HomeMy WebLinkAbout02-20-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C. (Lfr/!.3E]eL.R-NP
COUNTY, PENNSYLVANIA
Estate of Ka thYJYl e, /2itz.
also known as
File Number
:J-/-{fl- DJ7f
, Deceased
Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
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
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ortbf~i;1&l1umen~ offered,
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person:--; CJ ,,") "J::'u
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(If applicable, enter: c.t.a.; d.b.n.c.l.a.; pendenle lite; dura/lie absenlia; duranle minoritate)
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(Slale relevanl cirCUli/stances, e.g., renunciation, death of executor. etc.)
~ B. Grant of Letters of Administration
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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
Administralio/l, c.I.a. or d.b./l.c.l.a., enter date of Will ill Sectioll A above and complete lisl of heirs)
Name
County, Pennsylvania with ~/ her last principal residence at J 2 C1mu<<tJ
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Decedent, then I~o years of age, died on
l//tf/~7 at G6lden L/Y,1' t!fr.. G; fb,1I5~/)/Zi T~'
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 P A) Personal property in County
Value of real estate in Pennsylvania
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$ I t'SS ~ s:- ~tiO.pt;>
$
$
$
situated as follows: AJI A-
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Lellers in the appropriate form to
the undersigned:
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T ped or rinted name and residence
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Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF C,.L{ M r3/!ilU.Jf/tJ!D
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 affirnled and subscribed
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Sigllature of Personal Represelllative
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Estate of
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Signatllre of Personal Representative
Sigllatllre of Persollal Representative
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File Number:
C.,
en
, Deceased
Date of Death:
If/!t /07
AND NOW,
having been presented before me, I
are hereby granted to !.PIS ;fl.
, !J.ft)9. ,in consideration of the foregoing Petition, satisfactory proof
Letters /'}f /fdAJ//;'.J'lhthbll ~
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.
Short Certificate( s) . . . . . . . . $
Renunciation(s) .......... $
,] ( p .. . $
Odo .. . $
...$
...$
.. . $
...$
.. . $
.. . $
.. . $
TOTAL.. .. . . .. . .. . . . $~
FEES
Letters
Form R W-02 rel' /0./3.06
$
30.0D
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In o~
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Attomey Signature:
Attomey Name:
{!All r/es
3flSI.3
tb e/otlser Ifld'-
/lleM/VJt/csJ'l'] tf?+ 17IJSS'
Supreme Court I.D. No.:
Address:
Telephone:
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Page 2 of2
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This is to certify that the information here given is correctly copied from an original certificate of death duly liled with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent flling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
Oaajt!/'~
ocal RegIstrar ,
Fee for this certificate, $6.00
p
13366146
t,r'F~ 2
Date
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11. O<<:adllnt'a Uul lnOIIot ",Donoll<.~
Kind at Work KnI ~ BusNq IInduRy
homemaker domestic
. 16. OecedenI'i ~ Addr.- (SbwI, city / kMl. state, zip code)
12 Conway Drive
Mechanicsburg, PA 17055
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H1Q6.143 REV 11f2006
TYPE I PAINT IN
PERMANENT
BlACK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions snd examples on reverse)
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7.Elirt~( Ind..ltor
PA
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.!lb.'~lyolDe.1h
Cumberland
12. Wu Oecedenl ever in Iht
U.S. Armed FOfCU?
Dv.. KJNo
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AduaI Residence 17.. Site
17b. CoooIy
13._. e......IIonI_""'_g<ado com_
e_'SeoondarylG-12) C~"ll"'''S+)
8th
Pennsylvania
Cumberland
~~ 17'.~V..__. East Pennsboro
T"""".' 17d.DNo.___
Adulllinilaol
TWO.
18. Falher's Name {FirtI, mIdde, Iut, StAlbI
John Henry Ferree
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CiIy/Boro
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2(1), Infonnant's Mdlg AdlhII (Slreet, city I lawn, Ilall, zip code)
12 Conway Drive, Mechanicsburg,
21c. P\lICIdOl&posIlion (N.me oIcernetery,~OtothlrplKel
Freysville Cemetery
PA 17055
21d. l.ocatiorl (Cly 1k:Jwn,sIIM,zjp code)
Freysville, PA
Inc.,134 W. Broadway,Red Lion, PA 17356
23b.l.IcenIt NtntIer
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JJ 25. Da"P~~I_. diy, yKtj
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CAUSE OF DEATH (See Instructions end .amp..)
11m 27. Pert I: E"..the~-dlle_, 1njuries,00~iDnI-flMlInItlIyC8UlllldthlldMCtl. DONOTenhlrlflminatevenlslUdl8lcanlacllfell,
~""'OI'18f'11ricUarlblWmwllhoullhoWlngthBeliclogyLiltonlyone~
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DlJIto(Ofas.~oI)'
~~ClldiDnl.II~,
E::1:u:o=::rcru::a. DueIO(orUltonsflQUInetot):
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Approximale IrUMI:
0nItI1o 0ea1h
Pert It Enter other MnIbnI ~lanI aDiljjnn m dMIl
bUlnctl'8llAhglnlhll\roerlylngClUIIlPYtninPartl
28. Did TobIcco Use Conlrlbute 10 0eI1h?
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29.:!!,~
.,...J..d'!'IOlPf8l1\lfllwtilpaslytt,
o Pregnanlatllmfoldealh
o No! pntgnllN, but p1egNnt wilNn 42 dlys
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o Not pregnant. but pregon 43 days 10 1 year
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o UnkncMn If prepnI within the pell yell'
32c. Place of Jnj&Ny: Home, Farm, Slreet, Factory.
OfrICtBulldiog,elc.(SpIcIIyj
11ern124-2Snutbecornpleted~pIHIOI'I
who pronounceI dHIh.
001 to (or IS . consequence of);
308. WaI In AtIopey
P_,
d.
3<1>.__,_
Av.lllb1e Prior to Complebon
of c.u.. at 0eI1h?
Dv.. ~No
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31. Mamer aI DHlh
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O_tOPon<Ingln",1igI1ion
Dsuicide OCouldNotbeOelermined
32d. Ttmeoflnjory
M.
321. nTmnspol1alioo ll/JIY (Specify)
DClriw<'Opooa1o< Dp........, Dp-
Oltw,_,
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32g. Lcc:ation ~ InjLIy ISlraet. d1y Ilown, "~I
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33e.CertIIilw(c:hedIonIyOl'll)
""'lIytng_~n(__"""'~_--_"""""""""""~"'_",",23) .
To h belt 01 my knowtedga,dIIIh OCCUtNdutotl'ltC8UN(IIII'lCI",,",*IIItIl:Id... _..... _ _..... _ _ _.. _ _ _.. _.... _ _ _.. __ _ ____
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MIdIcII Examiner' Coroner ,
On !hi bnil of ...natIon Il'ld I or Investigation, in my opiftlon. dUItl occurred · the time, date, II'lCI pIKe, and due 10 Ihe cause(s) and IfIIMIl' II lilted... 0 34. Name ind AdchU 01 P-,r Who ~ed Cause 01 DeIlh (ham 27) T
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RENUNCIATION
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REGISTER OF WILLS
C lImJ3E1eLA.AJ.D COUNTY, PENNSYL VANIA
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Estate of K A 'TII R Y/// E. /(,/7 Z
, Deceased
I, /I.. JE;1-J) 7by€"
(Print Name)
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, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Lt/IS I?
sru 111 fl
(Date)
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(Street Address)
54 T7:S.iJ/I.(. ~ J Af.z as z S"I-I zy~
(City, Slale, Zip)
ROBERT MICHAEL MURRIETA
NOTARY PUBLIC - ARIZONA
MARICOPA COUNTY
My Commission Expires
October 6 2CJ9
~ 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 stat~d within on this -;:7 day
of ~6U'/~0 , /?'~?'
/
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Notary Public
My Commission Expires: ~~/~
(Signature and Seal of Notary or other official qualified to
administer oaths, Show date of expiration of Notary's Commission,)
Form RW-06 rev, 10,13.06
RENUNCIATION
REGISTER OF WILLS
C 1I In/JE1eLA.AJ./:> COUNTY, PENNSYL VANIA
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Estate of KA rJ./;eYI!/ E: IGITZ
C)
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, Deceased
I, :5>/1 ellA- ,40. /)tEAlI'fte./)
(Print Name)
(;-MA/lJ ON' L./)
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Lt))S tr.
srtl 111 fJ
fe~u~ Q \ ~CC56
(Date)
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(Signature) SI-I€IL-A- A-. /JtG/I/~
30'1 tS//HP"fJ1lS /24>1I*/J
(Street Address)
:J)/I-L 7o~ A/..~ 03598 -"S/z.Z,.
(City, State, Zip)
~ Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunc~'!tion for the
urposes stated within on this r J..- day
of , '600\ .
otary u lic
.. . SUZANNE C. MACDONALD. Notary Public
My CorrumsSlOTI EXplTeIlIV Comml88ion Exp!,. December 11, 2l!)12
(Signature and Seal ofNotaJ)' OJ other official qualified to
administer oaths. Show date of expiration ofNotaJY's Commission.)
F01'/11 RW-06 rev. 10.13.06
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RENUNCIA TION
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REGISTER OF WILLS
C 1I JnfjE1f!LA.AJ.l> COUNTY, PENNSYL V AN1A
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Estate of
K,If rj/ ft?y/f/ E IGI T Z
, Deceased
I, J<1/'UNf, I. fJlfll. LE$
(Print Name)
G/lIfNOeH/LD
, in my capacity/relationship as
ofthe above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Lt)/S 1(. srU /l1 fJ
(Date)
~g21~)e~~
670'1 IJ1/UAY ~.
(Street Address)
/J~tuf)()/~ /lIE 0'1217- 7'1-99
(City, State, Zip)
~ 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 -2 ~IQ day
~~.
Notary Public ~ -J
My Commission Expires: 0.) to) 100..
(Signature and Seal of No tar)' or other official qualified to
administer oaths. Show dale of expiration of Notary's Commission.)
Form RW-06 reI'. 10.13.06
RENUNCIATION
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REGISTER OF WILLS
C q JnJ:3E1eLA.AJ.b COUNTY, PENNSYLVANIA
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Estate of
K,If /J.I Jey/ll E: IG/T Z
, Deceased
1,
LL/I=7PAJ 1>. PIHA. LS
(Print Name)
G~tJ/!'NIW
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
UIS 1(. srt( 111 fJ
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(Date)
~J9,P~_
(Signature) C. LI f: 7iJ/lI~. P44. L ES
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(Street Address)
~t{(;IIS r~ h1E t::) '1'131:) -7"713
(City, State, Zip)
~ Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that~or she executed the renuncia~ for the
purposes stated within on this /.;2 day
of &~I ,~r
{'~p~/$<~~
My Commission Expires:
(SIgnature and Seal of Notar)' or other official qualified to
administer oaths. Show date ofe~aiYAntreo~CC_jon.)
~ct3rl/ Pubflc, Mame
My Cernmk;sic;; Ey-piros August 5, .11
Form RW-06 rev. 10.13. 06