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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
htate of. Lillian M. Peechatka
also known as
File Number ~/-Og ~()192-
. Deceascd
Social Security Number
Pctitioner(s). \yho is/arc 18 years of age or older. apply(ies) for:
(CO/'vfPLETE 'A' or 'B' BELOW:)
Ii] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the Personal Representative
last Will ot'the Decedcnt dated Novcmber I L 2000 and codicil(s) dated
namcd in the
(Stafe relerant circumstances, e.g, renunciation, dealh qf'execu/or, etc.)
I:xcept as Il)llows. Deccdent did not marry. was not divorced. and did not havc a child born or adoptcd after cxecution ofthc instrumcnt(s) olTcrcd
Jl)r probatc. \1~lS not the lietim oj' a killing and was ncYer adjudicated an incapacitatcd person:
o B. G rant of Letters of Administration
(If applicable. enler' C.I.a" db.nc.l.a.: pendenle !tIe: durante absen/to: durante /limon/a/e)
Petitioner(s) atkr a propcr search has / have ascertained that Decedent left no Will and was survived by the following spousc (ifany) and heirs: 1/1
idminis/ration, CUI. or dh.n.el.a" enter date 0/ Will in Section A ahove and complete list afheirs.)
c=:
Naill I:
Relalionship
ReSidence
(COlfP'LETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County. Pennsylvania with his / her last principal residence at
Golden Lilin~ West. 770 Poplar Church Road. Camp Hill. P A 170 II
(Usl slre('( address. liMn ellY. 100i'/IS/1IfJ. counly, slate, Clp code)
Decedent. then 92
PA 17011
years of age. died on January 15. 200S
at Golden Living West. 770 PopI'lL~'hureh Rpif9. Camp Hill,
, -'J
Decedent at death owned property with estimated values as follows:
(ll"domieilcd in PAl All personal property
(] I" not clomiei led in P A) Persona] property in Pennsy Ivania
(I I' not domiciled in P A) Personal property in County
Value 01" real estate in Pennsylvania
i'-.'.
3S.250.00
$. .
$
$
$
0.00
situated as tl)lIows:
'-
Wherefore. Petil1oner(s) respcctt"ully request(s) the pro hate of the last Will and COdiCil(s) presented with this Petition and thc grant of Lcttcrs in the appropriate t(Jf111 to
the LlIld,~rsigncJ
c=
~./
Tv .ed or rinted name and reSidence
\Valler N. Peechatka. 5 Lantem Lane. Camp Hill. P A 17011
Forlll "W-O} rc'\' 10.13.00
Page I 01'2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLV ANIA
SS
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
Sworn to or affirmed and ~ubscribed
nO
before me the {):).. day of
UR'-~fX)\(
'u~L\.J ~uf OxfU- tf
, ~ For the Register J
,)
X ~z4 r~lf?J/j
Signa/lire of Personal Represenla/ire
administer the estate according to law.
.r.,'lgnallfre (?lPersonal RcpreSeJ1fOfh'(!
Signature o/Personal Represen/allre
<'j
File Number: /) I-O&' " ()/9 d.....
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Estate of Lillian M. Peechatka
, Deceased
Social Security Number: 205,10,7079
AND \10\\/. 1ph(1)JJ..jL{ ;;J:.L ,f}.OOr;;,
having heen presented before me, IT IS DECREED that Letters
arc hereby granted to Walter N. Peeehatka
Date of Death: March 19, 1915
, in consideration of the foregoing Petition, satisfactory proof
Testementary
in the above estate
and that the instrument(s) dated November 11.2000
described in the Petition be admitted to probate and tiled of recor,d
the la. st Will ~. COdieil(s.)) 0 ~Deeeden..
) /d;. --2tJ.;V~L" '
Regis/C/' of Wills
FEES
TOTAL
$30. DO
$ dO.Of)
$
S
$
$
$
S
S
S
$
$
S i 5'5' no ();@O
Attorney Signature:
Letters
Short Certificate(s) . . . . . . . .
Renunciation(s) ..........
~MV'e"Jtc v..~
l)..)l \ l
~te
C~--hN"'(),* I ~
IS- - 0 D
IS-_ ({J
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5. (JU
Attorney Name:
Walter N. Peeehatka
Supreme Court I.D. No.:
Address:
5 Lantem Lane
Camp Hill, PA 17011
Telephone:
717-737-0407
!-orlll /III,!!.! rer /!!./3.!!(,
Page 2 01'2
H!n5_:~O) KE\
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. "6.00
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This is to certify That the information here given i:
correctly copied from an original Certificate of Dead
duly filed with m: as Local Registrar. The origina
certificate will he forwarded to the State Vita
Records Office I'(l:' permanent filing,
~?,i~1
Local Registrir ~
/ / /5!q{)
Date Issued
P 13967250
CertificatIOn Number
~........ .....
(I I /~0',_ . . ." -rl'
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H105+143 REV 1112006
TYPE f PRINT IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
'.J
-,..,
92
March 19, 1915
Monroe County, Pa
13. Decedent's Education (Specify only highest grade completed)
Elementary f Secondary (0-12) College (1-4 01"5+)
2
1. Name of Decedent (First, middle, last, suffix)
Lillian M. peechatka
5. Age (last Birthday)
YI;,
6. Dale 01 Birth (Month, da , year)
8b. County 01 Death
ed. Facility Name (If not il'lS1ilution, give slreet and number}
Cumberland
East Pennsboro 'IWp Golden Living West Shore
11. Decedent's U$JJ81 Occ lion Kind of worlc: done durin most 01 worki life. [)Q no! state retired
Kil'ld of WoOl: Kind of Business I Industry
Teacher Education
1'2. Was Decedent ever in the
U.S, Armed Forces?
Dyes 181 No
Decedent's
Actual Residence 17a. State
. 168~t~a;~tfrn (~da~town, state, zip code)
Camp Hill, Pa 17011
17b. County
PA
Cumberland
Did Decedent
live ina
Township?
14. ~t:~~~~:~np~;~r Married, 15. SUrviviC"~se (If wife, give maiden name)
N/A
East Pennsborg
idowed
18, Fathtr's Name (First. middle, last, suffix)
Arthur Post
17UQJ Yes, Decedent lived in
17d.O No, Decedenl Lived within
Actual limits 01
Twp.
City/Boro
20a. Informant's Name (Type I Print)
Walter N. Peechatka
2Ob, Informant's Mailing Address (Street, city !town. slate, zip code)
5 Lantern Lane? Camp Hill, Pa 17011
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SWiftwater, pa 18370
21a. Method 01 Disposition
21c. Place of Disposition (Name 01 cemetery, crematory or other place)
21d. Location (City flown, state, zip code)
. ~
l1ams 24+26 must bl! completed by person
. who pronounces death.
CAuse OF DEATH (Se<<e Instructions and examples)
Item 27. Part I: E:rl1:er the ~ - diseases, injuries, or Complications - that directly caused the death. DO NOT enter terminal evenls such as cardiac arrest,
~;piralory arrest, or ventricular fibnlfation without showing Ihe e<<atogy. Ust only one cause on each h,
Approximateintervaf
OnsettoDealh
Part If: Enter other sianiricant conditions contribtJtina 10 dRatl'l.
but not resul1ing in the underlying cause given in Part I.
28. Dkl Toba<:co Use Contribute !o Death?
o Yes J:;tProbably
[d'1fo 0 Unknown
29.\lP
Not pregnant within past year
o Pregnant at time 01 dealh
o NOlpregnant, but pregnant within 42 days
01 death
o NoIpregnant, but pregnanl 43 days to 1 year
before death
o Unknown if pregnani within the past year
32c. Place 01 Injury: Home, Farm, Street, Factory,
Oft<< BuUdinq, ek. (Specify)
Seq~ntial~ list COi'ldilions, if any.
~::,~o uJD'i~~~I~b~r~~ a
(disease Of injury that initiated the
events. resul1ing III dealh) LAST.
b.
i/~I
Due to {or as a consequence oQ: {
Ilct.J1 ( O~/;,.i/c.ho""
~~~~Je~~t~~~ J~~~\ dise::;.
Due to (or as a consequence o~:
Due to (or as a consequence on:
""
D Yes [2(~o
300. Were Autopsy Frndiogs
Available Poor to Completion
of Cause 01 Death?
DYes~
31.Ma~DeaIh
~tural o Hornicide
o Accident 0 Peocllng InveSligation
o Suicide 0 Couid No! be Determined
32d. Time of Injury
32g. locatloo ollnlury (Street. cify I lawn, state}
303. Was an AufOpsy
Performed?
33a. Cer1ifier(check onlyonel
CertIfying phy1leian (Physician certifying cause of death when another physician has pronounced death and COmpleted Item 23)
To rMbestotmylcncwfedge, deoath occurred due to the cause(s) and manner as stated-.. _ _ _ _ _ _.. _ _ _ _.. _.. _ _ _ _.. _ _ _ _.. _ _ _ _ _ __
~~::~~::: :=~J:.~~a~~;~~~ :~i~~~~n~:;:~~~a:rt~:~ot~hC:=~~:~ manner aa staled_ _ _ _ _ _ _ .. _ _ _ _ _ _ _ _ .... 0
~:::tl:5m~~~~;~=: and I or Investigation, In my opinion, death occurred at the time, date, and place, and due to the C8Use{S) and manner as staled_ 0
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Date Signed (Month, day, year)
I-/{" -<4-
I 2./l-r I D II 1,0,1
36. Date Filed (Month. day, year)
/- (5 0 R
Disposition Permit No
0079645
LAST WILL AND TESTAMENT OF
Lillian M. Peechatka
I, Lillian M. Peechatka or the Township of Pocono, Monroe County, Pennsylvania being
of sound and disposing mind, do hereby make, publish and declare the following to be my Last
Will and Testament, revoking any and all previous wills and codicils made by me.
APPOINTMENT OF FIDUCIARY
I appoint my son, Walter Norman Peechatka as personal representative of my will. Ifhe
has predeceased me or is unable or unwilling to act, or to continue to act as my personal
representative, I then appoint my daughter, Beverly Ann Y oungken as my personal representative.
No bond or other security of any kind shall be required of any personal representative appointed
in this will. My personal representative, whether original, substitute or successor, shall hereafter
also be referred to as my "Executor".
ORDERS AND DIRECTIVES TO MY EXECUTOR
i'.--,\
I order and direct my Executor to payoff my funeral and other expenses in connection ::.:
with the administration of my estate as soon as reasonably possible, or as he determines hihis sOle
discretion to be the most advantageous, should payment not be immediately due. ~
BEQUESTS
I hereby bequeath the rest, residue and remainder of my entire estate together with any~
insurance proceeds thereon:
A. To my son, Walter Norman Peechatka and my daughter, Beverly Ann Y oungken
to share equally and absolutely, provided each survives me by thirty days. If either
does not survive me by 30 days, I bequeath his or her share as follows:
B. If my son does not survive me as above, then I bequeath his share to be divided
equally among his wife, Bonnie, and his then-living children
C. If my daughter does not survive me as above, then I bequeath her share to be
divided equally among her then living children
IN WITNESS WHEREOF, I have hereto set my hand and seal this
/I~
day of
/1-r)l--er,,-~/
,2000.
~;LLi~ In, 1?e~~~?l--
Lillian M. Peechatka
Page two of two, Last Will of Lillian M. Peechatka
We, having been duly qualified according to law, depose and say that we were present and
saw Lillian M. Peechatka sign the foregoing instrument as her will, that she signed it as her free
and voluntary act for the purposes therein expressed; that each of us in her sight and hearing and
at her request signed the will as witnesses and that to the best of our knowledge she was at the
t~~und mind and und r no constraint or undue influenc. e.
C-& ~f . ~
l... _' / tL-
~.vitness sIgnature Witness I nature -/
Y)1,) \\~ E. ~\~II\~
Witness . nted name
:::b/I;U /I] ;3.Ey-#A&l-
Witness printed name
//-//-0:9
Date
I \ - \ \- 00
Date
OATH OF NON-SUBSCRIBING 'VITNESS(ES)
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
Estate of
riff/eLf) M
~ec~{c~
?eEC ~v- -H~
, Deceased
Jfp!1 (-h- !-
and
(eaCh). being ~UlY qualified according to law, d os., (s) ~ndfay(s) that she / he / they was / were ."~ell-
acquamted wIth t:Lv1;1,.1 e eL~tv..... and am/are f:;rylllIar
with the handwriting and signature ofthe decedent, and that the signature of /.1 ( 110.. "1 /l-1 t'12J2... ( L ~H L---...
to t~oregoing instrument purporting to be the Last Will and Testament/Codicil of l--i { I, Q-1 M;
r e EG{1 0- -f.--t:, is in his/her own proper handwriting.
(Signature)
(Street Address)
(City, SIll/e, Zip)
Executed ill Register's Office
Sworn to or affirmed and subscribed
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Form RW-04 rev. /0./3.0.6
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
Ltate of L i 1114 V1.
M )/e e'C- ~ /:1 if(q
, Deceased
!V~ ltc'\' {'J )~->ec ~ /J'1- kt1
and
(each) being duly qualified according to law, depose(s) and say(s) that she@)hey was / were well-
acquainted with L-! / J, /? Y\ /Vi. rJ Y" ~ t' t1 a t~ and, an1i!)fe fami.1iar
with the handwriting and signature of the decedent, and that the si ;nature of l j~),a yl /'1, f?~>ch c/jlG.-
to the foregoing instrume~1t purporting to be the Last Will and Testament/Codicil of L I J))q 11
f1l. }'7 e e c hLJ +kC/\ is in his/her own proper handwriting. n
r'...:
.-
(Sig/lature)
(Street Address)
I 7 cl (
(City, State, Zip)
Executed ill Register's Office
Sworn to or affirmed and srbscribed
bef03m~ this ,;< d. nc day
of ~ (~' :JDO?: .
~puty ~1
For/ll R W.04 rev. I IJ. /3. IJ6