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PETITION FOR PROBi\ TE AND GRANT OF I.JETTERS
REGISTER OF 'vVILLS OF C() .A16e:../('--^NtJ
COUNTY, PENNSYL V Al\L\
Estate of L.. U 7 HeR- P: C~l 7c 4/ e'l Jt<.....
also known as .((J U C tel rc4 / e 1
File Number
~\ - 0'0 -OOtJO
, Deceased
Social Security Number
Petitioner(sl, who IS are 18 years of age or older, apply(ies) for:
(COMPLETE '..j' or '8' BELOW:)
~ Probate and Grant of Letters Testamentary and aver that Petitioner(@ are the
last Will of the Decedent dated and codicil(s) dated I X
Z'"xecuTRlX
:J4f\/ (7~ ~
named in the
(State relevant circullIstances. e.g.. renuncialion. death of executor. etc.)
f"'-- ,.
Except as fol!ows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution(p~the instrumetil(:s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: . ~. q ,.;~
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o B. Grant of Letters of Administration
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(If applicable. enter: c.I.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante ili(1l9citate)
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spou.S:e (it any) ariti heirs: (If
Admillislration. c.t.a. or d.b.n.c.t.a.. enter date of Will ill Section A above and complete list of heirs.) '. ~~ 6
i
........ .
Name
Relationship
Residence
County, P;..nnsylvania with his / her last principal residence at
0..--0 ~vI16cYl~.o
7/'/ SifMJE
Decedent, then g .s-
years of age, died on JAtJ .s; 1..00cg at G:' 2.. ( AM.
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) AI! personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
$ 730, () 0 0
$
$
$ G:. 0, (100
79! (()(')
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate dicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
rinted name and residence
1& Cur1/'s b r.
t-as1 WI/VI
173j~
Forlll RW-02 reI'. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
SS
COUNTY OF Q U(V,t):> r lQI'Xj
The Petitioner(s) above-named swear(s) or affim1(s) that the statements in the foregoing Petition are true and conect 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 affirrriE;d anet subscribed
before me the I 0 " h day of
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Signature of Personal Representative
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Signature of PersOl I Representative
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Signature of Personal Representative
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File Number: (-!it - () 1$ - (J G ~ ~
Estate of L\J -\ n.Q r f. C \ \ -tch u. ~ c) ~ . , Deceased
Social Security Number: ~ Date of Death: l - 8- .'] 00 'K
AND NOW, IOIr clC~/ (~ jo I'ltJO- rv ' >>00 ~~ _' in consideration of~1e foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters 0-..-\ ,-D. f / l r ~~ 'LQ'2> T-d V,/LQ.. (\ -\-Cl. r ...../
are hereby granted to (' \ \ Q. f'l ( C, ~ i r\ \ p::; CIY, I
i'n 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)) ofDecectent.
-bf A II (I.,(}( cl a {"'VI lrIll2:h bU_D8t1 ..
Register of Wills .J-t t' e,'k ~ ~ J a ',,\ (7(1 'r~.)
, \.,
FEES
Letters ............... $ f) ( 0 D . (') ()
Short Certificate(s) . . . . . . . . $ L-{ 0 . 0 (j
Renunciation(s) .......... $
~JJI\\ ..,$
*f~~ IWi tJ 0I"l :: :
.. . $
. .. $
... $
... $
.. . $
.., $
TOTAL.............. $ Lo?-JO .00
Attorney Signature:
15 UU
10.06
f5 () ()
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Form R W02 rev. /0./3.06
Page 2 of2
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 13991900
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.
,'ee for this certificate. 56.00
Certification Number
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C)
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lEV 1112006
PRINT IN
ANENT
;K INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
Ul
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STATE FILE NUMBER
12. Was Decedent ever in the
U.S. Armed Forces?
~Yes ONo
Decedent's
Actual Residence 17a. State
-03
4. Date of Death (Month, day, year)
1662 Jan.5,2008
1. Name of Decedent (First. middle, last, suffix)
Feb.15,1922
Lemoyne,PA
Other:
o Inpatient 0 ER I Outpatient OoOA t2g Nursing Home 0 Residence 0 Other - Specify:
9 ~~~~es:~~t~~~~nic Origin? ~NO 0 Ves 10 ~;~:;,~merican Indian, Black, WMe, etc
Mexican, Puerto Rican, etc.) W hit e
8d. Facility Name (If not inst~ution, gIVe street and number)
Messiah Village
13. Decedenfs Education (SpecIfy onty highest grade completed)
Elementary I Secondary (0-12) College (1-4 or 5+)
12
14. Marital Status: Married, Never Married,
Widowed, Divorced (SpecifY!
widowed
17b. County
Pennsylvani3.
Cumberland
Did Decedent
Live in a 17c~es, Decedent Uved in (J p p "" r
Township? 17d. 0 No, Decedent Uved within
Actual Um~s of
'All ""n
Twp.
City/Boro
Luther F. Critchley
Cheryl Simpson
19. Mother's Name (RIllt,. middle, maiden sumame)
L3.ura Wri~htstone
2Ob. Informant's Mailing Address (Street. city Ilown, slate, zip code)
76 Curtis Dr., East Berlin,
PA 17316
21 b. Date of Dispos~ion (Month, day, year)
21 c. Place of Dispos~ion (Name 01 cemelery, crematory or olher place)
Rolling Green Cern.
21 d. Localion ICity I town, slate, zip code)
Camp Hill,PA17011
22c. Name at1d Address of Facility
Musselman FH&CS,324 Hummel Ave.,Lemoyne,PA17043
23b. License Number
230. Date Signed IMonth. day, year)
:Jlla.~.
2S. Dale Pronounced Dead (Monlh, day, year)
M .J"".5. ,;{OlJ[;
26. Was Case Referred to Medical Examiner f Coroner lor a Reason Other than Cremalion or Donalion?
OVes ~
CAUSE OF DEATH (See Instructions and examples)
Item 27. Pan I: Enler the ~ - diseases, injuries, or complications - lhat directty caused lhe death. 00 NOT enter terminal events such as cardiac arrest,
respiratory arrest, or ventricular fibrillation without showing the etiology. List only one cause on each line
I Approximate interval'
: Onset to Death
I
Part II: Enter olher sianificant conditions contribution to death,
but not resulbng in the underlying cause given in Parll
OVes ONo
31. Mayer.o. 1 Death
~ra) 0 Homicide
o Accident 0 Pending Invastlgation
o Suicide 0 Couid NOI be Determined
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i~s
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28. Did Tobacco Use Contribute 10 Death?
o VBS 0 Probably
o No 0 Unknown
29. It Female:
o Not pregnant within past year
o Pregnant at time of dealll
o Not pregnanl, but pregnant wilhin 42 days
01 dealh
o Not pregnant, but pregnant 43 days to 1 year
belore death
o Unknown if pregnanl wnhin the paSI year
32c. Place of Injury: Home, Farm, Street. Faclory,
OffICe Building, etc. (Specify)
Sequenlially list conditions, If any,
~~~~\h:,o JND"E~t~irbru~E a.
(t:lsease Of injury that initiated lIle
events resulting In dealll) LAST.
CftrlOJPL Mnor
b. DWitAL~ence~ Dt)~
Due to (or as a coosequence on:
=~f:;;'J:n~~; ~~~I) lOse:;.
Due to (or as a consequence of)
308. Was an Autopsy
Periormed'
3Ob. Were Autopsy Rndings
Available Prior to Completion
01 Cause 01 Death?
o Yes ~
32d. Time 01 Injury
330. Certifier (check only one)
. CertIfying physiclan (PhysiciaJ1 certifying cause 01 death when another physician has .pronounced daath and completed Item 23) .J71
To the best 01 my knowledge, death occurred due to the cause{s) and manner as statecL - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r"'"
~==~,~~ =~:~:::c~:~:a; :1t1"~~n;n:~~~~~~:i::':~~~~~ manner ae statecL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
Medical Examiner I Coroner
On the basis of examination and I or investigation_ in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as statecL 0
I v11 II ~I /1/
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3300 ~oout( 6~ L 33d Da~e 7; ~ntt'y, year)
34R"t~~ ofW jtff'fl ~;' oo;temtp tJtf"rOUPOIJPtMH'r (2-DAP /
n lJ lM' 'lJfJ-
Disposition Penmlt No.
00 q 3 71;, 9
LAST WILL AND TESTAMENT
OF
LUTHER F. CRITCHLEY
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I, LUTHER F. CRITCHLEY of the Borough of Lemoyne, cum~;~aand 9
en
County, Pennsylvania, declare this to be my Last Will and Testameet,
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 children, Cheryl Simpson and
Craig Critchley, the share of a deceased child to be paid to his or
her issue per stirpes.
III - I appoint my daughter, Cheryl Simpson, Executrix of
this, my Last Will and Testament. Should my said daughter fail to
qualify or cease to act as such, then I appoint my son, Craig
Critchley, to act in this capacity. Neither of my personal represen-
tatives shall be required to post bond in this or any jurisdiction.
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Page 1
ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 17011
IN WITNESS
I f? 71J,.
WHEREOF~.I.have. hereunto
day of iA...cL"i/V'ij
I
! .
set my hand and seal on this
, 1988.
the
~.~ -{ ~.~ J
,j ~Z-u?/y- -7: ,,-c--~
~ Luther F. critch~
(SEAL)
Signed, sealed, published and declared by LUTHER F. CRITCHLEY, Testator
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 oi each other, have hereunto subscribed au
names as attesting witnesses.
~~ p~
/ / Name
L'/
C dh~r tI-<-Lf; ~~ -
Address
tw~ ~~
1'1~ -I&..
Ad~'S
Name
ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 17011
CO~iMONWEALTH OF PENNSYLVANIA)
SSe
COUNTY
OF
CUMBERLAND)
WE, the undersigned, the testator and the witnesses, respectively,
whose names are signed to the foregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the testator
signed and executed the instrument as his Last Will and Testament and
that he signed willingly (or willingly directed another to sign for
him), and that he executed it as his free will and voluntary act for
the purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the testator signed the will as witnesses and
that to the best of their knowledge the testator was at that time
eighteen years of age or older, of sound mind, and under no constraint
or undue influence.
". ~..
. ~.z-Led 9 .:G-~
~ Test tor
~ [) JL-4L
" '~i tness
&
l l..-~Q~J t0U~~
Witness
and
day
ribed, sworn to and acknowledged before me by the test~~~
c ibed and sworn to beyore me by both witnesses, this / 7~
-:- l-&I....A-LL , 1 9 8 X- .
>ic~J J d~~
'Notary Public
THELMA S. McCAUSLIN, NOTARY PUBlIC
My CommissIon Expires July 3. 1988
Camp Hill, PA Cumberland Count,
ARNOLD & SLIKE. ATTORSEYS-AT-Lr\W, 21f1'l \1/\RKET STRUT, r:AMP HILL, P\ 17f1! 1