HomeMy WebLinkAbout11-20-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
COUNTY, PENNSYLVANIA
Estate of Marian L. Gardner
also known as M.. '''teA 5. ~At.r
~
File Number
02/ rc/(jO'1-- / ()~5
, Deceased
Social Security Number 209-12-8395
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
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(State relevant circumstances, e.g.. renunciation, death of executor, etc.) ,5 ~ CJ1 :~~ f.fi
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of ~ instrument(~ffered ' ~- r;
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the Executrix
last Will of the Decedent dated August 26,1981 and codicil(s) dated none
o B. Grant of Letters of Administration
(If applicable, enter: c.I.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 db.n.c.t.a., enter date of Will in Section A above and complete list of heirs)
Name
Relationship
Residence
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his / her last principal residence at
Claremont Nursing and Rehabilitation Center, 1000 Claremont Road. Carlisle. Cumberland County. Pennsvlvania 17013
(List street address, town!city, township, county, state, zip code)
Decedent, then 84 years of age, died on November 4, 2007
1000 Claremont Road. Carlisle. Cumberland County. Pennsylvania 17013
at Claremont Nursing and Rehabilitation Center,
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
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$
$
$
$
2100, O~ . -
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:
S i ature
T ed or rinted name and residence
~
Linda A. Mumper, 57 Red Tank Road, Boiling Springs, P A 17007
Form RW.02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
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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 of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner( s) will well and truly
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administer the estate according to law.
Signature of Personal Representative
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Signature of Personal Representative
File Number:
02/, c20D1- /O(P~
If K A- (Y7 cu ; an .5~ Gard/t.4/'
, Deceased
Estate of Marian L. Gardner
Social Security Number: 209-12-8395 Date of Death: November 4,2007
AND NOW, ~Vf.J~ o.,,7f , <YQO'7, in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters testamentary
are hereby granted to Linda A. Mumper
Executrix
in the above estate
and that the instrument(s) dated August 26,1981
described in the Petition be admitted to probate and filed of record
FEES
Letters
Short Certificate(s) . . . . . . . . $
Renunciation(s) .......... $
fdJ( ...$
~J1-o $
- ;Jr;-' $
$
$
$
$
$
$
TOTAL . . . . . . . . . . . . . . $
Form RW-02 rev. 10./3.06
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Attorney Signature:
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Michael A. Scherer, Esquire
Attorney Name:
Supreme Court I.D. No.: 61974
O'Brien, Baric & Scherer
Address:
19 West South Street
Carlisle, Pennsylvania 17013
Telephone:
(717) 249-6873
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Page 2 of2
HlU),XO:'i REV rOll(r-
LOCAL REGISTRAR'S CERTIFICATION OF DEATH 0 '1-1 o?S
WARNING: It is illegal to duplicate this copy by photostat or photograph.
This is to certify that the information here given
correctly copied from an original Certificate of Deat
duly filed with me as Local Registrar. The origin,
certificate will be forwarded to the State Vit,
Records Office for permanent filing.
Fee for this certificate. $6.0(}
Certification Number
.~#~~~OV/ 6/2007
Local Registrar Date Issued
P 13888072
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H105-143 REV 1112006
l"{PE f PRINT IN
PERMANENT
BlACK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
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Set FaciIlyName (n not instilutioo, !jvestreel and IlllrTber)
Twp. Claremont Nursing and
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Bb. Ccooly of IJeafu
~I . Cumberland
rnoatol Ite.Donotstale
1<>1d~""""J'nclI.olry
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12. Was Decedent 8Y8r in the
U.s. Armed Forces?
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AclualResidsnce 17a.Stale
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11. Oeceden\'s Usua\
KInd aI Work
Homemaker
. 16._,MaIlng-'eslSlr8et.0ly1_,_, zip_I
1000 Claremont Road
Carlisle PA 17013
PA
Cumberland
1lb. County
Middlesex
DOttl".Speci!y.
10. Race: American lillian, Black, While, etc.
(.\l>6cH)1White
Twp.
CftyIBoro
18. F_, ",,",("""-....._1 19.Molhor', ",,",(RlSl._,mOdensumame)
Dais Etter
2Ob. Inlormanfs Mailing AdO'esa (Street, city I kwm, state, ~ COde)
57 Red Tank~ Road Boiling Springs FA 17007
Dc_ 0- 21,.PlllceolllisposiOOnIName~_,""""loIy",_placel 21d.l<>ca""'ICIyII0Wll._,zip_1
,~"=''l\::~~Ov..DNo November 7, 2007 Westminster Mem. Gardens Carlisle FA 17013
22c.NameandAddlessolFaciIty Hoffman-Roth Funeral Home & rematory
Hanover St. Carlisle PA 17013
23b. License Number
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: Onset to Death
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29. 'It Female:
o Noopregnan'_paslY""
o Pnognsntaltime 01 deafu
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Due 10 (or as a cmsequence 01):
28. DId Tobacco Use ContrIbute to Death1
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Enter !he UNDERLYlNG CAUSE
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Due to (or as a ~ence oQ:
Due to (or as a consequence 01):
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at Cause aI Death?
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. Certlfylngpllytlclonl_CO<tilyingcauseol...fu.....__................._""'__2'3)
To the bell of my knowledge, deIIh occurred dlJetothe CIUI8(.)and manner asll8led.. _.................. _..... _............ _......... _......... _ -...... - - _......
. ~~=."'="~:"~:~=IO~,::~~..:._.....1ed.._________________ 0
. =' =~ and/or inveat\gltlon, In my opmlon, death occuned at the time.. _and~, and due to tbecause(S) andmann&l' as slat2d... 0
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. ...Ie. rubl1...nd e.:lare this..'. .a.cl-f_-<<.;::'.:~.f"~.-tJ:.:...:j.""t,;'
hereby revoklns and _~.I YOldalI f-"r...l11. by tile at any .il1ll8
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paid and 8atisfied out of !IY.es.tate by ., personal, repre8entatl.e
hereinafter nallted as' 8000 .s conveniently -",,,,be clonj! after -rel.ceaee.
.SECOIID. I give,.d...t.. and.bfMIu,eeth elJ.:.}CJt:..,-...SUte, 'real and
~\.r~l,;~o,.,. ,h~pand. Andrew!. Gardner "lf 11.ht&~.t....."t~ to
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