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Home My WebLink About02-27-08 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Dora K. Zook also known as File Number ;).1- 02' - ();l Of , Deceased Social Security Number Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' OR 'B' BELOW:) D 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 after 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: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) 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.) Name Relationshi 17240. Jeremiah Zook souse .-'-', > (COMPLETE IN ALL CASES:) AUach additional sheets ifnecessary. 0::- Decedent was domiciled at death in Cumberland County, Pennsylvania, with his / her last principal residence&: 80 Zook Lane Newbura. Hooewell Townshio Cumberland County PA 17240 (List street address, town/city, township, county, state, zip code) Decedent, then 56 Cuvmberland County years of age, died on 1/14/2008 at Hooewell Townshio Pennsvlvania 17240 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 $ $ $ $ 45.000.00 0.00 NONE 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: Typed or printed name and residence Jeremiah Zook 80 Zook Lane Newbur PA 17240 Page 1 of2 Form RW-02 rev. /0.13.06 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA : 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 ofPetitioner(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 the ~ day of FebrU::II:Y , 2008 Signature a/Personal Representative ~ o,rc\,'-'~ ~er ~ Sigoa"'~ qf"~1 lie""""""" ~_.~ -::(~ . '-1~] ~ - r ,I ..~ ! --;_._.; ,"I _":"~J t,__.J r:;.:;, ---:j r-q ;:;::, 1') --l :-r~ -:f / ~'. ):~ File Number: c2 I - O't - ()cJ. 0 '1 ";,1 C~ C;, \D Estate of Dora K. Zook , Deceased Social Security Number: Date of Death: 1/14/2008 AND NOW, February ;2. "( , 2008 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Adminitration are hereby granted to Jeremiah Zook in the above estate Letters ............................. Short CertifIcate(s) ............ Renunciation(s) ................ ...j~p ~~tl~\ t"'" 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. '~~~~~~~+ Attorney Signature: ,---~ ~ _ ~ FEES TOTAL ............................. $ gn. {)() $ );;:l, C'.C> $ $ $ $ $ $ $ $ $ $ $ \() .Do 5-co Attorney Name: H. Anthonv Adams Supreme Court I.D. No.: 25502 Address: 49 West Cranae Street Shiooensbura PA 17257 Telephone: 717-532-3270 i 1""1 .CI.:> Form RW-02 rev. 10.13.06 Page 2 of2 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 p 14007483 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital s Office anent filing. oJ" ,_::.::r c-::> -., i71 ()7;j r" --.J )::-... -- .) (y) C~ \.!) H105144 REV 1112006 TYPE I PAINT IN PERMANENT BLACK INK 1/31-188 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (See Instructions and examples on reverse) STATE FILE NUMBER ~I 1, Name 01 Dececlenl (Fin;i, middle, last, suflix) DORA 5. Age lla~ Birthdo,) K. lOOK 6. Dale 01 Birth (Month, day, year) 56 Feb. 6, 1951 y~ 8b, County of Death Cumberland Set Facility Name (1I noi Institution, rjle street and number) Intersection of PA Rt.696 &'Rt.997 13. Decedent's Education (Specify on~ highest grade completed) Elementary I 5sdary (0-12) College (1-4 or 5+) Did Decedent Live in a Township? 17c. r1J Yes, Decedent Lived in 17d.D NO,C/ec$denlLivedwithin Actual limits 01 CilylBoro moslolworki lila.Donot5taleretired Kirn:l 01 Bl.ISinessl Industry 12. Was Decedent ever in the U.S. Armed Forces? Dyes ~N' Decedent's AcIU11 Residence 178. Sate Pennsylvania Cumberland - 16. Decedent's Maihng Address (Streel. city / town, stale, zip code) 80 Zook Lane Newburg, PA 17240 17b. County 4. Dale of Death (Month. day, year) 4527 January 14, 2008 14. Marital Stalus: Married, Never Married, Widowed, D_ISpecilJ.j Married Jerry Zook Hopewell Top 18_Father'6Name(Firsl,middle,~.sutlix) Christ R. Glick 19. Mother's Name (FifSl, middle, maiden surname) Mary King 2Ob. Inlormanl's Mailiog Address (Street. city / lown, stale, zip code) 80 Zook Lane, Newburg, PA 17240 208. Inlormant's Name (Type I Print) J~rry Zook 21a. Method 01 DispositlOl1 ~ Burial 0 Removal from Stale o Q1he,-Spedty :- :2 ( 21c. Place 01 Disposition (Name 01 cemelery, crematory orolher place) 21d. location (City {town, state, zip code) Lurgan Township Franklin Ct., PA 17240 Mountainview Amish Cemetery 22cN",..a"'Add",,~Foci.y Fogelsanger Bricker Funeral P.O. Box 336, Shi ensbur PA Items 24-26 must be c:ompIeted by person who pronounces death 24. Tmeo1Dealh Aprx. 3:00 P. 25. Date Prooounced Dead (Month, day, year) M. January 14, 2008 CAUSE OF DEATH (See Instructions and examples) Item 27- Part I: Enterlhe~-dlseases, injuries,or~tions-thaldired.lycausedtnedeath. DO NOT enlerlerminalevenls such as cardlScarrest, respiratorysrresl, or venlricular librillalion wilhout showing the etiology. Uslooly one cause on each line ~~~;:s;t~~ d~~ll disea...::. Crushin2 Chest lniuries Due to (or as a oonsequence of)' b. Motor Vehicle Crash Due to (or as a consequence of) ~~~Ii~~~~:~'~ ~i~ a. Ent~e UNDERLYING CAUSE (dIsease or injUl)lthalinilialedthe e\lenls resuhlng to death) LAST. Due 10 (or as a consequence of) d. 3Oa,WasanAutopsy Perlonned? :n. Were Autopsy Findings AvaMable Prior to Comple1ior1 of Cause of Death? 31. Manner of Death D Natural D Homicide ~Acciden\ DPendirlglnvesligation o Sui"'" 0 COO, Not be ""am'" 3:00 Dyes ~NO Dyes ON' 32d. Trne 01 Injury ffi Iii ~ ~ o ~ 338. Cel1ilief (checll only one) ~~~:=~n::~~~:~=:.e ~t~:n~;:~h=~ ~:.~ ~:h_8~ ~~I~~ ~e~ ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 .. :c::':ec~~:,.~~ ~=~~~~a:c~:::: t:~i:~~n~~;::;~~Z;~ol:,:~~~a~~ manner as sl8tecL _ _ _ _ _ _ _ .. _ _ _ _ _ _ _ _ _ 0 Mtd4ca1 Examiner / Coroner On the buls of examinatIon and rred 81 the lime, dale, and piece, and due to the cause(s) and manner all slated- 35. Registrar's Sigoatur~ anQ ~ ' Disposition Perm~ No. 230. Data S~ned (Month, day, 10"1 26 Was Case Referred to Medical Examiner t Coroner for a Reason Other than Cremation or Donation? ~yes DNo Approximate intelVal: Part II: Enler other sionnicant condIIions contnbulioo 10 death, 28. Did Tobacco Use Contribute to Death? Onset Ie Death but nollesuKing in the underlying cause given in Part L 0 Yes 0 Probably ON' DUok_ 29,"Fernale o Not pregnant within past year o Pregnant 111 time 01 death o No1 pregnant, but pregnant within 42 days of death o No1 pregnant, but pregnant 43 days Ie 1 year beloredeath o Ullknown if pregnant w~hin the paSI year 32c, Place 01 Injury: Home, Farm, Street, Factory, OII,ceBuilding,~c~~~l Road 32g, Location of Injufy (Street, city/town, stale) Enola Road, Newburg, PA Coroner 33<1, Date Signed (Monlh, day, year} January 34, Name and Address of Person Who Cornpleled Cause 01 Death (Item 27) Ty~ t Plin1 Michael L. Norris, Coroner 6375 Basehore Road Suite #1 IS, 2008