HomeMy WebLinkAbout11-20-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C1J.WJ6.LJIL..1
COUNTY, PENNSYLVANIA
Estate of Dt-hn,'.s. 4,
also known as u'11 () ,.
S~ d. 111 V,4.('"
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File Number ;2./-()1- / D&>D
, Deceased
Social Security Number
1(;~-4y-~4s 3
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 cqdicil(s) dated
named in the
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(State relevant circumstances, e.g., renunciation, death of executor, etc.) ~,.~ ::D Z -, 1 ,~ )
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after exeCl\ti~m instt~ent(s/o~~~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: :~:;75 -;'f:! 0 ': ~ ;"1.3
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(If applicable, enter: c.t,a.; d.b.n.c.t.a.; pendente lite; durante absentia.:ilt~te lIlillorit!:r'i r,' __ '~I
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (ifa~ and heirs:'~(.[f
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete /ist of heirs.)
rg B. Grant of Letters of Administration
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5(.;."'1- /it,' seed DVC!.--r '3&(' (.-n',nor)
(COMPLETE IN ALL CASES:) Attach additiollal sheets ifllecessary.
Decedent was domiciled at death in <:'lM"\'\nll1 0..1\ ci County, Pennsylvania with his / her last principal residence at
~\\ C\^L(c\L.ee, ~r ~l'\'\{.\.I/'I'~t;bl.l.r!i) fA 17050
(List street address, town!city, township. county, state, zip code) . J 1.'- lI.
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Decedent, then /../.'1 years of age, died on No'll 1.'Z007 at Htllf 5.7inf /-k~/"'"" , ("~{l/hl(, ,W
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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
(I f not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
$ 1'jO IA /1
$
$ ()
$ 0
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 Letlers in the appropriate form to
the undersigned:
Ty ed or rinted name and residence
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Se.eJo 'II 1.-("
1/1 ChucJt.u. P r.
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Form RW-02 rel'. /0./3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF (l ~Y'v\ bUCll..4'\.J
SS
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 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 or affirmed and subscribed
before me the J. otk...- day of
"-loveO"b.e(" ~l
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Signature er nal Represe tati;;;;
Signature of Personal Representative
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Signature of Personal Representative
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File Number: ~ I - 01 - /0 l.o 0
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Social Security Number: I ~;}.. - 'f f -;) If s3
AND NOW, ~ov~~ ~ , ~I ,in consideration of the foregoing Petition, satisfactory proof
having been presente~fore me, IT IS DECREED that Letters --r.e ST A ~ 1'\+0. ~
are hereby granted to f\O~ \=\ ~Jn\H......A 0
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Estate of
, Deceased
Date of Death: \l-l- 01
"in the agove estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as
FEES
Attomey Signature:
Short Certificate( s) . . . . . . . .
Renunciation(s) ..........
-.J ~.p
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Letters............... $610,00
$ \ '-.0 . 0:::>
$
$ID.00
$ S,o~
$
$
.. . $
...$
$
$
$
TOTAL .............. $
Attomey Name:
Supreme Court LD. No.:
Address:
Telephone:
Form RW-O] rev, 10,13.06
Page 2 of2
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
13823609
Certification Number
- .jo
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.
W~R.~\{L
Local Registrar
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H106.144REV 11/2001
TYPE I PRINT IN
PERMANENT
BlACK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See In.trucUon. and example. on reverse)
STATE FILE NUMBER
4._..IMIl_day.jOII)
November 1. 2007
#31-129
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Dennis
6. Ago (Lu1 Ii_I
47
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Sealover
a._"_
June 7. 1960
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ad. FdIy _II ""--.n,,,.........NII1lbOI)
Holy Spirit Hospital
ond_"
Mechanlc.burg, Pa.
8bCot.nly..Oodl
Cumberland
11.DIcIdItt'aUaulll lROItol Ife.Donol'"
.ondol_ """-""Ilnduslly
Building Contractor Building
. us. 0ecedInI'. MailingAdchas (!lrHt, city I town. state. zipcodel
211 Cherokee Drive
Mechanicsburg, PA 17050
PA
Cumberland
13,_'_ISpoc;Iyonly_ ~
EIemonOIIy I_IV (1)-12) CcIIogo 1'-4" 6+)
2
12. Wea DecedInIIV8l' i\"
U.S. Armed FOf08I?
OV.. ~
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AduII RMid8noI 17.. SI8&t
170. Coun~
:.~ 17cilrV"_lNed~
-' 17d.O..._lNed_
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18._.._IF...._.__
Beulah A. Tosterud
2Cb _.-.s_(_.clyl__.."codo)
211 Cherokee Drive Mechanlc.burg, PA 17050
21c.PIoce"__"_._,,__ 21d.L-.(CIyI__.."codo)
Conollte Crematory Schaefferetown, PI. 17088
221:. Namoond_"FdIy
My.... Funeral Home, Inc. 37 East Main Street Mechanlcsburg, PA 17055
231>. UconM _ 230. _ Signod _. day. jOII)
II. Fahr'. Name (First. middII, 1asI, dix)
Vernon R. Seal over
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2OI1n1orml1rt', Name (TVPI f PrinI)
II / 3 /0 11
Date Issued
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