HomeMy WebLinkAbout11-21-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Estate of SANDRA L. ADAMS
also known as
File Number
:L1,07, JD{Pg
. Deceased
Social Security Number 288-40-4517
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE ~' or 'B' BELOW:)
1"0.)
(") <=
en 2ned in, th J.~
'C::o Z Xi""")
,-~? -0 e ffi b
njFp -< ?F,;U
>.; :z; m N i:ri ff:
-_v~32 _....J U
(State relevant circumstances, e.g., renunciation, dooth of executor, etc.) . .J (") 0 <::' 0
)O-n ]:a -," 4'i
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution onD~trnmentCloff~ ~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: -n -I c:?;:= rn
;::::s N 1::,;) C::>
\Q -n
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
iii B. Grant of Letters of Administration
(Ifapplicable, 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)
Name
Relationshi
Daughter
Husband
Residence
30 Faith Circle, Carlisle, PA 17013
504 Quail Court Mechanics
PA 17050
Paula D. Potteiger
P. Adams
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his / her last principal residence at
504 Ouail Court Mechanicsbure:. (Hamoden Townshio) PA 17050
(List street address, town/city, township, county, state, zip code)
Decedent, then 60
Camo Hill. PA 17011
years of age, died on November 6, 2007
at Holy Spirit Hospital, East Pennsboro Township,
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All perso;:al property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in PA) Personal rroperty in County
Value of real estate in Pennsylvania
'IDrAL
$
$
$
$
$
16,000.00
situated as follows:
16,000.00
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:
T or rinted name and residence
Paula D. Potteiger
30 Faith Circle, Carlisle, P A 17013
Telephone: 717-319-7107
Form RW-02 rev. 10.13.06
Page 1 of2
-
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
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) win wen and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~ day of
~~OD7
xC?~
Signature of Personal Representative
(")
~O
~;s
~__:tJ ,
'J:cQ
_'J~'
,'- m
:> -::0
,o':':(/) 7'
')00
}O "
;-'C
,---' ::0
-l
~
. Deceased
f',)
=
=
~
:z:
\.oJ
-<
N
Signature of Personal Representative
File Number:
C).I-Ol- I()(og
!i
,::0
-'''', rTl
f}1 (-,
\'j)O
()'5 :::0
--I CJ
('TIm
::u C?
c~
".f~
;:,~~
-'-""~
r~-
r....-'.
(',') (~
-T1
c:?
Estate of SANDRA L. ADAMS
N
\D
Social Security Number: 288-40-4517
Date of Death: November 6. 2007
AND NOW,
having been presented before
are hereby granted to
, !J ro 7 . in consideration of the foregoing Petition, satisfactory proof
S DECREED that Letters
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 Wi11 (and Codicil(s)) of Decedent.
Letters ............... $
Short Certificate(s) . . . . . . .. $
Renunciation(s) .......... $
~1W()h. ::: ~
... $
... $
...$
...$
.. . $
.. . $
... $
TOTAL. . . . . . . . . . . . .. $
I pO,OD
[00
5i9f
10, D
,f:).()7)
FEES
Attorney Signature:
Attorne~' Name:
Shelly J. Kunkel, Esquire
Supreme Court I.D. No.: 64485
Address:
109 Locust Street
Harrisburg, PA 17101
Telephone:
717-236-9301
<6<(~
Form RW-02 rev. 10.13.06
Page 2 of2
RENUNCIATION
(")
<'::;0
:"5~::o
'::0 -u
',;,] ;;;!;(")
c',-i zhi
:1';: en ::0
'" ^
'--00
:;0.,
<::>C
, :n
::u-f
:;po
~
<::::)
<::::)
~
Z
<:::)
<:
N
" ,,:;:U
uX:') , 11
'11 C"")
we)
c?5 ::0
--10
r'nm
::00
C
_""J,CJ
. . ..."
~~~
t.. fT'l
C/) c:)
--1'1
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYL VANIA
;)(-07 -IO(o<)
:bit
:x
c:?
N
\0
Estate of SANDRA L. ADAMS
, Deceased
husband
I, John P. Adams
(Print Name)
, 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
Paula D. Pottei~er
(Date)
Mechanicsbur~, P A 17050
(City, State, Zip)
Executed in Register's Office
Executed out of Register's Office
Before the undersigned personally appeared the
party executi this renunciation and certified
that he 0 executed the renu c' n for the
pes e within on this day
of
Deputy for Register of Wills
It
Notary Ptt lic no hi ,<f..
My ission EXPires~_.JOfe({l1
(Signa and Seal of Notary or other official qualified to
administer oaths, Show date of expiration of Notary's Commission,)
Form RW-06 rev, 10,13.06
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
SUZANNE M. DEDERER, Notary Public
Camp Hili Boro! Cumberland County
My Commlsslonupires AlII. 20, 2009
"TJ10.:".~0.:" ~SV (')1/071
:2 f -07 - I() & f
LOCAL REGISTRAR'S CERTIFICATION OF DEATtt
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6,00
P 13823741
Certification Number
----~_._-_.._---
HlOS-'<3~'1I2OOlI
TYPE I PRINT IH
_NT
IllACI\IHK
-'
This is to certify that the informatitln here given is
correctly copied from an original Celtificate of Death
duly filed with me as Local Registrar, The original
certificate will be forwarded to the State Vital
Records Office for permanent filing
WJa;R~ II / ilJ/(J'1
Local Registrar
Date Issued
8
---g
ffi-uo
lJ ~ r-:
'-.~m
'~~; d> ~
500
;')2-r1
',J::o
, ~
~
~
~
.c::
N
-
p..n.. ~~..'
G:.?
<-.,,., -
rTi
:D 0
C){}.
-n~
::~~
r:2!rn
r---
(.o~
!C
C5
..
N
,\l:l
COMMONWEAlTH OF PENNSYI.VANIA- OEPARJIIENT OF HEALTH. VITAL RECORDS
CERnFfCATEOF DEATH
(See Inatructlon. .net .ump1e8 on _..)
18._......(1101,_._~
Kay Corkist\
-,-'IllIlIilg-_clr/__,,..~
30 Faith Circle, Carlisle, PA 17013
~ """ 01.....-,..,.........." """*Y." _pllctl
Hollinger C:rEInatory
Mar
Mecl\anic
1...... <I_(fiooI. -,....,....1
Sandra L.
5..(I.MI~1
11. ,UIuII Gt .....DonQr....
Kildol_ _0I~1~
Nurse I s Aide Nursing
18.-'IllIlIilg_I_clrl_,_,,.._,
504 Quail COUrt
Mecanicsburg,PA 17050
.. F_'......lfVol, _,....,_
Unknown VanDeMar
Hb~
~
~
::&I:~=~ .. OIJAeiM ~ <-eR..
DwlIO'(orlSa~CIf):
I~-
, On..UO o.tI
I
I
i.5'i6
I
I
I
I
.
I
I
I
.
.
a"'-.fJllj,
.'10 tuelillld.WL
----
=-..:..\tt.~-ml"
b.
llua"(or"._oII:
OuIb(or...~~:
3Ila_..~
..........,
d.
30b _.......".,.. 31 ...,...._
~::t:.,~ I!J"'.....~ D_
O '/ao ~ 0 -.. 0 Pendng.........
Os_ 0C<>.ld..,..._
II
Ov.. ~
32d. T...oI~
:rac.o.r_........)
. ta.1ll,log~(I'hyomn'*"P'llcauoool_....."""""_...__"""__231
To........ "oar......... __ .......cauoa(I/and _..__ _. _ _"_ _ _"" _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ __
. =:=--::.!:.::::=::':"-:"":"':::'''~=-''______mm_mm 0
. ::- =:= ....1 or ~ M..,......, duIIIl occurred...................... n""" ClUll(etlftd_ II...... 0
I
l!l
~
!
35
.
00'1
T"p.
Qly/-
PA
2I._ea._,,__,eo.... ""_0lIl0r """er_.._,
ov.. I)(Ho
PIfII:&wCllhll . - ~""""'-lDdMIh.
...""-.g.....IIlIlooIlO'lI-.....""',
a. Dld_Uoa ~"0aaIl?
o Yao 0"""'"
0110 0--
a.."..:
O..,._-....lOI'
0"'-.....01_
0..._...__......
ol_
D ..............._......"'lOI'
n :::.=,..,.... -........lOI'
32l:.==~_F_,