HomeMy WebLinkAbout02-15-08
PETITION FOR PROBA TE AND GRANT OF LETTERS
REGISTER OF WILLS OF
CV\iM tn.r 1.oW ~
COUNTY, PENNSYL V AI\[A
Estate of
W I q I f.l '" .~_j:i:J L. l..
File Number
:J, 1- D'i .- 0/ f.R 7
also known as
, Deceased
Social Security Number
~/D L{--I .5bL.'i
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(CO/IIPLETE 'A' or '8' BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is I are the
last Wil/ of tbe Decedent dated and codicil(s) dated
named in the
t i ; I
r.r,~ ,J
..~) '.-,--.)
(State relevant circulIlstances, e.g. renllnciation. death of executor, etc) . .r~ f:- ',? ,:f~
=:; s=r - ~_ ,'; i-}~~
Except as fol/ows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution:of:t~nstru~t(s) offered)
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: . --; '~3 ;;-:i -0 ~' .~ (~
, .- .K _=-
Dl B. Grant of Letters of Administration
'55
:'.:J ---i
1> r-
(lfapplicable. ellter: c.t.a.; d.b.f1.c.t.a.; pendellle lite; dllrallle abselltia; durallte minorilattfl',)
~
::..... .I
il
Petitioner(s) after a proper search has I have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
Administratiol/, c.t.a. or d.b.lI.c.l.a., ellter date of Will ill Section A above and complete list of heirs.)
L,-YrJ J'.
IL'-
lno"""c
Name
(COt"'IPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in
R.
Decedent, then
53
years of age, died on \ ~ I?y I 0 1- at
ThA-'NUr ~c-
Decedent at death owned property with estimated values as fol/ows:
(If domiciled in P A) All personal property
(lfnot domiciled in PA) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
IX)
5D.-
$
$
$
$
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:
JW/
T ed or rinted name and residence
ft)4.c:A-c:.. .J I \.f'LL
't' ~k.e..j loAN':'
~"t 140 II S
1>4
IjoloS'
Form RW-02 reI' 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONvV EAt n l ()F I'ENNS YL VANIA
SS
COUNTY OF --C.11111.btcf~
The I'di t!'.~I;cn;1 ;lh.,\ 'C"!L!!: Id ,". C';i!(S! l1r ,1 ''fitl11(s) that the statements in the foregoing Petition are true and COlTect to the best of
lh,~ kihh', kd~e ;Jill] belief of Petitiona(.,) ;lnJ [h:I[, as personal representative(s) of the Decedent, Petitioner(s) will well ancI truly
administer the estate according to law.
Sworn to or affirmed and subscribed
"'-f.-h
before me the I ':J day of
~.W$
..~.!:)~,D;:v
:J-I-Og -- 0/&9
'-,-' /-...
Estate or--11Lil1't1KYI t:Lffi, J , Dec~f? ~
Social Security Number: '1JD-LJY-50foq> Date of Death: 1:Lla'//()7~~El ;.
Rb ' y ~
AND NOW, I STh , t)lX)Cl , in CO}1S1deration ofth~ foregoing Petition, satisfactory proof
haVIng been presented before m 'IT IS DECREEp l~~a~r,etters J3;Q.m L(l i waf? tI"h
are hereby granted to -Mad e .y () V. ITLU
and that the instrument(s) dated
descrIbed III the Petition be admitted to probate and filed of record as the last Will (and Codlcil(s)) of Decedent .
Lot'e" ......... fEES , dO,OJ) J;jt~ ~~ ~~p. _
if. C()
10.00
,5. DO
Short Certificate(s) . . . . . . . . $
RenUnClatlOn(s) .......... $
'iEfhzmaJidY\ . .. :
$
.. . $
$
$
$
$
$
TOT A L .............. $
Form RW-O] rev 10.13.06
;.a:J
SiglllltLJI'r.:: q/ Personul Rt:::presentative
SiglLature vf PersoNa! Representative
I~
=
=
c::t::>
-r'1
rl'"\
CO
--r-i
~o~;c~;
. / -"'\
: : :""'7\
File Number:
()
C9
:CC,. ? ;.1
}': tB
"
c..n
in theabovG c:sf,ate,
Attomey Signature:
Attomey Name:
Supreme Court LD. No.:
Address:
Telephone:
211. OD
Page 2 of2
H105.R05 RF:V (()1/()71
,) 1-01-0/&7
~
LOCAL REGISTRAR'S CERTIFICATION OF DEit\ TI-I
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
Certification Number
\II"'f~(1"'ffrpl,i----__
'~"
~\ SS.. -.~ - ~;.
f I J? -,- ;~- .T_-" ~_, ~\
~~ -,--ffi:: ~~
\. *" '-.'..' '....., ~'''.. '> .-~ * $
.. &! - -~-,-, ~
'\.~ ~,. ~\\\
."" :fA,. .....\.~ .1"
--,'T'AfENl ~\ ~ ,..1 -
""'-''''''''''''''1111,,'11
This is to certify that the infonnation 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 pelmanent filing.
P 13888814
. ~. ~~l. \. ~~~EV 2 6 /2007
, Local Registrar ~ Date Issued
I
H105-143 REV 1112006
TYPE / PAINT IN
PERMANENT
BLACK INK
20
:::::-.0
r'!~~::;:C)
~?;t8
'j):;:-,K::
} (-~, (:;.
~, ~~ -Tl
.' ~;'::~I
'.'J
~'1.>
t-...>
=
=
co
-n
f"T1
CO
Ul
-u
-~
._"0..
r;y
x:-
N
.-',)
1. NameolOecedenllFirst,mIdlIe,l8sl,llIIIb:)
William D. Hill
5, Age IWII!k1J>day)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examplas on revaras)
. I .
lkf. FaclIIy Name (If no! irIrtiuIion, give strMt and oomber)
STATE FILE NUMBER
VIS.
6. Doleol_IMonlh. .
7.
C aodstlleor
53
Sb, c....~ 01 Dea~
10/26/1954
Carlisle, PA
00lh0'. SpllcJIy:
10. AIC8:American Inlian. Black, White, etc.
(Spoc/(j1
Cumberland
11. Oecedtnt's UsuII most 01 IIe.Dom.....
Kmol_ """'01_11_
Car Detailer Love I s Auto Sal
. 16. 0ecedent'8 MdIng Address (SIree~ city I town, 81a1e, zip code)
12. Was Deced80t 8Y8r in \hi
U.S,ArmodFon:ea?
OV" ~
-.
AcIuIllResldence 17a.S1a18
PA 17065
17b, County
17" IX Yes. _, U"',,,, South Middleton
"d. 0 No. _1I.....wOt;n
_"""01
Top,
Jr.
19. MoIhe(s Name (F1I31, mIdcIe, ITI8lden surname)
Madel J. Caufman
COy/Bon>
201. Il'lfomur. NIme (Type / Prin()
~
J.
2Qb. Inlonnenr. MIIiIIng Addreaa (Stretl, city / town, sIaIe,.q" cede)
8 Larken Lane Mt. Hell S
21',Plooeol-,(Nsmool_,_or_pIoce)
30&. Was an Autopsy
..-
d.
3lJb. _ Aulopoy F.....
A'IlIiIIble Prior to CoqMIion
01 Cauae at Death?
DYes ON'
31.~ofDeaIl
[2(....., 0 _
0- OP_'_"oo
O~ OCotldNoto.__
~"lnlerval: Part II: EnterOlherlkllbnlalrKltion!l:mnltbllnnlodull\ 28. ~UseContrlbutttgDeath?
Onsotloo..~ """_.~undettying""gNan.""'L ~~.. OP-
ONo 0-
29.11 Female:
o Not__....""
OPNgn...alllmaol_
o Not_'''P'''I8'..._42days
ol_
D Not_....PfIllI18~43daysIo1"'r
boloro_
o UnImownilpregnanlwilhlltl'ltpast)'8llr
:!2c. Place 01 Injury: Home, Fann, Steet, Factory,
0Ific0_.",. (Spdyl
PA 17065
2'd,Locaticn(COy/""'._.zlp_)
Carlisle, PA
~
~
<I.
Westminster Matorial Gardens
.... 24-26"""" _ad" """'" 25,0.0. """"""'" Dead 1-. day. "'"
whop__. M. e.c /.,... J..<f .:i 007
CAUSE OF DEATH (See in8tructiona .ncI examp...)
ttem 27. Part I: Enlerlhe~-dIaeueI, injuri8s, orcomplcatlons-lhIIldrlclyC8U9lldlhedHth. DO NOT entertenninal events suchUcardiac81T1l1l,
resp/raIofyarJ8lt, orwntTlctiarlbtllatlon MIhoulshowinglheellology. UalonlyoneCNaoneachlne.
-.oAT! CAUSE ~- or I
CUllition.....ngin ) -.. t. '\'/'1 r'u..-( \J.Y
DueID(oraaa~of):
22c. Name and AddreIs of FacIIIy
&in Brothers Funeral Hane, Inc., Carlisle,
23b. Ucenae Noolber
(1../1 /70J77 - L.
-"'_.11..,.
IeedinalotheClllJlt....onllnea.
_Iho UNOEIIlYlNG CAUse
=-~":.~~
b.
Due 10 (or as I con&equence of):
Due to (or as a consequenoe 01):
OVes ~
32d.Tmeoflf1ury'
32g.Locationollnjury(Street,elty/lowll,8Iale)
M,
3
33a.CO<tilifi_onIy....'
. Cot1HyIng_I""'*""cartify;ng....oIdoa~_"""""_has__and_lI.m23'
ToU. beet of my know6edQe, deIth occtmtd ctut 10 the C8Ulle(a) and InInnIr n 811tttL......... _... _...... _ _...... _............... _ _ _... _... _... _...... _..._
. ~:=:n=~:ti~~~cer:tto=~~~mannerlSsteted....._...__...____........___.. 0
. : ble:"::'~c: IHId / or InYtatIg81ion, in my opinion, dulh occumtd Ill: the time, dl., and pIIce, and due to the CIUM(I. Ind man,*," 18 stated... 0
~-.-.:~~_. p ()
~
!j
~
w
"
l'
331:1. Dale S9led (Month, day, year)
I '2 /'~ We 1-
35. RegS r
~
W~~~~~
1~lIlal\IDI
0_ p,,,,,,, No'JO q 15"'ltP
34.N8meBndAdltessol~WhoComplefedCaJlleofOeBII\(lte~7} Type/Print
V/t"f""'1L e:,(.LI.rT...,r~
CO;.rk.sle. IPff'" 0 \:1