HomeMy WebLinkAbout02-28-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Estate of BRIAN JAMES BARGER
also known as
File Number
a \ ()~ ()8d~
Social Security Number 177 t:bO 6 f)?~
, Deceased
JAMES E. BARGER Mlel ieULAH BAnOeR-
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
c"')
. named in the
" ::i.J
. .
t~~J
7',~
0)
(Stale relevant circumstances. e.g.. renunciation, death of execulor, elc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrumen~~ offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
00 B. Grant of Letters of Administration
c:
(If applicable, elller: c.I.a.; d.b.n.c.l.a.; pendente lile; durante absenlia: dumllle minorirale)
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: ((f
Administration, c.t.a. or d.b.n.c.t.a., enter date C?f Will in Section A above and complete list (!f heirs.)
Name
Relationshi
Residence
BARGER
MIN
N
37~' S
MINOR S N
(COMPLJi:TE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his / her last principal residence at
(Lisl Slreet address, tOl+n/cily. IOwnship. cOJ/llty. stale. zip code)
Decedent, then 40
years of age, died on 2/10/2008
at
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PA) Personal property in Pennsylv~U1ia
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
$ /,tJ01.CO
,
$
$
$
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 appropliate form to
the undersigned:
J-
Signature
Typed or plillled name and residence
e
JAMES E. BARGER
129 CLOUSER ROAD MECHANICSBURG PA 17055
.etJ:EL/\11 LJAnOER
Form RW-02 rev. 10.13.06
Page 1 of 2
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 of Petitioner(s) and that as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
before me the
Sworn to or affirmed and subscribed
Signature of Personal Representative
B~.Jt IlbslAII~
Signafllre of PersOlUlI Representative
t~-\
File Number:
~ \ (jQ G9-.~~
Estate of BRIAN JAMES BARGER
, Deceased
.~...
Social Security Number:
Date of Death: 2/10/2008
(- ~ ~
AND ':-./OW, , 2008 , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters ADMINISTRATION
are hereby granted to JAMES E. BARGER a~g Q[I:JLAII w~~n
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
FEES
Letters ........L.P9.9......... $
Short Certificate(s) ....6-..... $
Renunciation(s) ........1........ $
.JCP $
Av,-1u $
$
$
$
$
$
$
$
TOTAL ............................. $
Attorney Name:
:;)0
~6
,S
10
~
Attorney Signature:
Supreme Court 1.0. No.: 15489
Address:
WIX. WENGER & WEIDNER
PO BOX 845. HARRISBURG. PA 17108
Telephone:
(717) 234-4182
lDOa>
Form RW-02 rer. 10. J 3.06
Page 2 of 2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
!"t'L" (or thi\ c...'nlh(.-: 1c,')6 00
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~em-#- 6 _;JuuiJ yetUi :
/"'-tLYC~ /b; /flt'
'-k- o2//3/{)g'
rhi, i; 10 ~'l'rul) llut the inforJnatJ'.lf1 h,~re gi\en i\
correctly c()pied (lclin an \lrigillal Ceniflc'at<: cf Death
duly filed w!lh me ;1\ Local Regi\ti'ar. The uriginal
c-crlificalc' \lill he lOr\\ arded [I' the Stale Vital
Rc~cord\ Otfice fer 1L'r1nanent filil1~,
~'1
~ 13 /OL
D:lle lc"ucd
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C"J
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1131-212
1 Nar'r\Q 01 OecedEml (Firs!. midde, last, sullit)
Brian
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
(j ~ (jd-.:A~
H1OSI44 REV 1112006
TYPE / PRINT IN
PERMANENT
BlACK INK
J
Barger
6. Date of Birth (Monlh, da , yearj
r_IC
Meehanltsburg, PA
5 Aqe lu~ &,""."
39
". _",Educalion(Spedlyonlyhi(/<esf.""Io,_,
EI_1arf12""""(IH2, College ("''''5>)
y",
March 16, 1968
8b. County 01 Dealt!
Sd. Fac~ity Name (It not institution, !jvt street and runbef)
Cumberland
11-C Richland Lane 11209
11, Decedent's Ul;ua! Occ tion Kind Of wo.1c: done dtl
Kind of Worll,
Forklift Operator
moslof lileDonotstateretif
KiIldolBusinessllnd,vstry
Warehousing
12. Was Decedent ever in !he
U.S. Aimed Forces?
DYes Cilt<o
Decedent's
Actual Residence 17a. ~te
. 16. Oecedenl's ~Iailing Address (Street, city (lown, state, ~ codel
11-C Richland Lane
Wormleysburg, PA 17043
PA
Cumberland
17b Counly
t9. Mo(he('s Name- (FIfSt, midlte, maiden sumame)
Beulah Zimmerman
18 Father's Narili (first. middle, last, suftill)
James E. Barger
20a. lflloanant'l. Name (Type I Print)
3. Social'Secl.lrityNUtT1ber
177 - 60 - 6858
Sa. Place of Death (Check one)
Hospilal, 0Iher,
o I"",he'" 0 ER I Oulpa.... O!lOA 0 N"""II Home 'till..........
..Was_oIHispenicOri~n? g.No DYes
(" ,es, -'Iv Cuban,
Mexican. Pueno Ftic:an. etc,)
00lher . SpeoIy,
10. Race: Nnerican Irdan, 8Iack, WNte, ale
(- White
14. Marital staIu$: MarriEKt, Never MarrWtd,
W_ed, DivO<Ced (_
Divorced
T..
();d_
Uveina
Township?
17e. 0 Yes, Decedent Lived in
17d.{] ""._Uwd_
AduaI Limits 01
Wormleysburg
Cllyl8oro
James Barger
2<<1. Informant's Mailing Address (Sl:reet, city/lawn, state, lipcooel
129 Clouser Road Mechanlcsburg, PA 17055
21dl~(Cllyr_,_,Zip_)
Camp Hili, Pa.17011
2k Place ol Disposition {Naml't of cemetety, ClfJmaloly or other place)
Slate Hill Cemetery
"
\1
~
..
'I
22c Name aodAddress 01 facility
Myers Funeral Home, Inc. 37 East Main Street Mechanlcsburg, PA 17055
Items 24.26 ml.l$t 00 completed by person
who pfOOOUOCllS dealh f..
25. Date Pronounced Dead (Month, day, year)
February 10, 2008
CAUSE OF DEATH (See In.tructfon. 8nd 8X.mpIe.)
l1enl21. Part I: En\eI' ltle ~~ - Qiseases, illju08s, Of cornpfica(jons ~ lhal dir&cl)y~!he death. DO NOT Ellller terminal evenls such as carooc arrest,
le$pililory arraS!, or vllfltricular fibrilahon wMout showing !he etiology. List only one cause 01'1 each QIlIl.
I WOllimateWrterval
: OnsettoDealh
,
.
,
,
,
,
.
,
J
,
.
.
.
.
,
~J:'~:~S:~~l\1l$e~
Pending Investigation
Due 10 lor at a COfl$8QlJ&OCe 01)
~*COOdIlion$,ilanv,
~UNDE~::.~:u;ee a
~~~~~U)~~~re
b.
Due 10 lor as a OOfIsequence oI}:
Duo 10 (or as a consequence of)
d.
30a Was an Autopsy
Peoonned?
~. Were Autopsy Findings
....vailabMlPrior\o~ellon
olCause 01 Oeatn?
DVes ~No
31 Manner of Death
o Natural 0 Homicide
DAccident .,k&pendlnglnvesUgation
o Suicide 0 Gould No{ bEl 0etetmirN:d
M
32d TtmeotlOjury
~'" 0""
s;
~
~
:5
I
33a. Cel1ifler (check only one)
~.~=~~:=O:=:'~~~u::7.:=r:~~_~a_~~~~~~:n~~_.._____________.._ 0 ..
~;;=:""':t~~:Ian~~~O:~:i:.~~~.:r:.iolo':=~:~nwmtf.. ....ed.. __ _ __ _.. _.. _ __ _ _ _ _ _ 0
= ~~~"'o.~~::'O;: and I or lny..tlgatM)n, In my opinion, dHlh occurred .11hI time, date, tIId pIKe, and dl.ll to thI cauM(1) and IMOhIf as..1ed.. ~
1,21 / L:Z I / l2 I
n;~"""-itlnn P'umil No
23b. license Numb&J'
2:lc Date Signed (MoIlIII, da" ,..,)
26. Was Case Aelerred 10 Medical Examiner I C()(OO8{ lor a Reason Other lhan Cremation or 00naD0n7
H,y", ONo
Part K: EnIer ~ sianIfican( CQIilj(joos ~ ft'ld8alh, 28 0icJ 1ctlacco Use CantOOute 10 DeaI'l?
tltAflO(reSlilioginlhe~ca~givet1Wl.f>aI1J 0 V8$ DProbabIy
o "" 0........
29 It FemaJe
o NcI"''''''''''''''''''"'''''"
o ,,-a1"""aldoalIJ
o Nor ptegnanl, tkA ptegnanl WIVWt 42 da)'i
aldea1h
o Not pregnam, 0tA ptegnatlf 43 days. 10 1 year
_......
o ........ I "'......."""'... ""',..,
32c Place 01 Injury: Home, fann, Street, Faaory,
Oftice&olding,"'(SpedIy1
Coroner
33<1. Oato S910d (lIooI!I, da" ,..,/
February 12,
34. Name and AdOreR of Person Who Completed CaU$ll of lJrea1h lnam 27) T)1)e I Print
Michael L. Norris, Coroner
6375 Basehore Road! Suite III
PA 7050
2008