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Home My WebLink About11-08-07 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~~/fH..J ~ COUNTY, PENNSYLVANIA Estate of --111.a-~. G-lctSeJL. also known as ~ File Number ;;? /- ()7- /0/9 , Deceased Social Security Number /Jo'8 - :J:i- (;5''8 I Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) >> A. P"b,t< "d G",' ,r L""'l T,",m,""'Y ~d '"" th" p,,;tio,~(,)!!! '" th, ~ LAP j TH AJ<' ea S Mm<d ;, th, last Will of the Decedent dated Clff.-.!lo / (J 3 and codicil(s) dated /1.(( - (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 instlUment(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: IV () n e..-_ o B. Grant of Letters of Administration (If applicable, enter: c.t.a.; .b.n.c.t.a.; pendente lite; durante absentia; dural;~ iilnoritate~ . (-~ ,-- Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following sj:lOllSe (if any) and heirs: (If Admiflistratioll, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) . ~ , ... .~ Name R"";'; .-/ /'" r Residehce i/~ I " ....... ./ --' Ul (COMPLETE IN ALL CASES:) Attach additiollal sheets ifllecessary. (List street address. townle!ty. township, county, state, zip code) Decedent, then -E9-- years of age, died ob g II S' / tJ 1 I I at I-frp,J/ee ~~r~AUo I 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 i.. $ 30-0) 000. DD :~t $ , rJ O"'V\ e.... 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: FO/'llJ RW-02 rev. 10.13.06 Page 1 of2 Oath of Personal Representative COMMONWEALTH OF PENNSYL VANIA COUNTY OF -C{)1'p\ ,WO/V'.~_, The Petitioner(s) above-named swear(s) or affim1(s) that the statements in the foregoing Petition are true and con-ect to the best of SS 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 o--\-L before me the D. day of \~~~'- . r9-00'1 ~'rq~~ ~ [JO.l1;W For the R~n6 Signature of Personal Representative '. -) "' '~=) ~ ~, Signature of Personal Representative File Number: eJ/- ()7- I D 19 Estate of k''1) E ~ W f1 ./'l..ll..A- Social Security Number: ~O& c.2X- - (OS~ I Date of Death: ~ 1ISI0f AND NOW, \\.\O~ &' , &OOr , in consideration of the foregoing Petition, satisfactOlY proof having been presented before me, IT IS DECREED that Letters \{'~\A NW n+(LVl.-t' are hereby granted to S}..~ ". \<' ri:>)as 0 -I ,. ". .~ ! <'"i en ,Deceased f'<l in the above estate and that the instrument(s) dated '-\-- d.D-c2c::>D.. ::z, described in the Petition be admitted to probate and filed of record as the last Will I . ~.--,.--- TOTAL $610.00 $ Qa..(JD $ $ 15"-OD $ ID-ov $ S~(;D $ $ $ $ $ $ $ "5l.Q 0 . u\) Short Certificate(s) . . . . . . . . Renunciation(s) .......... ( ~ ~\;\ - ~(If .. . o ' \ .:hJYY\Ji -'1T M\.-J. . . Attomey Signature: ~~ _u~ FEES Letters Attomey Name: Supreme Court 1.D. No.: Address: Telephone: Forl/l RW-O] rev. 10. 13.06 Page 20f2 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 13771808 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 ~ords Of~/~rmanent filing. AUG 2 0 2007 ~'</~/ / Local Registrar Date Issued .--) ~._...,.-: ~-....::: L_: f"".; en N REV 1112006 . PRINT IN "'ANENT CK INK COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (See Instructions snd examples on reverse) STATE FILE NUMBER 5. Age ILasI Birthday) 99 G \ 1lr::>e(L 5. Date of Blrll1IMonth. . r) 01 I la\ l~o8 7.B1rt/1l1aCe{C andslaleor VIS. 8b. Coun~ 01 Death 8d. FaclRy Name (" 001 institution. give ..... and numbet) Carolyn Croxton Slane Hosp1ce ReSl.Oence 12. Was Oecedenlever In the U.s.Arrned Forces? Dauphin 11. Decedenr. Usual K<<lof_ Hwsf. . 16. Decedent's Mailing Address (Street, city / lawn, state, zip code) Susquehanna Kil'ld of work done du' lTI08lolworki Ife.Donotstalerel!red Kind of Business I tnduslly 13. Decodenr. Education (S!>edly on~ higheot grede COmpleled) Elementary I Secondary (0-12) College (1-4 or 5+1 12 PA Cumberland Dves KlNo Decedenr. Actual Residence 178, Slate 17b. County 2080 Claredon st. '<' 14. Marital Slalus: Married, Never Married, Widowed. Divorced I SpecIfj1 widowed Old Decedent Uveina TCW1l!Ihip? 17c. 0 Yes, Decedent Uved in 17d~~~~to~Yedwit~n Camp Hill Twp. City/80m 1Q. Mother's Name (FIrst, middle. maiden sunarne} Mable Hughes 2Ob. Informanf. Melli1g Addreso (Street, QiIy 1_. _, Zi> code) 1724 Creek Vista Dr. New 21c. Place of Disposition (Name of Cftmel6fY. ctemlItoI'y or other place) East Harrisburg Cern. 22c. Name end -... of FacIIIy Musselman FH&CS Inc.324 Hummel Ave. Lemoyne,PA 24. Time of Dea~ V'- 25. Dale Pronounced Dead (Month, day, year) 6 (? M. RHo ,.:.r I:r J....;/./ CAUSE OF DEATH (See lnetructlone 8nd ex. plee) Ilem 27. Pan 1: Enterthe.~ - diseases. injunes, orcomplications-thalclreclly causedlledealtl DO NQT enlef terminal events such as cardiac arresl. respiratory arrest. or ventricular fibriMation without showing the etiology. Ust only one cause on each Ine. ~~~,:;\~ a. J!.J A7 0 Due to {or as a consequence 00: ~ Items 2'-26 muol be compIeled by person who pronoonces death. Approximate int8l'val ansetloDeoth ~~'~~a. Entar "8-.:: UNDERLYING CAUSE ~~~~"~U1e {~.L4YA77~ b. Due to (or as a consequence 00: c. Due 10 (or as a oonsequence 00: d. :JOe. Was an Autopsy 3Qb. Were Autopsy F"ndings Performed? Available Prior to CompletK>ri 01 Cause 01 Death? ~ D_ O _, 0 Pondng InvesUgallon 32d. TIme of Injury o Suidde 0 CoI;d No! be Determined M. Dyes Dves DNo 330. CeI1lfier I"'''''' on~ one) Certifying physician (Physician certifying cause of death when anotller physician has pronounced death and compleled Item 23) lothe best of my knowledge, de4IIh occurred due to the ca.use{I)and lTIIMer as steled-................................................ _..... _............. _......... Pronouncing and certifying physician (Physician both pronounci~ death and certifying to C8U1e of death) To the beat of my knowledge, death occurred al the time, date, and p6ace, and due to lhe ClUse(S) and manner as staled.. .. ... ... ... .. ... .. ... ... .. ... ... ... ... ... .... 0 Medlcal examiner f Coroner On the buls of edminltlon and f or Investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as Itat8cL 0 ~.R~"f'~.~N~ ~~ DIsposition Penn" No. 23b. LK:ense Number 23c. Date Signed (Month, day, year) 2ft Was Cay Referred to ~K8m1l'1er I Coroner lor a Reason Other than Cremation or Donation? Dves ~ Part II: Enter oItIer sianilicanl conditiMll contrbJlino to death, but not rellultlng In lheunc:lerlying cause gIVOO In Part I 28. Did Tobacco Use Contribute 10 Death? o Yes DProbabIy DNo ~ 29.~~ ~pI'flQf\aOtwtthjnpastY88r o Pregnant al Urne 01 daalh o NoIpregnanl,butpregnanlwilhln42da.ys 01 death o Not pregnant. but pregnant 43 days to t year before death o Unknown it pregnant within the past Y8llr 32c. ~ :u~~~ ~~~~~j Slr&et. Factory, 32g. l0C8tion of InjUIY (Street. dly flown, slate) . ~ ~ LJ~~J~ .j,/?1J ,.k~j~uf~~1 ~ "-""- d- -"-V.. ~, ~ '711 <<4>, ~ ~<t. ~<<A.I. 4...:. 4- ~ "if' --L=<z ~ ~ ~_ ~ :....~ .J ~ ~ .~ ~ dJ4 ~ ~ c4-f4-~-- ,~: k~l'~~, ~/~~n~ ./~ '7Y)~ ~ CA./..:-b:.,... ~'i ~.~ ~ ~-- ---.. r r () r-J ~, ~~??'v~ ;to ~~~ ~~ 'r r .-. _..-/- - - ~ ~~ ~ ~ ~~l!1J-. .~ , . / ' ti-lL~ ~~ ~ A. ~""~ ~~ ~d. AM--c (--] ~~ 7 ~.~ w~K3~1 ~ C.t)~~d 1 ~ ~ ,1~ ~ (]~ ~ IJ~~ ~C4A-rcL q:,. e~- ./ ~d ~ ~m'i-.7 KJc;~J~ tW.3~8~, w---;;- ~r4 s;r--- t, ~ ~, r~ (L. k~, ~ ;t., "rA-+.. .,9~~~4 k k ~:.w.- "4- 7~ <'Vz. ~ . J. 'Y'f--...dd r.%~ J r4 Ct. It /14.. .A, -t.... ~/~ ~.~w~, t'l>- fl\\ -vi J '}yj ""'1 'i A...t """"-=- ~<fi.A...,. --to~?tv:..v /.UZ. nr /..ev.....t. ~ .;2.04.. d'd r ~/ ;1063, /rl~ 1. ~ ~ $1- ~ ~ ~ ~ 1<; &r- I'>te.. .~ ~f. ~hvAe AtJ-K~ 1 ~JM3. ~Jnuud. ~~ Notarial Seal Publ' . . h NotarY Ie ShelbY'I~B~;)1Ilc~mberland County S Camp HI., Expires Aug. 20. 200 My Commission . . lion otNotarleS Member, pennsytvaOlaAsSOCl8 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND We, /'1{11' l /) J11 "II" k ('J Coy- c.r ~ I 0 i U and J a-se-p ~ witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will, that she signed willingly, and that she executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. , the /~ Sworn or affirmed to ~' / ( / / ~ l!~/ and subscribed to before me by the witnesses, vrJJ~;'-I !JlaJutf ~ this ,AIJ~ day of +J and ~ fM/J~~'" 2003. Notarial.. Seal SheJ~)' A. Minich, N.,. PubJlo Camp Hili Boro Cumberland County My COmmlglon a"plN. Au.. 20, 2005 MImbor, PlnntylVlnll AIIocIatlonotNotlrlll ~~c~ . .. AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND I, Mary E. Glaser, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will, that I signed it willingly, and that I signed it as my free and voluntary act for purposes therein expressed. IN WITNESS WHEREOF, I, Mary E. Glaser, have hereunto set my .fA.. . hand and seal this Jo day of .4fJA(L 2003. ")~~ 6' ~~ Mary E Glaser SWORN or affirmed to and acknowledged before me, and Mary E. . Glaser, the Testatrix, this ,j,1JK. day of ~ 2003. Notarial Seal Shelby A. Minlc:b, N~ Public: Camp Hill Boro, CumberIaM CounW My Commiuion Explm Au,. 20, m Mermw,~AIeocIIIMOf""'" dk/~ 14uud- No~ry Pu ic