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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Estate of KENNETH W. CARPENTER
also known as
FileNwnber ....)1- 01- 1031
. Deceased
Social Security Nwnber 200-22-6997
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
(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:
IZI 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 complete list of heirs.)
I Name Relationship Residence I
FLO H. GUTSHALL SPOUSE 431 CORNMANROAD,CARLISLE,PA 17013
D S;
. ~~< _...J
_..~..
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his / her last principal reSidenoe at c:
431 CORNMAN ROAD. CARLISLE. NORTH MIDDLETON TOWNSHIP. CUMBERLAND COUNTY. PENNSYL VANIA"'
(List street address, town/city, township, county, state, zip code) " J:':',
Decedent, then 68
years of age, died on SEPTEMBER 5,1997
at 431 CORNMAN ROAD, CARLl$1.-E, PENNSYLVANIA
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(Ifnot domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
c"
C:'
$
$
$
$
6,000.00
situated as follows: 10.022 ACRES OF LAND, CUMBERLAND VALLEY TOWNSHIP, BEDFORD COUNTY, PA (J/6TH INTEREST)
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and CodiciI(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
'1-3 f!o II
T
H. GUTSHALL, 431 CORNMAN ROAD, CARLISLE, PA 17013
Form RW-02 rev. /0.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
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.
~~!f/!::J:;~:d!a;;I;~
before me the
day of
Signature of Personal Representative
Signature of Personal Representative
File Number: & 1- 07- 103/
Estate of KENNETH W. CARPENTER
, Deceased
Social Security Number: 210-22-6997 Date of Death: 09/05/1997
AND NOW, AJo~ VY\.~ I 2> , 0-(i)"7 , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters OF ADMINISTRATION
are hereby granted to FLO H. GUTTSHALL
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.
Letters
$
45.00
4.00
Attorney Signature:
FEES
Short Certificate(s) . . . . . . .. $
Renunciation(s) .......... $
JCP
AUTOMATION FEE
EXEMPLlFICA TION
OF LETTERS
.. . $
.., $
.. . $
.. . $
... $
... $
.., $
.. . $
.. . $
.............. $
10.00
5.00
Attorney Name:
Supreme Court LD. No.:
40.00
Address:
Telephone:
TOTAL
104.00
Form RW-02 rev. 10.13.06
Page 2 of2
HI05.905\1 REV. 4/96
This is to certify that this is a true co f h ..
with Act 66, P.L. 304, approved by th PGY 0 tale ^r~cordblwhlch IS on file in the Pennsylvania
e ener ~sem y, June 29, 1953.
Division of Vital Records 1fi accordance
WARNING: It is illegal to duplicate this copy b
y photostat or photograph.
No.
~II~
Charles Hardester
State Registrar
0234976
OCT 23 1998
C:;l
a
Date
~~:..::
()
t'"-.._
d.l Curberland
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RcCORDS
CERTIFICATE OF DEATH
088S~. S
)~
Hl05.143 A8Y: 2187
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8LACllM<
SEX
SWE FILE NUM8ER
SOCIAL. SECURITY NUMBER
5, 1997
68 VO>.
COUNTY OF DERH
2. Male 3. 200 - 22
BIRllWLACE (City aAd PlACE OF DEATH (Ct>ecll r:rifone sMlI'lSlJ'lIClJOM en Olher"
S1aN Of For8lgf'l Country) HOSPfTAL:
._0
7. ...
MCIl.If'I'NAME(wnottr15lib.JtlOl1, gN8slJ""andT1tJlnb8rI
~)o
NAME OF DECEDENT (firS!. Middle. LM)
-
,
431 cornman Rd.
.~lisle, PA 17013
AlJHEA'S NAME (fnl. Middle. LalIl)
,I. Walter earpenter
_.......cr_
Flo H. earpenter
WTHOOOF 0iSi'0SIT10N
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17b.
C1.mberland
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-
.".ina
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PA 17013
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PART.: OIIW~ClC\IftdIianIcoreibUtinlItodMlh.bul
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ElO(OR ACONSEQUENCEa:'): ~
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d.
DUE 'TO (OR AS A CONSEOUENCE Of):
DUE m(CA AS A CONSEQUENCE OF):
WERE AUTOPSY FtNDINGS MANNER OF OEATH
.uJ.....BLE PRIOR 10 ~
CCl'WlETIOH OF CAUSE ....... Homicide 0
OF 0ERH1
- 0 Pending Invesl~iOn 0
,...0 No 0 """"'" 0 Could noC ~ Oetem'lined 0
QATE OF INJURV
(Month, Day, ~)
TIME Of iNJURY
INJURV IiI WORK? DESCRIBE HOW INJURY OCCURRED.
,.. 0 NoD
.MEDICAL EXAMINER/CORONER
On the bee" of examin-'kXt .neileM' investigation. in my opinion. de.th occurred lit the time. date. and place. and due to Ihe CMlM(S) and
mann.....st8ted................................. .... ....... .......................... ...... . .... ... ...... .....
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REGISTRAR'S SIGNAl"
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3OIt. M.
PlACE OF INJURY. A1 home. tarm.strHI. tactlXY, atftce
buikiinQ. etc. ISpecrtV\
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... 21b.
CERTIFIEJII (Check omy one)
.CERTIFYING PHYSICIAN (PhySICIltf" cerutyIng cause 01 oeam ","el" 3not/'1e< ptwSlCLan has pronounced oealh ana completed nero 23\
To the bMt at my knoW.... _.u-. occuned due to 1M cauM{s) and manner.. sYted. .
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"PfK)NC)lJNaNG AND CERTIFYING PHYSICIAN (PhySICian boIt1 Pfonoul1Clng oealh and Cef1llylng locause of deam)
To lha..... at my knoWledge. dHlh occurred at 1M dIM.~. and piKe. and due 10 the CIIU"'_) and manner.. .tat-.:i.. . .
34.
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