILLE. CUMBERLAND COUNTY. PENNSYLVANIA. 17241
(List street address, townlcity, township. county, state, zip code)
7
,
,
1
Decedent, then 79 years of age, died on AUGUST 15,2007
DERRY TOWNSHIP. DAUPHIN COUNTY. PENNSYLVANIA
at M.S. HERSHEY MEDICAL CENTER
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
HAIR ROAD, PENN TOWNSHIP, CUMBERLAND COUNTY,
$
$
$
$
PENNSYLVANIA
113,000.00
286,000.00
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:
I
Sil(l1ature
Typed or printed name and residence
I
/1/l-u\ '7, ~,
)
ROGER B. IRWIN, ESQUIRE, 60 WEST POMFRET STREET, CARLISLE, PA 17013
/
,
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
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 ofPetitioner(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
before me the I [)+L day of
~~-j~~ . ~COl
0~~(c--\ ~~,~ (lC'~iJ~ C\_ \~
~ \ For the Registe~ iJ
0. c!i-,
Signature of Personal Representative
Signature of Personal Representative
File Number: }../ -0 l .- Or; s- s-
Estate of GERALDINE A. SEIBERT
, Deceased
Date of Death: AUGUST 15,2007
Social Security Number: 202-20-3416
<' . r
AND NOW, (:J2~~ ;0
having been presented before me, IT IS DECREED that Letters
are hereby granted to ROGER B. IRWIN, ESQUIRE
, ~ CI{) 1 ,in consideration of the foregoing Petition, satisfactory proof
OF ADMINISTRA nON
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.
, Nh~ ~~~,'-~ ~ _/px( ~~"
RegzsterofWil/s' ~dJ~-::t{
0~~ "di~ ~
ROGER ~R N, ESQUIRE
FEES
Letters
$
360.00
4.00
20.00
10.00
Short Certificate(s) . . . . . . .. $
Renunciation(s) .......... $
JCP
AUTOMATION FEE
... $
... $
... $
... $
... $
... $
... $
... $
... $
TOTAL .... . . . . . . . . . . $
5.00
399.00
Form RW-02 rev. 10.13.06
Attorney Signature:
Attorney Name:
Supreme Court LD. No.: 6282
Address:
60 WEST POMFRET STREET
CARLISLE, PA 17013
Telephone:
(717) 249-2353
Page 2 of2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARN!NG II is illegal to duplicate this copy by photostat or photograph.
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Hl05.143 REV 11/2006
TYPE I PRINT IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
79 y"
Bb. COllrltyOI Death
6. Date of Birth (Mooth, day, year)
3, Social Security Nllmber
202 - 20
4. DaIS/rS/2r10'Oa7 year)
1. Nameot Decederlt (First. middle, last, sullix)
Geraldine A. Seibert
5. Age (Lasl Birtl1day}
3/26/1928
Carlisle, PA
Ba. Place 01 Death (Check Orlly orle)
Hospilal:
~rlpalient 0 EA I Outpatient DDQA 0 Nursing Home 0 Residence DOther - Specify
9. Was Decedent of Hispanic Origin? XJ No 0 Ves 10. Race: Amelican Indian, Biack,White, ete
(If yes, specify Cuban, (Specify)
Mexican, Puerto Rican, etc.) White
&I. Facility Name III not ins1t!ution, give street aoo numt>erj
Dauphin
.S. Hershey Medical Center
11. Dec!!dent's Usual Occu lion K~d 01 work. done durin most of workin life. Do not state retired
Tire fuiioder Ca isl~ooTr~~II&ustRubbe
12. Was Decedent ever in the
U.S. Armed Forces?
DVes ~No
13. Decedent's Education (Specify only highest grade completed)
Elemegry I Secondary (0-12) College (1-4 or 5+)
14. Marital Status: Married, Never Married.
Widowed, Divorced (Spedf}1
WidcMed
17b. County
PA
Cumberland
Did Decedenl
Liveina
Township?
Hc. 5a Ves, Decedent Lived in P~nn
17d.O No, Decedent Lived with!n
AcluaiLimilsof
Twp
- 16 Decedent's Mailing Addrass (StrlN.ll, cily !lown. state, zip code)
195 Hair Road
Newville, PA 17241
18. Father's Name (First. middle, last, suffiX)
William W. Brownawell
Decedent's
Actual Residence 17a.Stale
City/ Bore
19. Mother's Name (First, middle, maH:len Sllmame)
Alice Fulton
lOa. Informant's Name (Type I Print)
M. Louise Kelle
20b. In'ormant's Mailing Address (Street, city !Iown, state, zip code)
185 Hair Road, Newville, PA 17241
. ..
21c. Place 01 Disposition (Name of cemetery, crematory or other pjace)
2td. Location (City I town, slate, zip code)
esbninster Manorial Gardens
Carlisle, PA 17013
Home, Inc., Carlisle, PA 17013
23b. License Number
23c. Date Signed (Month, day, year)
Items 24.2fi mlJSt be complated by person
who pronoul1C8s death
24. Time of Dealh
1.{",53
25. Date Pronounced Dead (Month,day, year)
PM flt.l9U..')i:; 15',2-007
26. Was Case Referred ~edical Examiner! Coroner for a Reason Other than Cremation or Donation?
DVes ~o
CAUSE OF DEATH (See instructions and examples)
item 27. Part I: Enter the~ ~ diseases, injuries, 01' complications -thatdirectty caLJsed 100 death. DO NOT enter terminal events such as cardiac arrest,
respiratoryarreSl, or ventricular fitlrillation without showirlg the eliology. Lisl oniy one cause on each line
ApproximateinteNal
Onset to Death
Part II: Enter Othel siollificalll coooilions contribulino to dealh,
bLJt not resutling in the LJndertying cause given irl Part I
28. Did Tobacco Use COIltritlule to Death?
DYes 0 Probably
DNa ~known
29.~le
b1' Not pregnant within pasl year
o Pregnantattimeofdeath
o NOlpl"agnant, but pregnant wilhin 42 days
of death
o Notpregnant,butpregnanl43daystolyoor
betoredeath
o Unknown if pregnant wilhin the past year
32c. Place of Injury: Home, Farm, Street, Factory,
Olliee BlIilding, etc. (Specify)
Sequllfltially list conditions, if any,
~~t~~fu~ SNDERLyi~~AU~nE a.
(lisease Of injury that intliated the
events resutllng In cleath) LAST.
a. 01u.\ bi ~f'~tVl
Due to (or as a consequence of).
b PI 11m C1\nC2l.f g
Due 10 (or as a consequence oD:
.f!Qi/ /J..f e.
eMhC\lllS
:~dTt~A~;atn~~~ d~~\ dise:;
Due to (or as a consequence oD:
d.
o
~
IAIIIri.IIIOI
32d.T1meollnjury
32f.11Transportaliorllnjury(Spocify)
o Driver I Operator 0 Passenger DPedestrian
DOlher - Specify:
33b. Signature and Title of Certifier
32g.location of InjiJIY(Sl.reet,city/lown,statej
DYes~
3Ob. Were Autopsy Findings
Available Prior to Completion
otCause at Death?
DVes DNo
31.Ma~rolDeath
I21"Natural o Homicide
DAccident DPend!nginvesllgation
3Oa. Was an Autopsy
Performed?
o Suicide
o COLJld Not be Determined
33a. Certitier (check only one)
Certifying physician (Physician certifying cause 01 dealh when another phYSICian has pronoLJnced death and compjeted Item 23)
To (he best of my knowledge, death occurred due 10 the cause(s) and manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
Pronouncing and certitylng physician (PhysICian both pronourlCingdeath and certifying tocaLJse of death)
To Ihe besl of my knowledge, death oceurn!d althe lime, dale, and place, and due 10 Ihe cause(s) and manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
~~~~cea~:~m~~~;::;:~ and / or Investigation, In my opInion, death occurred at the lime, date, and place, and due 10 the cause(s) and manner as slated_ D
z
w
o
'0
34. Name and Address of Person Who Compleled Cause of Death (Item 27) Type / Print
N' o.d p. dha.rK r M.S. Hershey Medical Ctr.
In t:,n 0... Hershey, PA 17033
Disposition Permit No
RENUNCIATION
..--..- )
.,~
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
"
re., :"
c.:~':l
Estate of GERALDINE A. SEIBERT
, Deceased
1 MELVIN L. SEIBERT
,
, in my capacity/relationship as
(Print Name)
SON
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
ROGER B. IRWIN
AUGUST 27, 2007
, ;' /1 ~L ;-2_ <(~/L~
(Sigyrure)
(/Jate)
171 HAIR ROAD
(Street Address)
NEWVILLE, P A 17241
(City. State. Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
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
purpose,s stated within on this !;IJ!"~ day
of I-~I/Y-, (:9(167
~u'" (72--- ,
N tary Public
My Commission Expires:
Deputy for Register of Wills
(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
COMMONWEALTH OF PENNSY VANIA
c; Nota,jaJ Sea;
, Kat"n Si'.iaeL NOla:, Public
CIYJi:;;le BOrG. C~mlberLilld County
My Com,mlsslOli i::xplres DCL. 8. 2007
RENUNCIATION
,.---.."
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
'-
~-' :
('::r
Estate of GERALDINE A. SEIBERT
, Deceased
I STEVE A. SEIBERT
,
(Print Name)
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
SON
administer the Estate of the Decedent and respectfully request that Letters be issued to
ROGER B. IRWIN
AUGUST 27,2007
,JL _ A _ 4~147'
(Signature)
(Date)
179 HAIR ROAD
(Street Address)
NEWVILLE, P A 17241
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
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
purpo81s st~te. d within on this ~.~ (L- day
of I-Iu,~!. >1- ._?()LJ 7
/)/) ( / / -" /f/7z./
Notary Public
My Commission Expires:
Deputy for Register of Wills
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commissioo.)
Form RW-06 rev_ 10.13.06
COMMONWEALTH OF PENNSYlVANIA
Notarial Seal
Karen S. Noel, Notary Public
CArliile Bora, Cumberland Coonty
My Commission Expires Dec. 8, 2007
'~ )
RENUNCIATION
r.....-,
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
;.)
Estate of GERALDINE A. SEIBERT
, Deceased
I, ROY C. SEIBERT, JR.
(Print Name)
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
SON
administer the Estate of the Decedent and respectfully request that Letters be issued to
ROGER B. IRWIN
AUGUST 27, 2007
fir [' 52.cl'&~l/;; ,C
(Signat re)
175 HAIR ROAD
(Date!
(Street Address)
NEWVILLE, P A 17241
(City. State. Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
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
purpo~s stated within on this ) ]1'-- day
o~U 9007
Notary Public
My Commission Expires:
Deputy for Register of Wills
(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
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of GERALDINE A. SEIBERT
, Deceased
I, MARGARET LOUISE SEIBERT-KELLEY , in my capacity/relationship as
(Print Name)
DAUGHTER of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
ROGER B. IRWIN
AUGUST 28, 2007
$z?1d ~#ey
(S nature
(Date)
185 HAIR ROAD
(Street Address)
NEWVILLE, P A 17241
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
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
purpo s state, d, within on this c,';} rJ 1"1"--, day
of 'Sj- dU7
,
---",...
Deputy for Register of Wills
/
/
Not Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission,)
I'" ',:ff':" " ;-':\ib!ic
c~;'ij~\~; \ ~(l!':" ':,iC:i,_;}ld. Count?'
. " " .". " n,,( 8 2,107
M)' Conlll1t;-';:;JU~; c,:\!q~~ L~ ~'
---
Form RW-06 rev. 10,13,06