HomeMy WebLinkAbout09-28-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF t'J,,.,-:;SL:,ft ~A-,AJ])
COUNTY, PENNSYLVANIA
Estate of R.cwl't-l..'r:> T 0- ~ .,-
also known as
File Number
c21,-,;lO(J'I.08g'7
, Deceased
Social Security Number / $,tI- 38 - 7 B .s ~
Petitioncr(s), who is/are 18 years of age or older, apply(ies) for:
(COi'dPLETE 'A' or 'B' BELOW:)
o A, Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated and codicil(s) dated
r--"l named in the
C",",
(, :3
C:: l) v:>
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution o(the\i~rumeft?s) offered,'
for probate, was not the victim ofa killing and was never adjudicated an incapacitated person: -. '~?,;'~ ~
.~ ~
(State relevant circumstances, e.g, renunciation, death of executor, etc.)
I5?J B. Grant of Letters of Administration
''33
--i
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-'!-~
is
(If applicable, enter: c.t.a.; d,b,n.c.t,a.; pendente lite,' durante absentia; durante minoritate)
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
Administratiolz, cJa. or d.b.ll.u.a., emer date of Will in Section A above and complete list of heirs.)
(CO,I'IPLETE IN ALL CASES:) Attacll additiollal slleets ifllecessary.
pecedent was gomiciled at death in
^~ IVE ~,Pr'" /0
(List street address, towl/lcity, townS/lip, counly, state, zip code)
Decedent, then S-~ years of age, died on Ant~ lZ...19S",t 7~n/~e #$"~
County, Pennsylvania with his / her last principal residence at ~4 ~(';~~""'~
"?oll
~.
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) 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
~ one'.
<--..
$
$
$
$
situated as follows:
Wheretore, Petitioner(s) respectfi.Jily request(s) the probate of the last Will and Codicij(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
~~'1~
.3.<3
3€c-~.# L C/L'>.:>T
~~#.LA-""'~ .A'~r<..,I~ 4-'P7 ~zc>E
rinted name and residence
C',1?A1,;d #.....~c::..
~
1'7-=-...
For", RW-02 rev, 10,13.06
Page 10f2
Oath of Personal Representative
2DD7 SEP 28 MIlO: 42
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF
(lA-1m ~/ll2d
ss
CIP:iL'
I \; I
The Petitioner(s) above-named swear(s) or affinn(s) that the statements in the foregoinUetifiol1are trueanct cbri.ect 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
~ ~-L4 (fJJL
Signature of Personal Representative
Signature of Personal Representative
Signature of Personal Representative
FiI, ~"}"b" ot,j- o? CxY7 - () ee, 7
Estate of kfJw d J 0 lei -I:: , Deceased
Social Security Number: 188-3g-78'38 Date of Death: ~ 1.~a7
AND NOW, ~ c2 ~ , ~oa7, in onside~atio_n of the foregoing Petition, satisfactory proof
having been presented befo?1me, IT IS DECREED that Letters
are hereby granted to ~~ r.J2Q.. l. () 1 r:lk
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 \v.ill (and Co
FEES
$ JIG, (J)
JO.fV
Attomey Signature:
AttomeyName: ~'"'1>"""", '0. C..,--,~c,/.../~
Letters
Short Certificate( s) . . . . . . . . $
Renunciation(s) .......... $
~ ~... $~O;
...$ 5.
.. . $
... $
.. . $
... $
.. . $
... $
Supreme Court LD. No.: 2-1 I 1../'7"
Address: 2;> 2-0 P- 2'& S'r
/~;S4~..rce<i--, 4- /7/to
,
Telephone: 6/7) 278- c:; 5' /G
...$ r;StV
TOTAL .............. $J .
Forlll RW-02 rev 10.13.06
Page 2 of2
HIOS.80S REV (01/07)
o 1 ,-'&.,
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 13858119
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
Records Office for permanent filing.
t:hn.. /J; ~~ $lP 1 f Z007
Local Registrar 0 ;::::; Date Issued
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions snd examples on revereel
~EV llf2006
PRINT IN
!ANENT
;KINK #31-087
I.Nameol~(Rrst._,lasI.sutIIx)
Ronald
S,NJOILaslBil1hday)
56
STATE FilE NUMBER
y,.
ea, PIactl of o..1h (Chock ...
_, 0It1e<
o .....1 ~R I 0uIpa_ OoOA 0 Nursing Home 0 R'-nee OOlhe<' Specify'
9, Wes _ 01 Hi_it Origin? XI No 0 Yes 10. Raal, _'ndan. Black, White, elC.
(" yet. opeciIy Cuban, (Speci/)l
Holy Spirit Hospital _.PuoI1oRlcan,eIC.) White
12. Wes _ _in Ihe 13.llecedenf. E_ (Specify ooIy hlpeI grede compIeIed) 14, MerltaI Sletu8: Married, _ Mallled. 15, SwvMng SI>ouse (hille. give'- name)
U,S,_Fon:es? Elementery/_ry(O-12) COlIego(I""'S+) Ma-i.Dlvon:odd (SpecIIyl 1> be
OYos lJINo 5+ rr e ...e cca Schwartz
J
Oldt
6,Deteof_(Morrtt1. .
7,
IC' endoteteor
April 22. 1951
Bethleh_,PA
8el. FeciIty Name (~noI _, gIve_ end_rl
Bb. CounIy of Dee'"
Cumberland
11._'U8ueI _01 ".Oonol_
Pr Kindol-'l Kirdol_11ncMlry
ogrammer ADa YSiI Higbaark
. 16,~.M*og_(_,city/_._.zipcode)
3b R1.chland Lane, Apartaent 1208
Hill, Penns lvania 17011
18, F_.NemlIFiI1I. _.IUl,_1
Donald W. Oldt
llecedenf,
__ 17e,_
'P.....w'll:~y1VaYl... a
fIb. CounIy eu.berland
~838
4. Dele 01 DHth (MonIh. day. yeer)
September 7, 2007
DId_I
lIveina 17c.il Yes.DecedenlUved~ East Pennsboro
T~? 17d.D No.DecedenlUved_
_LinllIIoI
Twp,
C1lyIBMl
19. MoIher',NlmeIFil1l.___1
Delores Binder
2lI>1nformenf.MaiWlgAddress(SIreeI,city/_._.",code)
26, Wes Cue RefIflOd to _1_1 Coroner for a Reeson Olhe< than Cremelion or 00neIi0n?
~Yes 0 No
I ApproxImatelntervat: P8f1II:.Enttrolher~condIIlonsaJntrbJtlnolodMlh, 28. DidTob8ctxIUseCootrlbuletoOedl'!
OnsetklDH1h bulnolJesullinginlheundellylngcauestiVll1inPartl. 0 Yes OPl\lbIbly
ONo OUn"'-
2UFen'Ole,
o Notpregnenl_pestyeer
OPTegnentlttimeoldeeih
o Notpregnenl.bulpregnenlwilhin~days
oIdeeih
o Notpregnenl.bulpregnenl43dayskllyeer
beIoredeeih
o UnknownW__....pestyeer
320. ==:mrs:.;; -. FlIdOry.
321.ffT_lIOnlnjury(Speclly)
OOtMlrIOperelor OP_ 0-
M. oo..~
33a ~ (d1eck anIy one) 33b, SIgnalln and
. COIUfjIng ~ (1'I1ysIc:Ilw1 certlylngcaues 01_ _ __ physicien has ~ _ end completed hem 231 ..
ToIhe_oImylolclllllllOl.__dlIelOll\eceuel(ll"'''''--' ___ _ _ __ _ n _ _. n__ _ _ __ __ _ _u _ __ _ _ 0
. """"""'"In'" cartIfylng ~ (f'h!sicien both pRlrtOIIlClng _ end certIyIng kl caues "'_I 33c. Ucenes 33d. Dele SIJp>ed (Monlh. dey, yeeJj
=.,==__ItIhe-._...pIece,...dlIelOlheceuel(a)..._es-"'_n_nn_un_-n 0 September 10. 2007
OnIhe_oI_"'/",~ In my opinion, - _1I11\e-'_"'pIece,"'dlIelOlhecouee(al'" -.. -. ts' .34'llfrc!l\ft!oI~~e8"f'1)~ Type/PTlnt
SIpI\n ",) I -" I / 38.DeleFled~...:.. .~day.yeeJj 6375 Basehore Roadl Suite ill
I <.>\ I I c?( I I I (Cf,blZPDl) 7 Mechanicsburg, PA 7050
0070330
IIem8 28-28 _ be completed Ily person 24. T"", 01 Deeth 25. Dele _llesd (Monlh. day. veer)
___ 3: 17 P. M. September 7. 2007
CAUSE OF DEA1'll <_I_..nd ..........)
hem V. Part I, EmerIheJ:bliUll.Jlllll-_.R1juries,or~-lhI1dlrec:l1yc:eusedlhedeeih.DONOTlll1Ier_evenII_.._e_
-....v arrest. or _ _liOn willIcQ -.g Ihe etillIo9I'. Li8I anIy one caues on _line.
=~~=-....;
e, Probable Myocardial Infarction
Duekl(Or..a_of)'
b. Occlusive Coronary Artery Disease
Due kl (or.. a_of),
~list_.!"'I'
10 C8U181isted on Ine..
EnIer _YING CAUSl!
=:e~~~
c.
Due kl (or _ a consequence oil'
308. Was "" AilIop8y
-
d.
3ll>. W... Autopsy RndIngs
A_PrtorIo~
01 cause oIllee1h?
3t._oIllee1h
){- D-
O - 0 PencIng InYesligIIlion
o SuicIde 0 CoukI Not be De-..ed
32d. Tine 01 Injury
DYes ~No
Dyes ONo
DIspoeItionPermil No,
17011
PA 17109
(Morrtt1. dey. year)
Coroner