HomeMy WebLinkAbout01-30-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
File Number 21-08- 0 I o.s
Estate of Jean C. Patton
also known as
, Deceased
Social Security Number
191-12-2709
David E. Patton
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELDIN:)
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.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted atler execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
00 B. Grant of Letters of Administration
(If applicable, enter: cf.a., d.b.n.c.t.a., pedente liIe; durante absentia; durante mmontate)
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 d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
I Name Relationship Residence I
David E. Patton Son 5905 Westover Drive
Mechanicsburg, PA 17050
Edward K. Patton Son 4832 Bass Point Road
Orlando. FL 32820
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his / her last principal residen~l:-~,)
417 Parks ide Road, Camp Hill, East Pennsboro, Cumberland, PA 17011 ' : 23
(List street address, town/city, township, county, state, zip code) ',:: ;-l
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84 years of age, died on 01/13/2008
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Decedent, then
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Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
situated as follows: 417 P.arkside Road, East Pennsboro Township
$
$
$
$
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<B,900.00~)
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145,000.00
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
'/..
Typed or printed name and residence
5~05 Westover Drive
ech icsburg, PA 17055
Form RW-02 Rev. 10-13-2006
Copyright (c) 2006 form software only The Lackner Group, Inc.
Page 1 of 2
Oath of Personal Representative
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COMMONWEALTH OF PENNSYLVANIA
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
administer the estate according to law.
Sworn to or affirmed and subscribed
before me this~-1I--' . day of
~:IiJz7 Fe? /- / --~
Sign ure of Personal Representative David E. Patton
Signature of Personal Representative
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Signature of Personal Representative
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File Number:
21-08- ()IOS-
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Estate of Jean C. Patton
AlKJA
Social Security Number: 191-12-2709
AND NOW, ~ """"'%: ?:o
having been presente efore me, IT IS DECREED that Letters
, Deceased
Date of Death: 01/13/2008
d-oo~/
, ...
, in consideration of the foregoing Petition, satisfactory proof
of Administration
are hereby granted to David E. Patton
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filled of record as the last Will (and Codicil(s)) of Decedent.
Short Certificate(s)
............ $
$ Q100 ,~
c20 . <.)U
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Attorney Signature:
cJ1~U1(k.. ShVc.QA ,.~-J''(ll ,~
RegIster of Wills
M-fAA 7,/5 _J
Michael L. Bangs j/
~dcl
FEES
Letters
Renunciation(s).......... .
......... $
~\ JCP $ If) .()~
O~~-tl()'l' $ S.u\)
$
$
$
$
$
$
$
$ 6()t). lrD
Attorney Name:
Supreme Court 1.0. No.: 41263
Address:
429 South 18th Street
Camp Hill, PA 17011
Telephone:
717/730-7310
TOTAL............................ .
Form RW-02 Rev. 10-13-2006
Copyright (c) 2006 form software only The Lackner Group, Inc
Page 2 of 2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee 1m thi" certificate, S6.00
P 14120227
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.
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REV 1112006
I PRINT IN
'AANENT
,CK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
19, Mother's Name (First, middle. maiden surname)
Lela Oz-:!nbau;rl:1
2Ob. Informant's MalHng Address (Street, city I town, state, zip code)
5903 W2stov2r Dr.,M2chanicsbur~,p\ 17050
21 C. Place of Disposition (Name 01 cemetery, crematory or other place) 21 d. location (City flown. state, zip oodei 7 0 6 5
Hollinger Crematory Mt.Holly S~rlnJ3,?~
1, Name 01 Decedent (Firsl, middle, last, suffi~)
6. Dale of Birth (Month, day, year)
84
Dec.20,1923
Pleasant Unity,p
v"
Btl. County of Death
ad. Facility Name (If not inslHution, give street and number)
Cumberland
Pennsboro Select Specialty Hospital
ITlOslof'NOrkin life. Do not state retired
Kind 01 Business I Industry
12. Was Decedent ever in the
U.S. Armed Forces?
DYes ~NO
Decedent's
Actual Residence 17a. State
13. Decedenrs Education (Specily only highest grade completed)
Elementary I Secondary (0-12) College (1-4 or 5+)
12 4
Pennsylvaai3
Cumoerland
417 P3r~(sid2 Rd.
17b. County
18. Father's Name (First. middle. last, suffix)
Taylor Carson
20a. Informant's Name (Type I Print)
David E. P3tton
10. Race: American Indian, Black, White, etc
lSpep;"II
WhIte
14. Marital Slatus: Married, Never Married,
Widowed, Dr~orced (Specifyl
widowed
Did Decedent
Liveina
Township?
17c.D Ves, Decedent Lived in
17d,~No, Decedent Uved within
Acluallimilsol
Twp.
Carn,) Hi 11
City/Boro
22c. Name and Address of Facility
L MUS32l~an ~H&CS,324 Hummel AV2.,L8~Of02,PA17043
24. Timeo/Death
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CAUSE OF DEATH (See Instructions and examples)
Item 27. Part I: Enter the ~ - diseases, intones, Of COlTlplications that directly caused the death. 00 NOT enler lerminal evenls such s cardiac arrest,
respiratory arrest, Of ventricular fibrillation without showing the etiology. Ust only one cause on each "ne.
1
~~n~L7 LL
Due to (or as a consequen.~ I): . f
b. /1'1/'..:'l/)'~'iU"L-i.
Due to (or as a consequence of):
Items 24-26 must be completed by p&!'SOfI
who pronounces dealh
() ,SS"
ApproXimate interval:
OnseltoDealt1
='~AT:~t~Si a~~) dise::-
Sequentially list conditions, if any,
~~~~~~o ~~e~~~II~~~~u~~ a.
(disease or injury that initiated lhe
BVBI1I5 resultrng In death) LAST.
c.
Due to (or as a consequel"lCe of)
d.
3Oa. Was an Autopsy
Performed?
DVes ~
30b Were Autopsy Findings 31. Ma~of Death
:~~~: :~i~e~olh~omPletion EfNatural D Homicide
D Accident 0 Pending Investigation
[] Suicide 0 Could Not be Determined
Ov" ONo
32d. Time of Injury
23b. License Number
Part II: Enler other sianificant conditions contrihutina 10 death,
but nol resulting in the underlying cause given in Part L
28. Did Tobacco Use COfIlribute to Death?
o y" 0 Proba"y
o No O""";';;;;n
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/Ltu" ',.. (c it<."
/ufiU~frt. i""IL",1L
29.tfFemale
Q-1fo\ pregnant wilhin past year
o Pregnant at time 01 death
o Not pregnant. butpregnanl within 42 days
of death
o Not pregnant, but pregnant 43 days to 1 year
beloredeath
o Unknown if pregnant wilhin the past year
32c. Place of l.nlury: Home, Farm, Street, Factory,
Office BUilding, etc, (Speedy)
M
321, If Transportalion Injury (Specify)
D Dliver I Operator 0 Passenger 0 Pedestrian
OOther-Specify
33b. Signature and Trtle ot Certifier
32g. Localion or Injury (Street, City I fown, slale)
338. Certifier (check only Ofle)
Certifying physician (Physician certilying cause of death wilen another physician has pronounced death and completed Item 23)
To the best of my knowledge, death occurred due to the cause(s) and manner as staled_ .. .. .. .. .. .. .. .. _ .. .. .. .. .. .. .. _ .. _ .. .. .. .. .. .. .. .. .. .. .. .. ..
~~~~u:~~,a~~ :::::hJ:~~~8~(~~~~ t:htl~~~~:.n;n~e;~c~~~:rt~~;i~~:::~~~a~~ manner as stated.. .. .. _ .. .. .. .. .. _ _ .. .. .. _ .. .... 0
~~~cea~:~~m~~~;~;I~: and I or investigation, in my opinion, death occurred at the lime, date, and place, and due to the cause(s) and manner as stated_ 0
33c. License Number
;I1lffi/11'1 ~ r e
33d. Date Signed (Month, day, year)
35. Registrar's Signalu
~
/1 1'1
34. Namiat~:~~s~~on w~f~om~~~t~ ?fu~ Pi- ~alh (~Dt211Jrype I Print
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DiSposition Permit No. ~ 0. q ~ 771
RENUNCIATION
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
Estate of Jean C. Patton
, Deceased
I, Edward K. Patton
in my capacitylrelationship as
(Font Namd)
son
of the above Decedent, hereby renouncE(,tpe right to
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administer the Estate of the Decedent and respectfully request that Letters be issued to
David E. Patton
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(Date)
4832 Bass Point Road
(Street Address)
Orlando, FL 32820
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me thi!':
of
day
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this ~l.,lI-'day
of ---::JA,..JJ At-f , a(X)1. .
-~_./
Notary pu~
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 10-13-2006
Copyright (c) 2006 form software only The Lackner Group, Inc.
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