HomeMy WebLinkAbout12-03-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CLLYY\ tt:L1 a nJ
COUNTY, PENNSYLVANIA
Estate of
t:Ju./f-<<
r;.. g(}(rl'r
File Number
{)I-O 7- II DO
also known as
, Deceased
Social Security Number ?;J.:J - /6 ~ </.;J .1L
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
u;:? A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated 10 / ;1 ~ /')1 and codicil(s) dated
, (
&."'f"'~ .A- rl X.
named in the
(State relevant circumstances. e.g.. renunciation. death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ,. 41
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(If applicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durant~ iilf;fJlnte) ("") .:.';; F9,
. ::,": CD Ii; i:f~l
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following sp0:u:s6~ny) ar,~Pheirs:'flf'..:::::J
Administration. c.t.a. or d.b.l1.c.t.a., enter date of Will in Section A above and complete list of heirs.) '. -0 -::,-~ ~
n
("")
o B. Grant of Letters of Administration
Name
Relationshi
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(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in d v "" ~.t r ~-i County, Pennsylvania with his / her last principal residence at
'1 '11') H...."h"'~"'.4~ ,~,^.J 1 h /b.- rJIJJ r-
(List street address. townlcity. township. county, state, zi~ code) ,
Decedent, then ,.., ~
years of age, died on II - I ~ tl-")
at
J..-ID "'^ ~
( <11( '1 Hw-''('h ~.J,. "
A~)_
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
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
$ .;)() \ ODO
$
$
$
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:
Signature
T ed or rinted name and residence
/} 0
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ForlllRW02 rev. 10./3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH uF PENNSYLVANIA
COUNT'r'or~
The PetiUI,cneP:, I ahu'. t:-:u:nd ,'.'. e:H!,) (>r ,1 :'flrl11(s) that the statements in the foregoing Petition are true and correct to the best of
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l\1,: Kd(>l,', !ed",c anu bdltOt' of Pditionen S i emu thal, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
:;'/-07-1100
Estateof-WLll1cx- &. -ex,\/t:r
, I
Social Security Number: Y} ~~ -lLP -- 4a qltJ Date ofDeath:-Ll=J - D 1
AND NOW, rd" , f;)O() 1, in consideration of the foregoing Petition, satisfactory proof
havll1g been presented bef~e 1e, IT IS DECREW that Letters y 1)ttlfYlerrlttr~
are hereby granted to '(1 r D \ L-, t:JOYff"
File Number:
Signnture q( Persona! Representative
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Signature oj Per..\'o/w! Representative
, Deceased
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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 Will (and Codicil(s)) of De cede
FEES a
~J..gg
Renunclation(s) .......... $
~ $ 15,00
" " ...$-10.
vna~. , . $ F5.D[b
$
$
$
$
$
Letters .......,.,.".. $
Short Certificate(s) , . . . . . . . $
~J)d 00
TOTAL
FO/'III R W-O] !'ev 10, J 3,06
Attomey Signature:
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Attol1ley Name:
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Address:
Jt(t;y
II~ (
36'//()
Le'll I-"'S~- ~e r
1'",- 11ft) r
Supreme Court l.D. No.:
Telephone:
( 11 '}) C ~ 0 - 0 FJ'"]
Page 2 of2
HI05.805 REV (011071
() I -0"7 - 1(00
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 13988791
Certification 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.
~_ ./J( ~', NOV o/J lOOf
Local RegIstrar" Date Issued
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REV 1112006
I PRINT IN
VlANENT
,CKINK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
5. Age (lasl Birthday)
6. Data of Birth (Month, day, yea~
79
Vrs.
3/7/1928 Harrisburg, PA
ad. Facilily Name I" not insIhufion, give stre&t 8IId rnnnber)
347 Huntington Ave. Enola PA
8b. County 01 Death
Cumberland
most of world lije. Do not slale retired
Kind of Business flnduslry
Conrail
12. Was Decedent ever in the
U.S. Armed Forces?
QgVes ONo
13. Decedenfs Education (Specify only highest grade completed)
Elementary I Secondary (0..12) Coi1ege (1-4 or 5+1
12
. 16. Decedent's Mailing Address (Street. city flown. slale, zip code)
347 Huntington Ave.
Enola PA 17025
18. Father's Name (First, middle, last, suffix)
Harvey L. Boyer
208. Informanfs Name (Type 1 Print)
Carol L. Boyer
21a. Mefhod of Disposition
Decedent's
Actual ReskIence 17a. State
PA
17b. CouIl~
Cumberland
19. Mother's Name (Rrst, middle, maiden surname)
Gertrude Smith
4. Date 01 Death (Month. day:year)
4296 November I, 2007
8a. Place of Dealh (Check only one)
Hospital: Other'
D Inpatient 0 ER I Outpatient 0 DOA 0 Nursing Home IlReSidence
9. Was Decedent of Hispanic Origin? IX! No 0 Yes
(II yes, specify Cuban,
Mell:ican, Puerto Rican, etc.)
OOther. Speci~'
10. Race: American Indian. Black. White. etc.
(Spocifyj
White
14. Marilal status: Married, Never Married,
Wldow9<1, Divorced (Specifyj
Married
Did Decedent
Liveina
Township?
Carol L. Shields
17c.gg Ves,DecedenlLivedin East Pennshoro Twp.
17d. 0 No, Decedent lived within
Actual Umits of
TW\>,
City I Bora
2Ob. Informant's Mailing Address (Street, city I town, stale, zip COde)
347 Huntington Ave. Enola, PA 17025
21 c. Place ot Disposition (Name of cemetery, crematory or other place)
21d.location (City flown. state, zip code)
Woodlawn Memorial Gardens
Lower Paxton Twp. PA17105
22c. Name and Address of Facilily
Richardson Funeral Home Inc. 29 S. Enola Dr. Enola, PA 17025
23c. Date Signed (Month, day, year)
Nov.em be..-- / 2w7
IIems 24.26 must be completed by person
: who pronounces death.
2Ch) 7
I Approximate interval:
I Onset 10 Death
f
f
f
I
I
I
f
f
I
f
I
I
I
I
I
1
=~~~~~~dise~
a.
Ctt-\4.t VL-
Due to (Of as a consequence of):
~~'~~~a.
Enter (he UNDERLYING CAUSE
~~~~~1n~~~
b.
Due to lor as a consequence 01):
c.
Due 10 (or as a COf'lsequence of}:
d.
308. Was an Autopsy
Performed?
3Ob. Were Autopsy Fmdings
AvaHable Prior 10 ~elioo
of Cause of Death?
31. Manner of Death
~lurat D Homicide
o Aoodenl 0 PeMng I_lion
D Suicide D Cou~ No! be Detmned
M.
321. Hra_1ion InJu~ (SpedIy)
DDriYerlOperalor O..ssen9Or 0-",
DOther 0 Specify.
33b. Signature and Tille 0
32g. Location of InjuTy (Street, dty I kIWn, slale)
DVes fJilNo
DYes DNa
32d. TIf08 01 Injury
338. ~ (check only one)
=''':r:::=~=:..':'~''':-=:=:'~;~_ ~~h_~_~~~ ~e~ ~~ _ _ __ _ _ _ _ __ _ _ __ _ _ _ ~ ~
~n:.a~=~~la:C~U=:~:~I~;:~~~~~ot~::c:~ manner as sfatetL __ _........ _........ _...... _ 0
~:~~":'n:r~~= and I or invear/gaflon, In my opinion, lIMIt! occurred at the time, dMe, and place, Ind due to the eaust{l) and manner u stated.. 0
33(:. license Number
!'ADO {
35. Registrar's Signa
~
n;..........itinnP'umitNn
Part 11: Enter other sloniflCllnl condIIions conlnbulina 10 death
but not resulling in the underlying cause given in Part I.
28. Did Tobacco Use Conlribute to Death?
o Ves OProbebly
~No 0 Unkl1OWl1
29. n Female:
o Not pregnant within pasl year
o Pragrtartl 'lllme of death
o Nolprtgnant,butpregnamwithin42days
ofdealh
o Not pregnant, but pregnanl 43 days to 1 year
belore death
o Unknown if pregnant within the past year
32c. Place of Inju~: HOfnO. Ferm, _,, FeclOl'{,
0llIce Bui\d;ng, e~. (SpedIy)
J830 Good Hope Rd. Enola, PA 17025
ARNOLD, SLlliE & BAYLEY
AlTORNEYS ^T L,~W
'2l09 M....RKET STHE>;:T
CAMP HILL,PENNSYLVAli(A 17011
LAST WILL AND TESTAMENT
OF
WALTER G. BOYER
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I, WALTER G. BOYER of East Pennsboro Township,- ~mbe:rf1'>andi--:; n
)f! N t,_' .1 t..~1 "
County, Pennsylvania, declare this to be my Last Will and C)
Testament, hereby revoking any will previously made by me.
I - I direct the payment of all my just debts and
funeral expenses out of my estate as soon as may be practical
after my death.
II - I devise and bequeath all of my estate of whatever
nature and wherever situate unto my wife, Carol L. Boyer.
III - Should my said wife predecease me, then I
devise and bequeath all of my estate of every nature and where-
soever situate unto my issue per stirpes.
IV - I appoint my wife, Carol L Boyer, Executrix of
this, my Last Will and Testament. Should my said wife fail to
qualify or cease to act as such, then I appoint Dauphin Deposit
Bank and Trust Company, Harrisburg, Pa., to act in this capacity.
Neither of my personal representatives shall be required to
post bond in this or any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
on this, the
19n1
(J t;rfJ/'k't
, 1979.
day of
/"' '
'l H- \ 9-.-. if) i
t, (:\"J..A~..}...1 .-/ ,9 "",,'J~ ,(.f\)
l/\Tal ter G. B yer
l
(SEAL)
Page 1
ARNOLD, SLIKE & BAYLEY
A1TORNEYS AT LAW
CAMP HILL, PeNNSYLVANIA 17011
Signed, sealed, published and declared by WALTER G. BOYER, Tes-
tator therein named, on this and one (1) other sheet of paper
as and for his Last Will and Testament in our presence, who, in
his presence, at his request and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
9~ I~ a.-..~~
Name
C~.h'~j IPr
Address
ZAP- N'i.
All;;
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1~1( JQ 4.1!rw
1 ' Address
Page 2
ARNOLD, SlIKE & BAYLEY
ATTORNEYS AT LAW
2109 MARKET STREET
CAMP Hill. PENNSYlVANIA 17011
COMMONWEALTH OF PENNSYLVANIA)
55.
COUNTY
CUMBERLAND)
OF'
I, WALTER G. BOYER , the testat or whose name is signed
to the attached or foregoing instrument, having been duly quali-
fied according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will: that I signed it will-
ingly: and that I signed it as my free and voluntary act for the
purposes therein expressed.
of
Sworn or affirmed to and acknowledged before me, by
WALTER G. BOYER, the testat or this _ 29>>1- day
October , 19~.
>-iU~ // A ~I
v NO~ry Public
.Thelm~ S. McCauslin, Not;V p~'"
~MY ton;;"'!:'"il txjlires Juiv 1, 1980
ClImp ~:ja, PA Cumberland Counlf
COMMONWEALTH OF PENNSYLVANIA)
55.
COUNTY
CUMBERLAND)
OF
WE, the undersigned,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose a~d
say that we were present and saw the testator sign and execute
the instrument as his Last Will: that WALTER G. BOYER
signed willingly and that WALTER G. BOYER executed it
as his free and voluntary act for the purposes therein expressed:
that each of us, in the hearing and sight of the testat or signed
the will as witnesses: and that to the best of our knowledge the
testa~r was at that time 18 or more years of age, of sound mind
and under no constraint or undue influence.
9 A...J,) ~---"'-f
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Sworn to and subscribed before me
this l~ day of October , 19-19
" \
~/~/h~~)
tjOtary Public
,. ..,
:Yhelma S. M..r~~fs1in, Nota,,~Jil:
~. My (om:: L:;~ L 1980
Camp ilia, PA tumberlund Coun"