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Home My WebLink About11-01-07 PETITION FOR PROBATE AND GRANT OF LETTERS CUMBERLAND REGISTER OF WILLS OF COUNTY, PENNSYLVANIA Estate of Susan C. Duncan File Number dJ-07-0Qg0 also known as . Deceased Social Security Number 191-42-8592 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE ~' 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 ~ '" ) :"'-) ~::::;:r " ~,< ~L) '.r_"} ,-_._,; Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ofilli~trum~s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: c. . r-; I (Stale relevant circumstances, e.g., renunciation, death of executor, etc.) --...J ,"-" ..~ m B. Grant of Letters of Administration ~ (lfapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durank..:minoritate!-.... .0 --j ;? Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if anytand heirs: (If Administration, c.t.a. or d.b.n.c.t.a., enter date afWill in Section A above and complete list of heirs.) Dau Son Daughter Name Teresa J. Free Frank Duncan Rachel Mellott 232 (COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary. Decedent was domiciled at death in Cumber land CountYJ'ennsylvania with his / her last principal residence at 375 Claremont Drive, Carlisle, Middlesex lownship, Cumberland County, PA (List street address, town/city, township, county, state, zip code) 59 . August 30, 2007 Decedent, then years of age, died on Rehabilitation Center, Carlisle 17013 at Claremont Nursing and Decedent at death owned property with estimated values as follows: (If domiciled in P A) All personal property (lfnot domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania 3,300.00 $ $ $ $ None 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 fonn to the undersigned: T ed or rinted name and residence ~~ Teresa J. Free 232 Stonehed eLAne, Mechanicsburg, PA 17055 Form RW-02 rev. 10.13.06 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. before me the 1st day of y ~.~~~ Signature of Personal Representati J F eresa . ree Sworn to or affirmed and subscribed "-::1 November 2007 ~1\tzfk U/1Ai1fJllcnJ For t~eglster . '--,~ Signature of Personal Representative C.) -\-~~ ,'~ :.: ~r, Signature of Personal Representative File Number: fA 1- 07-- cqQ ltJ ",--, __w ~.,' ""l Estate of Susan C. Duncan , Deceased Social Security Number: 191-42-8592 AND NOW, this Edav of Novembe;r; 2007 having been presented before me, IT IS DECREED that Letters are hereby granted to Teresa J. Free DmeofDemh: August 30. 2007 , in consideration of the foregoing Petition, satisfactory proof of Administration in the above estate and that the instrument(s) dated N/ A described in the Petition be admitted to probate and filed of reco Letters $ ~?;O. OD a..O . 00 10. L'O In ()O .5.00 FEES Short Certificate(s) . . . . . . . . $ Renunciation(s) .......... $ ~ ... $ m (l tlliil .. . $ . .. $ .. . $ .. . $ .. . $ . .. $ .. . $ .. . $ TOTAL .............. $ Attorney Signature: Attorney Name: Keith O. Brenneman Supreme Court I.D. No.: 47077 Address: 44 W. Main Street Mechanicsburg. PA 17055 Telephone: 717-697-8528 7~ Form RW-02 rev. 10.13.06 Page 2 of2 1I1ns HO:" R.EV (1l1/{)71 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 13822904 Certificaliion Number This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ~R:;:;"~ ~ ;,!;,;,!e: 7 (""-"', ______1 co -<=" Hl05.143 REV 11/'2006 ~. TYPE.' PRINT IN PERMA.NENT BLA.CK INK COMMONWEALTH OF PENNSYLVANIA 0 DEPARTMENT OF HEALTH 0 VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) 1 Name 01 Oecedenl (FIrst, midlIe, las!. suItix) Susan Co Duncan 5 Aga(la$lBirthdavl 6. Date 01' Bitth (Month. da . year) 59 l'~ Bb. Coonly of Death December 3 Clarem:mt Nursing & Rehab Center 12. Was Decedent eyer in the 13. Oecedenfs Edllcalion (Specify only hiyhesl grade compleled) U.S. Armed Forces? Elementary I Secoodaty (0-12) CotIege (1-4- Of 5+) OV., lXNo 12 _'s AclualResidence 17a.State Pennsylvania Cumherland lib. County 4. Date of Death (Month, day, year) August 30, 2007 O...-.ce OOlho,._ ~No OVes 10. Raco'___.Illacl<,.....,"" (Sj>o<o~ White 14. Marital Stalus; Married, N~er MarriEld, W_"'. Divorced (Specj/j1 Divorced l>d_ Live in a Township? Middlesex 17,. 29 Yes, Decedent U\led in t7d,O No, Oecedenl LiYed within ActoaI~oI Top C<Iy /8oro 18_ Faltlef's Name (firs~ middle. last. sutfix) Frank W. Stevick lOa llIlormanl's Name (Type I Print) Frances Stevick 19. MoIher's Name (FIrSt, midlIe. maiden surname) a Duncan "" InIo<manrs Mailing Address (SIt.... cily I town. _. ..,-1 425 West S. n Street Mechanicsbur 21,.""'oIDisposIlion(Nameol_._or_pIaco) 321. If Transporlalion injury (Specify) o Ori~et / Operator 0 Passenger OPedeslrian Other. Specify 33a Ci!ltJflef (check only one) 33b, SignalUl8 and Tille ~:~,r::f.1~=~ ~=:: :"~:~h~nu:~~~~ar:rr: ~=~ed_ ~:th _~ ~~~ ~te~ ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ .,. _ _ ~ .." Prooouncing and tetl.ilylnll ph~,lcian (Physician both prOO()O(lcing death and CeflityinglO cause of dealh) 331:. license Number To the bell of mw knowtedge. death oa:urred'I the time, dale, and place, and dot to the cauM(s) Ind manrUN" as stated.. - - - - - - - - - - - - - - - - - 0 ft 1 = ~~sm::~:= and J or investigatiOn, In my opinion, death ~\ured" the lime, date, and place, and due to the cause(s).nd manner.. staleeL 0 o '" '" " '" < ~ 1 zzi Fun r 1 ~ I Approximate interval I QnselklDealh , , ! ~e.:11 ~ , , , , . , , , , , ::=~~~ta~lik>e~ M tt-o:rS+~f.I' L Due to (or as a coosequeOCEl of)' Cc;,nie-t. B 1'l"Q~.f- Seqt.enllaly ~st coodilions, II any, ~~ ~.:oERLV~1::=: a ldisedse or Ifljufy thai inillaled lhe 8Y8fIlifbsul1ii'1gNldeathlLAST. b. Due to (Of as a consequence 01): Due 10 (or as a CO(Isequance 01) 30a Was an Aulopsy Perlormea? Th. Were Autopsy Findings A~a"able Prio, 10 Completion otCauseotDealh? 31,MannerolDealh ~a1ural 0 Homicide o ACCident 0 Pending InvestigaliOfl o SUICide 0 Gould Not be Delermined V) ~ t{ Of" ~o Oy" ONo 32d. Trmeoll:1lury M. 'Z ~ ~ ~ Dispositioo Parmil No PA Part": Entel"olher ~lconditiooscontrtlulinalDdealh, bulnotresul1ir9ir1lleoodeltyingcausegiYeninPatll 28. Did Tobacco UH Conlltlute 10 0eaItl? o Ves OP- ~ 0 ""'<>OW" 29. II female ~NolpregnantWlthtnpaSlYflat o Pregnanl al tifnj 01 death o No! pregnant but j.lf8gnanl wlli'llfl 42 da~ oIdea~ o Not pmgo;lI'M. bul pltl!)llalll 43 days 10 1 year ..... do... o Unknown if pregnant withln \he past year 32c. Place of 1rIjury: Home, farm. Street, Faclofy, Oftlo. ....."9. llIc ($p<<dy) 329, location 01 Injury (Streel, city I town, slale)