HomeMy WebLinkAbout11-13-07 (2)
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Charles R. Leach No. a \ Dl \ () d..\
also known as To:
Register of Wills for the
, Deceased. County of Cumberland in the
Social Security No. 164-30-3319 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older and the execut rices named
in the last will of the above decedent, dated September 27. 2007
and codicil(s) dated.L
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvani.
h is last family or principal residence at 4124 Rosemont Avenue Lower Allen Townshi
Cumberland County. Pennsylvania
'\
(list street, number and municipality)
1
Decedent, then 75 years of age, died 11/6/2007
at Golden Living Center West. 770 Poplar Church Road. Camp Hill. Pennsvlvania
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adfii~iBted
incompetent: .- .....,
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$
$
$
$
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140,000.00-::-
(,,)
c~~
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
thereon. (testamentary; administration c.I.a.; administration d.b.n.c.l.a.)
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Terry S. Din'more
972 Blackberry Lane
Jacksonville
6207 Westover Drive
Mechanicsburg
FL 32259
PA 17050
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH 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 of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed4nd subscribed { () ,,:', I.~- \'\ 4-.\.e J \...1lo )
befor me this ay of
t;
Register
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2
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
SS
COUNTY OF
The Petitioner(s) above-named swear(s) or affim1(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 \~
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lj ... Foe th, R,g;,~ U
day of
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<On,.-
Signature of Personal Representative
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Signature of Personal Representative
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.. $
... $
... $
. .. $
TOTAL .. ........... $
File Number:
Date of Death:
AND NOW,
having been presented before me, IT IS DE
are hereby granted to
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed ofreco
FEES
Letters
$
Register of Wills
Short Certificate(s) . . . . . . . . $
Renunciation( s)
Attomey Signature:
Attomey Name:
Supreme Court LD. No.:
Address:
Telephone:
Forlll RW.O] rev. 10.13.06
Page 2 0[2
I L11n'::::_~n" ',>_T'_~V In'/n~\
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 13989044
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 filin~OV 0 B 2007
U/wn- /'~ /~~' / /
Local Registrar Date Issued
Fee for this certificate, $6.00
Certification Number
Q
"'Q
-.j
AEV 1112006
! PAlNllN
\!ANENT
,CK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
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-.-.
75
Sept. 13, 1932
Lemoyne, PA
STATE FILE NUMBER, --r.
~. Dat!~ath (Month. da~
3319 llovember S,'?2007
1. Name of Oecedtnt (Arst, middle. last, suffix)
Charles R. Leach
5. "lie (las1 BirtMay)
VN!.
6. Dale of Bi<1h (Month, , ar)
7. Birthplace and state or I
Othar.
f',..)
o Aasidence OOlhar. Sped~:
~ No 0 Yes 10. Race:.American Indian. e~ck, 'Nhlte. etc.
{SpociM
Whi te
8b. County of Death
ed. Fadtlty Name (II noI. Institution. give: s1ree't and number)
Cumber land
Twp
Golden Living Center
12. Was Decedent ever In the 13, Dec:edenrs Educalion (Specify only highest grade completed)
U.S. Armod F.....1 Elemantary I Sacondary (().j2) Collaga (HI or 5+)
~as ONo 12
Dec:edanl'.
Actual Residence 17a. State
14. Marilal Status: Married, Never Married,
Wolowed, Divorced (S/lfIdf'II
Widowed
11. Oec8denrs Usual ion. Kind 01 work done du mosl of life. 00 not state
l<il1dofW<><1< Kroofllus1l\assl~
Technician Lucent Tecn.
. 16. OeceOenI's MaiJng Address (&reel, city flown, stale. zip code)
770 Poplar Church Rd.
Camp Hill, PA 17011
18. Father'. Name 1Ant. miOdle, last, sultix)
17b. County
P^
r"mN:>l" 1 .<Inri
Did Oacadont
Uveina
Towna~p?
17c. ~ Vas, Decadanl lived In Ii:
17d. 0 No, Decedenllived within
Act"" limits of
Pilt\l:U;OO~O
Twp.
Cityllloro
2Oa.lnf
Susan Headle
19. Mother's Name (Ars!, midlIe, maiden surname)
Pauline Gaebler
20b. Informanfs MalNng Address (Street, city i town, slale, zip code)
972 Blackberr Ln. Jacksonville Fl 32259
21c. Place of Disposition (Name 01 cemetery. Cfematory or other place\
21d.loca\m {C-i\>j I tOYln, state, ~ code)
9, 2007 Rolling Green Memorial Park
22cNam'andAddJassofFadI1y Myers-Harner Funeral HQl!le
1903 Market St. Hill PA 17011
Camp Hill, PA
ttems 2<4.26 mu&l be oompIe\ed by person 24. Time of Death
. Yh>PfOOOlJI'lC8Sdeath. s:
CAUSE OF DEATH (_ InlllruCltona .nd ...mpIH)
118M 27. Part I: Emer lhe ~ - dseases, injuries, or compIk:atlons -that directly caused the del1th. 00 NOT enter temlinal events sum as cardiac arrest,
rtspkatofy 8lTftt, Ot' VWltOOJlar fibrillation w\thoo\ showino th& e-\\oIogy. UsI onty 0Illil' cause on &actllioe.
IlIlIEptATE CAUSE IFlnal d8ea.. Of 1#1". ~~I A /; J.-- AA (';: . ~ . f.')'
condltionlOSlJlti1\9il\daathl ~ a. r"v. _-'lV-17 /'(~ ..AoJ~-, c ~
Due 10 (or as a conaeque OO:b '.k.. _ ,. /
~lIo\contIllons,hny. b. -re. /"'t/,t I." Jr ~ c-i4
= ud~l~r~~e a. Due to (or as a consequence 00: ;'
=:s'~~~a~ST~
308. Was an A~V
P8I10rtned?
OVes ~
d.
~.WereA1JtoI;lsyFIl'\dings
Available PriOr 10 Completion
of Cause 01 Oeath1/
o Ves [3"No
31. Man Oee.th
tur~ D-
O Accident 0 Peo~no In...lig8tion
o Suidde 0 Could Nol be 0e1.11!Iined
ApprolCimale nlervaJ: Part It: Enter other sianificant cordticns c:onIributioo 10 dAalt1, 28. Did~Obacco U Contribute 10 Death?
Onsello Dealt1 but not resuking in the ~ awse gi'46!\ in Part \. 0 Yas Probably
No 0 Unknown
29.11 Female:
o Not pregnant within past year
o Pregnant at lime ot death
o Not prQgl'ant, bul pregl'I8l\t 'fritmn 42. cays
01 death
o Not pregnant, bUt prtgJiUr.t 43l3a'f5 to 1 YIla!
belonl death
o Unknown il pregnant within the past year
32c. Place or InjUlY: Home. Farm' Streel, Factory,
Office Building, etc. (Specify)
Due 10 (or as a consequence 00'
32d. Time 01 Injury
M.
338. Certifier (check only one)
Certifying phyliClan (PhYSician certllylog cause of death when another physician has pronounced c1eath and COfTllIeled Item 23)
To the bello' my knowledge, dNth occurred due 10 Ifte caute{a) and mlnneras 'lated........... __ __ __ _ _... _ _.. _ _ _..... _ _... _ _.... _ _ _ __
~;~heoo~:,:,a~ :~~::.~:~=: ~i:~~:::::~~01~:~~8~~ manner as slated_..... _.. _ _ _.. _..... _ _ ... _ _ _ 0
~:~~~::~:= and f or Investigation, In my opinion, death occtJrntd It the time, date, and place, and due to the cause(s) and manner as slated_ 0
35. Registrar's SIgnature
~
/1* IjtJ (,
Disposition Permit No.