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PETITION FOR PROBATE AND GRANT OF IIETTERS
REGISTER OF WILLS OF tV;lV} het tH~ J COUNTY, PENNSYL V ANL\
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Estate of Ik~1/l:7/~ (~ /Ji'#y~
also known as
, Deceased
File Number -d-l- 08- 00 l L{
Social Security Number /6 ~ - / Z, - ') ~ It ~
Petitioner(s'l, who is!~re [8 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
~~. Probate and Grant of Letters Testam n ar and aver that Petitioner(s) is I are the C '(. (I ;) --; 0 f..-
last Will of the Decedent dated N () J I t and codicil(s) dated IV j ~
named in the
~
(State relevant circumstances, e.g., renunciation, death of executor, etc.) 2 ~
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Except as follows, Decedent did not many, was not divorced, and did not have a child born or adopted after execution oft~f~..ument(sF4tfered ....
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: . ';'} ~ ~ ;::; .' .'
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(lfapplicable, enter: c.t.a.; d.b.n.c.t.a.: pendente lite; durante absentia: durante l1Iifl~i'tiii€)
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by tJ:le following spouse (gany) and heiWi (If
Admillistration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) . W
o B. Grant of Letters of Administration
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Name
Relationship
Residence
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years of age, died on T#... (... 2 cafat
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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
(l f not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
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$ /.,to/)
$
$
$
situated as follows:
Wherefore, Petitiuner{s) respectfully requestls) 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:
Ty ed or rinted name and residence
51 r OWL 8~1 OGe t:I fI1lt()l5\1,L~ f4
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For/ll RW-02 rev. /0.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF L \Jyy,\\JQ (\0. nd
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The Petitioner(s) above~named swear(s) or affirm(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
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administer the estate according to law,
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Signature ofP<!'fSOnal Representative ,
Sworn to or ~ffirmed and subscribed
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'before me th.e' Ot " day of
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(jonHiJp LI~~
F or the Rister
Signature of Personal Representative
Signature of Personal Representative
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Social Security Number: Date ofDeath:~ - \ - 0 ~i;::::'t ( n
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AND NOW, ~~ riCx.j dCU1LD..r\ / ,JooX, in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECRiED that Letters I~S ta Yl/l.ln40. r"J
are hereby granted to GtA \" '1 L I'-.AC\,X ~
File Number: /) I ' CJ t - 007 L-l
Estateof~ n-Y\1 ~><l^--'l.LU
C-) (--)
, -~ "",
, Dece~1(ed I
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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 Decedent.
Letters ..........FE~S $ ()OOO ~[\cM1 oa~~~t~~
Short Certificate(s) . . , . . . . . $ 1:;J, OU Attorney Signature:
-Rl;,llullcianonCs) .W.l',ll... $ 16. aU
Jh.tOHYLi-hO)\ ::::~'~
.. , $
... $
.. . $
.. . $
... $
... $
Attorney Name:
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Supreme Court J.D, No.:
Address:
Telephone:
... $ D
TOTAL.. .. . .. .. .. . .. $ Lo~ .(
Form RW-02 rev. 10,13.06
Page 2 of2
,05.805 REV (01107)
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
ee for this certificate, $6.00
P 13991625
Certification Number
criMI ? ..f'
SHOULD RBAO AS rot tOWS-
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This is to certify that the information here given
correctly copied from an original Certificate of Dea
duly filed with me as Local Registrar. The origin
certificate will be forwarded to the State Vit
Records Office for permanent filing.
/? m~ JANnSZUl
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Local Registrar Date Issued
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
;EV 1112006
'RINTIN
ANENT
:K INK
1. Name of Decedent (Forst. middle. last. sullix)
6. Da\e 01 Birth (Monltl. day, year)
Nov.13,1921
17a. State
PennsYlvania
Cumberland
208 Senate
Cam Hill,
18. Falhe(s Name (Firs!, midde. last. suffix)
17b. Coonly
STATE FILE NUMBER
14. Marital Slatus: Married. Never Married,
Widowed. Divorced (Specify)
ivorced
Did Decedent
Uve in a 17c. ~ Ves. Decedent Uv.. ad ill E a s t
Township?
17d. No. Decedent Uved wilhin
Actual Umits of
Pennsboro
Twp.
City I Bora
Joseph Henry Weirich
Gary L. Maxwell
19. Mother's Name (First. mlddte, maiden surname)
Dais Shue
20b Informant's MaUing Addtess (Streel, city I town. state, zip code)
315 Owl Bridge Rd.,Millersville,PA 17551
208. Informant's Name (Type I Print)
21C. Place of Disposiliof1lName of cemetery. crematory or otller place)
Hollinger Crematory
210. Locatioo (City 11own, state. zip code}? A
Mt.Holly Springs
220. Name and AddreSs of Facility
Musselman FH&CS,324 Hummel Ave.,Lemoyne,PA17043
~=~.[:\-=
I Approximate interval:
I Onset to Death
I
I
.
I
I
I
I
=~a:e~~'~~a
Enter ll1e UNDERLYING CAUSE
(cis8ase or if)jlry !hat ilitiatad II1e
events resuItii'9 In deatl1) LAST.
b.
d.
308. Was an A1A0IlSY :lOb. Were A1A0IlSY Findings
Plll1ormed! Available Prior to Completion
of Cause at Death?
Dves P!No Dves D No
31. Manner of Death
Q!l Nalural D Homicide
D Acticlenl 0 Peodng Invastigatioo
o Suicide D CooJd Not be Determined
M.
32d. Tima of Injury
330. CeIti1ier IcI1eck ortv onel
CertIfyIng physiciIn (PI1ysiciaIl c9f1itying cause 01 death whan anothet' physician has pronounced death and oompIelad lIem Zl)
To \he bell of my tmowledge, delIlIt oceurrwd due to \he causo(s) and "",nil<< IS slated- ~ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - - - - ~ -
=~r-;::::'~~:; :ti~;~.:r:"'tot~=~~~ manner as slalod.. _ ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
. = =sm~~= and I Of investigation, In my opinion, death occurred at \he lime. dale, and place, and due to the "usels) Ind manner IS stated- D
35. Registrar's SignatUll!
~
~I/I '-t/l/l
23b. License NUlT'ber
2&. Date Signed (Month. day. yearl
26. Was Casa Referred to Medical Examiner I Coronar lor a Reason Olller than Cremation or Donation?
Dyes DNa
Part II: Enter other sim1ificant oonditions contributino 10 death,
but not resultiog in tile underlying cause givoo in Part I
01 pregnant IY1thin pasl year
o Pregnant at time 01 death
o Not pregnanl, but pregnant wilhin 42 days
of death
o Not pregnant, but pregnant 43 days to 1 year
b<llore daeth
o Unknown if pl9gl8Ill within the paSI year
32c. Place Of Injury: Home. Fann. Street. FactOly.
Office Building. etc. (Specify)
32g. Location of Injury (Street. oily I town, state)
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L.J\ST'WILL .JtND T'ESTXM.'ENT
I, KATHERINE LOUISE MAXWEll, of Camp Hill, Cumberland County, Pennsylvania,
declare this instrument to be my last will and testament, hereby expressly revoking all wills and
codicils heretofore made by me.
ONE I direct my execfi~o pay all of my debts, funeral and administrative
expenses as soon as may be done conveniently after my decease.
TWO I authorize and empower my personal representative to sell any realty.
and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at
public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in
fee simple, as I could do if living. My representative is authorized and empowered to engage in
any business in which I may be engaged at my death, for such period of time after my death as
seems expedient to said representative.
THREE
I give, devise and bequeath all of my estate, of every nature and wherever
situate to my son Gary L. Maxwell, and if Gary L. Maxwell predeceases me, the child or children
of my son Gary L. Maxwell, taking the share their parent would have taken if living.
FOUR If the gift in paragraph three does not take effect, then I give, devise and ~-.;!
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bequeath all of my estate, of every nature and wherever situate to my remaining childj~share ~
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and share alike, the child or children of any deceased child taking the share their parent would
have taken if living.
FIVE
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I nominate and appoint Gary L. Maxwell to be the executrirof this my last
will and testament; to serve as such without bond.
SIX I hereby suggest that my personal representatives retain the services of
Irwin, Irwin & McKnight as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this I~
November, 1993.
day of
~~-'... ~7JJ~SEAL)
KATHERINE LOUISE LL
Signed, sealed, published and declared by Katherine Louise Maxwell, the testatrix above-
named, as and for her last will and testament, in the presence of us, who, at her request, in her
presence and in the presence of each other have subscribed our names as witnesses hereto.
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C~1F~ &~ot
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ACKNOWLEDGMENT AND AFFIDA VIT
WE, KATHERINE L. MAXWELL, SHARON L. SCHWALM and CHERYL L.
CLELAND, the testatrix and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testatrix signed and executed the instrument as her last will and that she had signed willingly, and
that she executed it as her free and voluntary act for the purpose herein expressed, and that each
of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that
to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of
sound mind and under no constraint or undue influence.
~~~
THERINE L. MAXWELL
~~~4X. d,kJ,~~--/
SHARON L. SCHWALM
e~/;(:~
CHE~ L. CLELAND --
COMMONWEALTH OF PENNSYLVANIA :
:ss:
COUNTY OF CUMBERLAND
:
Subscribed, sworn to and acknowledged before me by KATHERINE L. MAXWELL,
the testatrix herein, and subscribed and sworn to before me by SHARON L. SCHWALM and
CHERYL L. CLELAND, witnesses, this ~ day of November, 1993.
3cL
Notary
Notarial Seal
r 8. Irwin, Notary Public
Ca Is,e 8oro, Cumber1and County
My Commission Expires Oct 3, 1996
em/;;IQr, PQnn.ylvania As.mation of Notaries
2