HomeMy WebLinkAbout10-30-07
Register of Wills of Cumberland County, Pennsylvania
Estate of Clair Y. BurQer
also known as
PETITION FOR GRANT OF LETTERS
1 \ 61 Cf1to
.
No.
, Deceased
Social Security No. 178-16-3403
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
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(COMPLETE "A" OR "B" BELOW:)
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A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut
Decedent, dated and codicil(s) dated
'. .
name(hn the ~ast Will of the
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State relevant circumstances, e.g., renunciation, death of executor,;~tc 'v
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of tne documents ef:fered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
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B. Grant of Letters of Administration Clair Y. BurQer
(c.I.a., d.b.n.c.l.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
I Name Relationship Residence I
Joan M. Shambauah dauahter 5101 Inverness Dr..Mechanicsbura.
Jane M. Pritz dauahter 8136 Hillcreek Drive Midlothian VA
Beatrice V. Buraer (deceased) wife date of death 5/16/07
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 113 N. 36th Street, Camp Hill, PA 17011, Hampden Township
(list street, number and municipality)
Decedent, then 81 years of age, died March 11 ,2005 ,at HarrisburQ Hospital, HarrisburQ, PA
(Location)
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 ........................................................................................ $
Total ..................................................................................................................... $
2,400.00
2,400.00
Real Estate situated as follows:
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:
Typed or printed name and residence
Joan M. Shambau h
5101 Inverness Drive
Mechanicsbur PA 17050
RW-7
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and 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 and affirmed and subscribed
3)
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Estate of Clair Y. Buraer
DECREE OF REGISTER
No.
also known as
Deceased
m ~Y~'\)l cAID
',-
Social Security No: 178-16-3403 Date of Death: 3/11/2005
AND NOW, 6c:\tk.r 30 ;;f>ol ,in consideratiorfof the Pettt~n
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on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters a Testamentary !XI of Administration
(c.ta., d.b.n.c.t; pendente lite; durante absentia; durante minoritate)
are hereby granted to Joan M. Shambaugh
in the above estate and that the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
f) LfOD0'6
Letters ......... ..... .~,.................
Short Certificate(s) ...../?......
R . t' I
enuncla Jon ..........................
$
$
$
$
$
$
Inventory & Tax Forms............. $
$
Affidavit (
) .......................
)............. .
Extra Pages (
Codicil .................................
JCP Fee .....::~....f.\dQ..........
Other..................................... .
TOTAL .............................$
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$ :?b. 00
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Register of Wills rc.k~
vzt:
\ Attorney
15
Attorney: David W. ReaQer
1.0. No: 20868
Address: 2331 Market Street
Camp Hill
Telephone: (717) 763-1383
DATE FILED:
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~;tU
PA 17011
HI058U'REV 1/05
This is to certify that the information here given is correctly copied from an original certificate of death dl,Ily filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent 'filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
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11336832
No.
H105. 143 Rlrll, 2187
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Local Registrar .
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ate
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TYPElPRlNT
IN
PERMANENT
BLACK INK
SEX
2. Male
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (Fnl. Middle. L.,,)
I. Clair Y. Bur er
AGE (last Birthday)
BIRTHPlACE (City and
State or Foreign CW'ltry) HO Al.:
"h.~m.~ ........IKI ERIOu....~IO
7.'.............L1'.L"t'.,m ...
FACILITY NAME (If not institution, give strtet and numbef)
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WAS DECEDENT OF HISPANIC ORIGIN?
Nom Yes nIf,yes, speofyCuban,
M8.lOC8I1, P~RlC8n. ale
. . 81 Yrs
COUNTY OF DEATH
.b. Dauphin
DECEDENT'S USUAL OCCUPATION
(~:o..~oflif~t~llc:.~':di'
Harrisburg
~s DECEDENT EVER IN
U.$ ARMED FORCES?
y..1Xl NoD
12.
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DATE PRONOUNCEO DEAD {Month, Day, Year)
24. 9:22 PM 2.. M:u:d1 11
27. PART I: ElItet 1ltI. di....... Jntun.. Of comp(ll;:ction. 'flt\Id\ ~ \Q.1hIIII\. 00 not -merh mode of dying, sua... cant_ or ,..,htory _.t. shock Qf Mart taiklN.
lisl Qflly on. ~H Qfl qeh N....
'<-d<
Due TO (OR AS A CONSEO
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Sequentially list COl1dltlOOS
If any. leading to immediate
. cau5e Enter UNDERLYING
CAUSE (Disease CK injury
thallt'libated events
resulting on death l LAST
'hERE AUTOPSY FINDINGS
AVAILABLE PRIOR TO
COMPLETION OF CAUSE
F DEATH?
OUE TO (aRAS ACONSEQUE
oue TO (OR AS A c~seaueNCE ):
DATE OF INJURY
(Month,Dly.V,,,,)
MANNER OF DEATH
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<lOAD
OTHER:
MARITAL STATUS. Married,
Never Marrted, IMdOwed,
o;"'rced (Specify)
14. Married
He. I!Q Yes, decedent lived in
17d. 0 ~~~=~i~~: of
twp
cll~fboro
PA
m 1"7055
21.
: ApprOximate
. inlef'Val betwee
: onset aM death
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TIME OF INJURY
INJURY AT VVQRK? DESCRIBE HOW INJURY OCCURRED
Pending Investigation
Could 00\ be delermlned
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30.. 30b. tot 3Ck:.
o PLACE OF INJURY. At home. fann, street, factory, office
bllijdlng,ek:.(Spegl'yl
30..
NalUl'al
Homicide
Accident
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NOD
SUicide
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281. 28b.
CERTIFIER (CheCk only one)
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.PRONOUHCING ANO CERTIFYING PHYSICIAN (Physician both pronooocing death and certifyIng to cause 01 death)
To the bqt 01 my knowledge, ddth oeeurred at. the time, date, and place. and diM to the uU..'I.) and manner.1 Itated.... .
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34.
Cumberland
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RENUNCIATION
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
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Estate of Clair Y. Buraer
r\.-;
:-;:,~ Deceased
I, Jane M. Pritz formertv Jane N. Schaffner
(print Name)
DauQhte~
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Joan M. Shambauah/
/?'k ;;7
(Date) / I
Executed in Register's OffICe
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
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(j/M{-P l/I ~
(Si+re) ,
8136 Hillcreek Drive
(Street Address)
Midlothian
(City, State, Zip)
VA 23112
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
purpos stated within on this IJ H- day
of , ot60 .
/
Notary Public
My Commission Expires: '/ 3ft)'
(Signature and Seal of Notary or other official q~ified to
administer oaths. Show date of expiration of Notary's Commission.)