HomeMy WebLinkAbout02-11-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CIJ{Yl fyJ f~ COUNTY, PENNSYL V ANL\
Itich<;<:l) ';l" \~.<:.
also known as N\c.~Gc\ ':s-~"",,, l> 'i~r<"",<c-
, Deceased
Estate of
File Number
J/-Og - OIL/:;
Social Security Number ~ ~ - -S d - Go "& ~
Petitioner{s). who is/are 18 years of age or older, apply{ies) for:
(COIllPLETE '.-I' or 'B' BELOW:)
g;. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is I are the
last Will oftbe Decedent dated and codicil{s) dated
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eonamed: in the-~
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(State relevant circumstances, e.g., renunciation, death of executor, etc)
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Except as follows, Decedent did not malTY, was not divorced, and did not have a child born or adopted after execution Of'f~'instrume~) offefed:, II
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: !"..1
~ Grant of Letters of Administration
(If applicable, enter: c.t,a.; db,n.c.t.a.; pendente lite; durante absentia; durante lIlinoritate)
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.)
K~ILI
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Name
A~ \./\.crc,c_
, (
Relationship
~ll\)4C
Res~nce fl
Fd^{~(~~~ (~~~_~
t( ~ aa~<{
"ptt
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
$0.6 0 '. D'Z)_
$ /'
$/
$ - 0
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:
\<~I\
(to '3"]
Form RW-02 ,.el'.IO.I3.06
Page I of2
Oath of Personal Representative
COMMONWEAL! H (JF PENNSYLVANIA
COU~TY OF -C.ur11berJ (1[]d
SS
Till: l'eliti'.:!;Cl"iil ~lf-')\':"!LI::ld ""c'~iI(S) lll' ,!:'f:lm(s) that the statements in the foregoing Petition are true and con-ect to the best of
lh.~ kilU\" kds~ JIHJ beliei' of Petitioll~r( s) ~\I:J tbr, as personal representative(s) of the Decedent, Petitioner(s) will well ancI tml)!
administer the estate according to law.
/
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Sworn to or affirmed and subscribed
before me the J I i17 day of
=J~~
Signature q/ Pi!rson,d Rt!preSetltalive
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Sigllolllre vf Persol/a! Representative
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File Number:
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Estate of
Social Security NUl11ber~d- - S d
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AND NOW, 'Hth
Date of Death:
, NW ~rin consideration of the f9r.egoing Petition, satisfactol)' proof
Letters IJ Ad f)11 'n J slrllfr 111_
having been presented before me, IT
are hereby granted to
Short Certificate(s) , . . , . . , .
~''''*). .
rro blll
and that the instrument(s) dated
descnbed 111 the Petition be admitted to probate and filed of record as the last Will (and CodlcIl(s)) of Decedent
Lot',,, .uFEES $ JD,OD vJi/zrb,. v-a~f?~1!. Jt2a$11~
$ c9t},OO
$
$ I{),DO
$ J),O/)
$
$
$
$
$
$
$
TOTAL.. , .. .. . .. .... $ EtLOO
in the above est<:te
AttoIlley Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
F()rm R WIJ] rev 10.13.06
Page 20[2
HIOS.80S REv 101/07\
c;)/-Cf-Olt/{)
LOCAL REGISTRAR'S CERTIFICATION OF DEJ~THI
WARNING: It is illegal to duplicate this copy by photostat or phot.ograph.
Fee for this certificate, $6.00
Certification Number
This is to certify that the mformation here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificat~wi be fo'wocded to Ibe SI"e Vit.]
(~rjs ff for permanent filing.
'IV" ~ -1LJ P8
Local Registrar Date Issued
P 14189682
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Dec. 19. 1958
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5 ~4-4 REv 11,2006
VPE' PRINT >>II
PERMANENT
BLACKIN/( 1131-207
,. NImt 01 ~ (rnt, rridt, IIIl. dill
Michael
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COMMONWEALTH OF PENNSYLVANIA 0 DEPARTMENT OF HEALTH 0 VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions end exemple. on rever.e)
3. Soc.. Soc""'Y"""'*
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Yurcic
5 Age (lAlil Birthday)
6. ~Ia 01 8lIth (Month, day. Vlal'l
7,~lCllyandsaaltor
Cumberland
485 St. John's Church Road
18'000000.st>o<'r
10. Roco'__.__1IC.
l~ ,
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dO Clunly 01 Oealh
ad Folailty NamI (It no( If\5tiMion, fIW" streel and number)
11 Dec:eoior's Usl.lii most 01 tn. Do noc sace relired
KirldolWol'k Kindol&..ines.s/lnclustly
fnA"A~ER. WAIUII~"'S~
. 16. O8c:edero's ~ Addtei& (SIt_ city I klwn, stale, lIP code)
.Joe. q~ St,
o ,rkw C urtle.t>-/..AN'> P4. '70 '10
II FU\t(', N.vnlt IFirst. rnD.Sll, Ii:i(, StMix)
BoiSe P SflANI'tt3t<O'-fGH
201. 1n1orminl'1 Name (TWI' Pnnll
KfLL A. YLf/U. Ie..
21iMlllho,),,10101$posrtion
12 Wu Oectdtnt I..,er in the
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17c. 0 Yes. 0ecIdn l.Md in
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Top.
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19, Muller's Nimt jFirst, Illldde, maiden surnamel
NNErT[t Yu~ci"
2(1), IrItonnint's MalIing AddreM (S&rN~ cfy 11OWO, stalt, lip COde)
I Mo,./rE:R.E. 1-1t:/l..5H€.
21c. Place of ~ (PWne 01 cemetery, crematoryOtothel place)
EVANS ('I2.EMAr/cN 5f/;?v'ia:
22c Noune and AdQllIilS$ ol FacaIIIy
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21d~IC'Y'_,_.Op_1
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23b. license Nl.UfIber
8:00
25 o.to _Dead 11otonat,....,..,1
February 4. 2008
26. Was Case Rei_red 10 MedicM ~ (Coroner for a Raason Oltltr INn Cr.rnaIic:rl or 00niIign?
rltvea DNo
Appr<WtN1l inletval" Part II Enter Olher sianrficanl COI'llMinnI. mnIrb.1linn III dMlh 28. Did Tob<<:aI U. ~ D 0NI'l1
OnselloOeaItl bulnolrMu/1lOglfllht~catMlJY"IflPMtt. 0 VM DPrabIt1tw
o No 0 l.I1u-.
29. If F8fl'IIIe:
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32a Oil. oIlllfUtY lWonlh. ~y. year) 32b. OescrQi How ~ Occurred J2e: PIIoI of qury. Home. Film, SIrMl, Fdlry,
Feb. 4.2008 Intentional Hanging ~~~~~se
32' T""......, prx 321I1T'_......I_1 32g,~.......I_.""_._)
8 00 P DO-lap...,.. Dp"""\lOl Dp....."'" St Joh 'Ch h Road.Camp Hill. PA
: . M 00...._. . n sure
Coroner
1lems24.2til"FlUilblCOO'opleledbyptf$On
..-.0 ptOOOu'Ica dellh
24 TIrT'II 01 Dealh
CAUSE OF DEATH (See In.trucUon. and examplea)
I&em 27 Partl Enl" the ~ - dlSNNs. 1IljIJ....., Of compiIc;Illon$ -lhaI ~ CIUMd lhe "'aIh, 00 NOT iI'Il8f 1tm1inal evenIa iUCh as carINe arrtil,
teSplfalOry atTl$(. or ~ncuIat IlbnllallOn ~ showing !he 8\I0Io0'. LisI r:ri<J 0IlI cause on eadlllne
===~ d:a~llbe':;
Hanging
Due to (01' as a consequence of)
-"""'-.'''''
~toItleYuMli5tedonllnt.
Enw &. UNDERlYING CAUSE
I~Ofll'lfJl')lhalll'lltliW>dl1wl
"'enII1tIUlbtlg tl i18a1h) lAST.
Due to (01 as a consequence 01):
Dut to lor as d consequence 01)
~_W..anA"aopsy
.'""""""
nWt'f.Autopi'1F~
AwIliaolePOOllO~
~ Cause of De.altl"
0'" ell""
D'es DNo
31 MiMef IX DNln
DNa""" D_
O- Dpon<lng_
)lj s..oo. 0 CoUd "" bo Do_
~ C.rofIer \ctl8cIl ~ Ol"IllI 33tl, Signature and Tille
~::"J:==:=:u,~:..o.:the~~=r:~_~_ltl_~~~~_n~_________________ 0 ...
~~=~:=~~=:::"~~~=:OIo~:::'NMWUstNcL__..______________ 0 lJc,~N~
::: :.::':'~ ...,.. ",'O,",,"lIon.", m. - -................... _,'" piKo, .......10Il1o.......'... __ 50 '''Ood., .p(
::-l 36 Date Filed (Moolrl, diy. yearl
I ~ ,3-117-1 i}..1:}....t d -B-,wCJ fJ
33<l.lloJoSv>o<lI........O'y,_1
February 6. 2008
)4, NMne MldAlJot.&sof Person Who WnpieIlldCauMofo.~(1lem 271 Type! Pm!
Michael L. Norris. Coroner
6375 Basehore Road Suite #1
15~stfarlS>gn.ltut.
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D''''''.loon """" No 0 I ~{;<)O