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Home My WebLink About03-13-08 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF (', u JY? h t' / /a " <-f COUNTY, PENNSYLVANIA , Deceased FileNumber ~ /-Og- - Oo?SD Social Security Number ~), ~ ~ '~...3 c; 6 0 Estate of r. 'A /' /-. :5 also known as o /Jee/ :Il< f 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 1--' ~~~~ .. '" named in the , ~ _.- j.1 (...J (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 instmment(s) offered , r _.~) for probate, was not the victim of a killing and was never adjudicated an incapacitated person: 'f . " ~, Grant of Letters of Administration (Ifapplicable. 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) ~ 30 "tf ~j/V (COMPLETE IN ALL CASES:) Attach additiollal sheets ifllecessary. Decedent was domiciled at death in -tI C"';- 4 c4 Decedent, then Y f;, years of age, died on 3 / .J / v l5 at J ()"3 .;z., '7 <I s-/. Decedent at death owned property with estimated values as follows: (If domiciled in P A) All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania situated as follows: jJ f!./:::,' a/1'~ I /f" -f,'/f'""""iC'~ r I? A h-f.~,h./ qr $ $ $ $ ~ (j,. 0,,",,,,,, ~.>-~ 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: Ty ed or rinted name and residence J}f':e ( tc/es T h//ur 'p~~ rA /76:><' Form RW-02 rev. /0./3.06 Page 1 of2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tme and conect 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 tmly administer the estate according to law. before me the day of Signature of Personal Representative C) '~.:~ 0 " ,""-', ::~X~ Signature of Personal Representative ; I I File Number: ~ / -{)'c3- OJ-8! I Estate of C A.)jLli~ ~ lliJ j ~ (' ~.i r"'.J' , Deceased Social Security Number: .;2do-lo LI ~ ,-~q(oO Date of Death: '3 - 3 - 08 AND NOW, V'Y\(l r- c k l 2) ,dudS(' l in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Ac fY\ I () i sir (\-J-l Or-. are hereby granted to \'\a-..o~. l ~\ 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 ( nd Codicil(s)) of Decedent. FEES Letters .............. . $ Lf CJ . fJ{) Short Certi ficate( s) . . . . . . . . $ 4.cO Attorney Signature: Renunciation(s) ......... . $ -J CP $ \O.(~ Attorney Name: ~ 'T"''<Y\ 4. +- \ ":f<" $ C, (/V Supreme Court LD. No.: $ $ Address: $ $ $ $ Telephone: $ TOTAL ............. . $ l'i. tfU Form R W-02 rev. 10.13.06 Page2of2 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Pee lor thi~ certificate, $6.00 P 14123081 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 Records Office for permanent filing. ;~ lJ? ~.. M~R 06/Z00B Local Registrar Date Issued :- , .;;i) C.') ). :r::"_'_:t ; -~ c...) N ~EV 1112006 PAINT IN ANENT ;K INK #31-230 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (See Instructions and examples on reverse) 1. Name of Decedent (Rrsl. mWe, last, suffix) Curtis Deel, Jr. D 5. Age (Last Birthday) 12. Was Decedent ever in the U.S. Armed Forces? o Yes C3No 13. Decedent's Education (Specify only higheSI grade completed) Elementary I Secondary (0-12) College (1-4 or 5+) 8 6. Date 01 Birth (Month, da , year) 46 Feb. 12, 1962 BaltinDre, Maryland Vrs, Bb County of Death 8cl. Facility Name (If no1 institution, gi'18 street and number) Cumberland 308 2nd Street most of world Ine. Do not stale retired Kind 01 Business f JnduSby McItmalds Corporation 11 . Decedent's Usual Occu lion Kind 01 work done du Kind 01 Worll. Maintenance 16. Oecedenfs Mailing Address (Street, city /10Wll, stale, zip code) 308 2nd St. West Fairview, PA 17025 Decedenfs Actual Residence 178. Slate PA 17b.County (l rnPT 1 ;OM 14. Marttal Status: Married, Never Marriad, Widowed, Divorced (SpecifY) Widwed Old Decedent Uveina Township? 17e. aQ Yes, Decedenllived ill Ea..:; t Pennsboro 17d. D No, 09cedenllived within AcIualUmIlsof Twp City / Born 208. Inloonanfs Name (Type I Print) Naani 1. Deel 19. Mother's Name (First, middle, maiden surname) Naani 1. Enos 2Ob. Informant's MaNing Address (Street, city I town, slate, zip code) 308 2nd St. West Fairview, PA 17025 21c. Place 01 Disposition (Name of cemetery, crematory Of other place) 18. Father's Neme (First, middle, last, suffix) Curtis D. Deel Sr. 21 a. Method 01 Disposnion s PA 17065 22c. Name and Address of Facility Richardson FUneral IlenE Inc. 29 S. Enola Dr. Enola, PA 17025 hems 24-26 must be completed by person who pronounces death 24. TIme of Death 25. Dale Pronounced Dead (Month, day, year) March 3, 2008 26. Was Case Referred 10 Medical Examiner I Coroner for a Reason Other than Cremation or Donation? ~Yes ONe Approximate interval" Part II: Enter other sinnllicanl CMCtitions conlriblltino to dAath, 28. Did Tobacco Use Contribute to Death? Onset to Death Dut not resuhing in the undertying cause given in Part I. D Yes 0 Probably o No 0 Uoknown 3:00 CAUSE OF DEATH (See Instructiontl and examples) Ilem 27. Part I: Enter the ~ - diseases, iniuries. or complications - that directly caused the death. 00 NOT enter terminal events such as cardiac arresl, respiralol)' arrest, 0( ventricular fibrillation without showing the etiology. UsI only one cause on each line =~~a:~'~~~)d~~ a. Occlusive Coronary Artery Disease Due to (or as a consequence on sequen:~~~=.c:, ~ a ~ UNDERLYING CAUSE ~~~~rytn":iail~lmre b. Due to (or as a consequence on: Due to (or as a consequence of): d. 308. Was an Autopsy Performed? 3Ob. Were Autopsy Andings Available Prior to Completion 01 Cause 01 Death? 31. Manner 01 Oeath ~atural 0 Homicide o Accident 0 Pending Investigation o SUicide 0 Cot<d NoI be De~rm;oed M. 321. IfTranspoftalioo I~u~ (Specify) o Driver I Operator 0 Passenger OPedestrian OIhar - Specify: D. Signature and Till ~Y" 0 No '!)d..ves 0 No 32d. Time of I~ 338. Certlller (check only OIle) =::'~i=.n==:'de:n:=~~~n:, ~ ::..~_ ~~_a~ ~~~ ~e~~~ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ 0 .,. ;::u:rn:. -= :'~~::~':c1a: =fl::=r:::':~~~1ol~=~:~ manner.. stBted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 MedlClI Eumlner J Coroner On the besl. of examination and / or investigation, in my oplnlon, death occurred at the time, date, .nd p1ac., and due to the cauJe(a) and manner 18 statecL 23b. Ucense Number 23c. Date Signed (Month, clay, year) Remote MI 29. 11 Female: D No! pregnant within pasl year o Pregnantaltimea/death o Not pregnant, but pregnant within 42 days a/death D Not pregnant, but pregnant 43 days 10 1 year before death o Unknown it pregnant within !he past year 32c. Place of Injury: Home, Farm, Street, Factory, Office Building, etc. {Specify} Coroner 33d. Dale Signed (Month, day, year) March 5. 2008 34. ~~fi"1 ~ ~8'f'll.''f'S'':'" ~em€l:-T,pe /Priot 6375 Basehore Road! Suite #1 Mechanicsburg, PA 7050 DisposiUon Permit No.