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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF cUMERLAND
COUNTY, PENNSYLVANIA
Estate of FLORIBERT ALLEN FRERE
also known as
File Number ;< / - O~ ,()1Q cj
, Deceased
Social Security Number 200-42-3776
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE~' 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 codicil(s) dated
named in the
(State relevant circumstances, e.g., renunciation, death of executor, etc.) 0 ~.::;
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution~~instrum~S) offered
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person: . .. . ~ ~J -c;;
IZJ B. Grant of Letters of Administration C.T.A.; (~:~ 22 c6
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; dur~~ ritate~
) c-: __!f>~
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the fOllowing,~~e (if any~d 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.) ):'> .;...:..
-
I Name Relationshio Residence I
ZACHARY A. FRERE SON 1160 NORTH MIDDLETON RD CARLISLE PA 17013
LUCETTE I. FRERE SPOUSE 12201 GLENLIVET WAY, RALEIGH NC 27613
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his / her last principal residence at
95 FANUS ROAD. GARDNERS. SOUTH MIDDLETON TOWNSHIP. GARDNERS. PENNSYLVANIA 17324
(List street address, town/city, township, county, state, zip code)
Decedent, then 56 years of age, died on DECEMBER 4, 2007
CARLISLE. PENNSYLVANIA 17013
at CARLISLE REGIONAL MEDICAL CENTER,
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(lfnot domiciled in PA) Personal property in County
Value ofrea1 estate in Pennsylvania
16,000.00
$
$
$
$
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:
T or rinted name and residence
ASHELEY N. ROTZ, 1107 PHEASANT DRIVE N., CARLISLE PA 17013
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH 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 ofPetitioner(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 ~ day of
c::~.Yi\ Signature of Personal Representative
~r\
Fo, the Regi,re, ~ ~gM_ ,"Pm",.} "pmm"',",
File Number: 6/ J -OR' - ()ocJ1
Estate of FLORIBERT ALLEN FRERE
, Deceased
AND NOW,
having been present
are hereby granted to
Date of Death: 12/04/2007
'>3' in consideration ofthe foregoing Petition, satisfactory proof
OF ADMINISTRATION C.T.A.
in the above estate
and that the instrument(s) dated NOVEMBER 23, 1999
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
Letters
$
60.00
8.00
10.00
10.00
1 .~
Attorney Name:
, ESQUIRE
. ,\ at-
~?r
FEES
Short Certificate(s) . . . . . . .. $
Renunciation(s) .......... $
JCP ... $
AUTOMATION FEE ... $
W j Ii... $ 15. (}J
... $
... $
.. . $
... $
...$
... $
TOTAL .............. $
t
Attorney Signature:
5.00
Supreme Court I.D. No.: 6282
Address:
60 WEST POMFRET STREET
CARLISLE, PA 17013
Telephone:
(717) 249-2353
93.00
15 t.o
-
fOg .00
Form RW-02 rev. 10.13.06
Page 2 of2
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OF
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I,F'~'"JO~I.~L+:-<~' ,1.LL~I-:r F .~.'.~, a r0,~id;3nt of Ga:"d.ner.:-,, CUJlberla"'1d County, P~.
bein/:: of sOi.J.nd min!3~t memory :md unc1eI';~'t~:-nding d.o here1)~l ms....'ke and declare
th:i s to ~e
r~2r
L&,;t '\rJill and
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t r~,r:l8n t.
Item 1: I direct :.: t all ~'r.y ju.::t d,.:.bL;, the exp:C'!1ses of my la~,t illne;-;
2x:d .c"uc:' 1 e:-cpen..: cC be paid L1C .:3oon aft"r my d -.;cea,:.0 as can convcwien tly
be one.
"rere p rovid ..;c;
';hey
:~lt:r'7i ve
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.Jlould
one be
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I d~tffct th<::."6 his
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mixed
Item 2: I '"ive, (:Vir'd 3"d ,Q.CJ.ueath all my u::tr:.te, real
in equal 811'8 to ny children, A::,:'heley Nicole Frer-.; iJnd
or her ~h~re be g~ven to the survivor.
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To :~-;i~
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:.:end
Te;.;t ,ment I
sign
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~-i 'nee, 2s,'1.1.0(:. (J.nG declar~;' by ?"~OEIB-,-,-T:rr LLd.r Y.. ...c" .. for b.i.b L2i.J: '~'lill {~nd
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f!o ~',,~/;J full
'.is reque,ot u-s
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Kovember 20, 1999AL
NOT.L 8!A1.
lOR' A. GAR"!R, NoIaty PIMII
CeftIete I!loro, Cumbetblld County, PA
My eo"......." IbplNe _14. 2001
TlW tM ~3fd f-6
. NOU1mbvu /q91
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Certification Number
This is to certify that the information here given is
correqly 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.
Fee for this certificate, $6.00
P 13888558
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H105-143 REV 11f2006
TYPE I 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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STATE FILE NUMBER
CLlnberland
<t. Dale of Death (Month, day, year)
12/4/2007
1. Name of Oecedent (FIrIl, nIdlJe, lest. 8ufflll:)
F. Allen Frere
5. Age I..... B;rthday}
6. Date ofBlrlh (Monlh, day, year)
7._1
OIhec
l .
56 Yo.
Bb. County or Death
11/17/1951 Natrona Heights, PA
&d. FacIlity Name (II not i1stitutlon, give slIM! and number)
OOIhe'-Specily'
10. Race: American tncII8n, BIsek, WIllie, ele.
1-
White
11. Decedent's Usual tion Knd 01 work done d
KlndolWol1c
Lal::crer
moslof Mle. Do no! illte f9tirecl
Kiod~_I_
Vectron Intern.
12. Was Decedenl8Vllr In the
u.s. Armed Forces?
o Y.. [>>No
_.
Actual ResIdence 17a. Slate
'lb. County
13. OecedenI's Education (~only highest grade oompieted)
E1emen12 Secondary (0-12) College (1-4 Of 5+)
. 16. Decedent's Mailing Address (Stree~ city ftown, stale, ~ code)
95 Fanus Rd.
. Gardners, PA 17324
1& Father's NIme (First, middle, last, suIIIx)
Floribert A. Frere
PA
Cumberland
14. Merllal SlaIU8: MarrIed, Never Married,
w_. Olvon:ed 1_
Married
Did Decedent
Uvelna
Towns~?
170.1:81 Yes. _, Uved"
17d.D No,Decedllntl..Nedwlthin
ActueIlinitsof
Top.
City/Boto
208.. Informant's Name (Type I Print)
19 "Crn:OOIA"'J~' P~ter~
2Ill. Informant's Mailing Address (Street, cIly f town, stile, ~ code)
1107 Pheasant Dr. North, Carlisle, PA 17013
21d.locI1iooIC",,-,,_.,,"',de} PA
, Olmb. Count
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:
Inc. Carlisle PA 17013
23b. Ucense Nun'tler
23c. Dale Signed (Month, day, year)
c:;. .- Q() f. M.
Ilems 24-26 mwl be completed by person
whopronounceadealh.
24. TIme of Death
DYes DNa
31. Manner of 0e81tl
~"'" D-
O-O_'....Ugsllon
Os."", DCooidNolbeOolomlined
26. Was Case Referred ~I Examiner I Coroner for e Aleson Other than Cremation or Oonatlon?
o Y.. Bfio
Part II: Enltrotherslanlllcanlcordllonscontribullnl:llodMth, 28.~UaeContrbuletoDeath?
bu1""_"~._ngCllUMgiven.PaI1r. .l6Yes OP-
DNa OU-
29. If Female:
ONol~wIlNn....'yeer
o Pregnantllllmeofdealh
ONolP_,""Pf09'l8~_42"ys
ol-
D NoIpnlgnlll1l.""_43dayslolyeer
belore_
D Unknown'__tIepeelyeer
32c.=~I=::;~jSlJHt,FacIory,
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CAUSE OF DEATH (See InetructIona .ncI exemplee)
!18m 27. Part I: Enlerthe~-clseMea, injurtea,orcompllcaltons lhItclr9clly caused Ihe deall. 00 NOTenlertemlinallYlll'llssuchascardacerrest,
~arrest,orvenlrtcularlbillatlonwilhoutshowlngtheetiology.Listonlyonecauseon88Chlne.
I Approltmalelnterval:
: OnsettoDeath
,
,
a. r.dUIJIA-L- ~5" !)v8 n 6Mr.{>Wl-'7.M..'"6Q 01l;:.~ /VlUVli
Oueto (or as a llOf'IS8(JJtr'lof): I
b. ,.....r" cl'~~".c (t-A7'AVtfc:..lf",- U+r16-~~ + ,,/o/~
DU8to(or8Sa~of): :
ff'-Il';:""'~f, .vv :
Due to (or 8& a consequence of): :
,
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=:tlllce::='~~a.
_.. UNIlERLYIlQ CAUSE
=:a~a:...'1mr~
d.
:.11. WII an AliopBy
P-
DYes ~
3Ob._AulopsyA_
AvaWlIt Prior 10 CompIItion
01 Cal8 of Death?
32d. TIne 01 Injury
32g. localIonoftnjlHy (StreeI,clty/town,slel8)
M.
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33lo.ee.tfiaIlcllackoolyona}
Certlfytng physIdan (Physician certilying ClIUII of dMth when another physlcian Au proncu\C8d death and compIeteclltem 23)
To" bill of my knowledge, ct.th occunwd due lotht C8U1A(a) and IIlanoef. staWcL...... _.......... _............................................
Pronoundnt and certifytng phy**' lPhyslclen both prtlIlllOOCing death end certifying to cauee of deaIh) "t7t
To the bell of my knowtedga, deIth OCCUnH III thttlme, date. and pI&ce. end dill to the ceuse(I' end 11\II'IfIII''' stIIIed.......... -.. -.......... -........ rr
::- =n:.= Md lor InvelItlgetion.ln my optnlon, dNth occurred al ttle lime, date, and pltlce, and dull to the CllUae(.) and manner.. stilled.. D
33cI. Date SIgned (Month, day, yee.r)
I ].,( )" ( rr
35.
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34. Name and Address of Pemon Who Completed Cause of Oealh (Item 27) Type I Print
7)/.!rv,1l )f.dW/V ~AVVC/l'rU
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Dlspos/lion PermH No.
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
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Estate of FLORIBERT ALLEN FRERE
m
, qweased
I, ZACHARY A. FRERE
(Print Name)
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
SON
administer the Estate of the Decedent and respectfully request that Letters be issued to
ASHELEY N. ROTZ
(City. State. Zip)
DECEMBER 31,2007
(Date)
Executed in Register's Office
Sworn to or affIrmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certifIed
that he or she executed the renunciayon for the
~. o~ssm~ @y.
,Of 2: '. .
/f.k..-I -
N ry Public ---
My Commission Expires:
Deputy for Register of Wills
(Signature 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
Karen S. Noel, Notary Public
Carlisle Bom Cumberland County
My Commission Expires Dec. 8, 2011
Member, Pennsylvania Association of Notaries
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
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Estate of FLORIBERT ALLEN FRERE
m
~
, Deceased
I, LUCETTE I. FRERE
(Print Name)
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
WIFE
administer the Estate of the Decedent and respectfully request that Letters be issued to
ASHELEY N. ROTZ
DECEMBER 31,2007
(Date)
~tJ~
12201 GLENLIVET WAY
(Street Address)
RALEIGH NC 27613
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunc~a~ for the
p es stated within on this ~I . day
of . . , 'XJtJi .
Deputy for Register of Wills
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev, JO.n06
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Karen S. Noel, Notary jJu!""
Carlisle Bol"O, eumbeliand COli,Pry
My Commission Expires Oec. 8, 2011 .
Member, Pennsylvania Association of Notaries