HomeMy WebLinkAbout03-10-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF (;JMt5E;( ll}.fYV
COUNTY, PENNSYLVANIA
, Deceased
File Number JI- 02(jJt- tJ:2t;t/
Social Security Number
Estate of
also known as DA VI' 0
GAI'1"RE
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 I are the [,,/; r V trIlL
last Will of the Decedent dated !)(~, If ""2.(!C .? and codicil(s) dated
)
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named in the
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(State relevant circumstances, e.g., renunciation, death of executor, etc.)
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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 oHhe'instru~(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ---,
o B. Grant of Letters of Administration
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(Ifapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante /Jlinoritat~...
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
Relationship
Residence
~I
V9~r ~/Hi-
6'0 (Pi'l'l
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
situated as fOllOWS:./ivtrJMdtiLi.
$ '19 or}. C'Ii
$
$
$
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:
IY'
!of !i-J b tll< h,
IIC n-
Farm RW.02 rev. 10. /3.06
Page 1 of2
Oath of Personal Representative
COMMONWEAL TH OF PE"N"NSYL VANIA
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COUNTY OF ell fYl[prlafti .
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing PetitionG~iruea.n~ c6rre~t'to the best of
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e Decedent, Pehboner(s) will wen and truly
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of
,
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r,gn~t're of Personal Representative
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the I (j V-A day of
'!f/!JJ &lOa;
LA l~ .It;~
. ~FO"h~
"nature of Personal Represelllative
Signature of Personal Representative
ol/'dOOg- 112&1
f'c aIr~
Social Security Number:
AND NOW, /('10ACh /0 ';1200<t
having been presented before meAl}' IS DE~E /
are hereby granted to..J2ej Ian l!e/ L
~ctmbe.y <:( I UC()~
File Number:
Estate of ~Vi'd
Date of Death:
, Deceased
~(2~ vltJ o?tJ[f
ration of the foregoing Petition, satisfactOlY proof
in the abc.ve estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of recor
FEES
Letters ............... $~' 0';;
Short Certificate(s) . . . . . . . . $ 1v [4
R,"undotion('J .. .~~;( :1 S::'v
Jt $ IOu)
jjl ... $ !i
.. . $
.. . $
. .. $
. .. $
.. . $
'" $
HI). 60
TOTAL. '" . . ... . . .. . $ . IV'
Attomey Signature:
Attomey Name:
Supreme Court LD. No.:
Address:
Telephone:
Form RW-O] rev. 10. /3.06
Page 2 of2
H \05.805 REV iOl/07i
tJfoZY'
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 14122588
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
~ ~ ~ FEB/z 6 7~OB
Locaffiegi, rar r~ Date Issued
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REV 1112006
PRINT IN
AANENT
CK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
1. Name ol Decedenl (First middle, last. suflix)
.:r::lf\1I10 ~
5. Age (Last Birthday)
13. Decedent's Education (Specify only highest grade completed)
Elementary I Secondary (0-12) College (1-4 or 5+)
12 2
6. Date 01 Birth (Month, day, year)
92 Yr>.
8b. County of Death
Nov. 8. 1915
Manhattan. NY
Sd. Facility Name {If nollnsmution, give street and number}
Cumberland
Manor Care
1~. Was Decedent ever in the
U.S. Armed Forces?
IXJve. ONo
Decedent's
Actual Residence 17a. Stale
17b. eoooty
11 . Decedent's US/J81
KindolWorl<
Buyer
. 16. Decedent's Mailing Address (Street. cily I town, stale, zip code)
1700 Market Street
Camp Hill. PA 17011
18. Father's Name (FirSt. middle, last, suffix)
Max Sander
Pe1lll$ylv..ni..
Cumb@Tland
--.)
3. Social Security Number
083 - 01 - 3643
4. Date of Death (Month, day, year)
February 24. 2008
8a. Place 01 Death (Check only one)
Hospital: Other'
o Inpatient 0 ER I Outpatient 0 DCA KI Nursing Home 0 Residence DOther - Specify
9. Was Decedent 01 Hispamc Origm? IX) No 0 Yes 10. Race:.American Il'Idian, Black, While, elc
(If yes, spetify Cuban, (Specify)
Mexican, Puerto Rican, etc.) Vb! te
14, Marital Stalus: Married, Never Manied,
W_. 0"'0_ (Sped'"
Widowed
Twp
Did Decedent
Uveina
Township?
17c.D Yes, Decadent Lived in
17d. ~ No, Decedent Lived within
Actual Limits of
City/Bora
Cmqp DB 1
208. Informant's Name (Type I Print)
Mr. Joel A. Centre
19. Mother's Name {First, middle, maiden surname)
Gussir Stiogatski
2Ob. Informanfs Mailing Address (Stfflet, city ( town, state, zip code)
1438 Raven Hill Road. Kechanicsburg. PA 17055
21c. Place of Dispasllion (Name of cemetef)', crematory or other place} 21d. Location (City I town, stale, zip code)
'" 21a. Method of Disposition
Cremation Society of PA Harrisburg. PA 17109
22c. Name and Address 01 Facility Auer MeJIOrial Home and Cremation Services. Inc.
:a~J1:rN<eL<-
Complete 1_ 23a-c ooIy _ cerlifying
physician is not available at time 01 deatt1to
certify cause of death.
Items 24-26 musl be completed by person
who pro<1OUI1<:8$ death.
CAUSE OF DEATH (See Instructions and eX8mptes)
Item 27. Pari I: Erner the ~ - diseases, infurtes, or complications - that directly caused the deam. DO NOT enter terminal events such as cardiac arrest,
respiratory arrest, or ventf'icular fibrillation without showing the etiology. Li$t only one cause on each line.
I Approximate interval:
I OIIsettoDeath
1
I
i I tic'y
I
I t'
: 01 etA) 'Ie"
1
I
I
I
I
1
=,~~~~,~d~
a Co.iJ'loc Am..<;;t-
Due to (or as a conseq~ oij:
b \-\etl4 -p'rvj'.l!W(e.
Due to (or as a consequence of):
~:he~ca::::'~~a.
= UNDERLYING CAUSE
~~mu:i.~r.lU"
Due to (or as a consequence of):
308. Was an Autopsy
Performed?
d.
3Ob. W... Autopsy Foongs
A~Priorlo~etioo
01 Cause Of Death?
31.~oIDeeIh
[j?'Nalural 0 Hom_
O Accldera 0 PeOOng In....ligation
o Su<kIe 0 Could No! be ~ined
M.
OVes )Zf'No
OVes ONo
32d. lime of Injury
33a. Certifier (check ooly one)
. Certifying phyafclan (PI1ys<cian cerlifying CJJUSa 01_ _ ano/I1eI p/lysJcian />as pronouncod dealh and comp~lod lIem 23)
_ .To the best of my knowledge, deattl occurred due to the ClUee(I) and manner 88 sIIted.... _.... _ _ _.. _... _ _..... _ _.... _.... _.. _.................. 0
~=~f:=~::C~U:::~I:'~n~~::~10tou:~::'et:~~ mannerss stated............. _.. _................... _ 0
. ~:~;~m~:,:~~;:: and I or Investigetk)n, In my opinion, dellth occurrad lit the ttme, date, lIftd place, and dw kI the cause(s) and manner as stated... 0
I oll'I..{I/ I" I
D~posll;on Permit No. 0195634
L
26. Was Case Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation?
OVe. ~
Part II: Enter other sianificant enndilions conlributina 10 dBath,
but not resuning in the undertylng cause given in Pari I.
28. Did Tobacco Use Contribute 10 Death?
o Yes 0 Probably
~o 0 Unknown
29. II Female
o Not pregnant within past year
o Pf9g1Tettlathmeoldeath
o Not pragna11t, but pragnanl within 41 days
of death
o Not pregnant, but pregnant 43 days to 1 year
",tore dealh
o Unknown if pregnant within \he past year
32<:. Pface of Injury: Home, Farm, Street, Factory,
DfficeBui~ing,elc.(Specify)
-h1I-iM(( tv -fhdve
~wf ort Cofe
A-ty ICJ P,- br,itl.A-ftV/
32g. Location of Injury {Stree!, clly ( lown, state)
J)h'M
"2../~5/2.Jri3
JI- ;}{)O?-Dc2fvt
LAST WILL AND TESTAMENT
OF
DAVID CENTRE
I, DAVID CENTRE, now of 4833 East Trindle Road, Mechanicsburg, Cumberland
County, Pennsylvania, being of sound and disposing mind and memory, do make, publish and
declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any
other time previously made.
I have a son named Joel A. Centre (hereinafter referred to as "My Son"). My Son's
spouse is named Linda A. Centre (hereinafter referred to as "My Daughter-In-Law").
1. TANGIBLE PERSONAL PROPERTY.
I give and bequeath all of my household furniture and furnishings, automobiles,
appliances, books, pictures, jewelry, wearing apparel, articles of household or
personal use, to My Son. If My Son is not living at my death, then I give all of
my TANGIBLE PERSONAL PROPERTY to My Daughter-In-Law.
2. RESIDUE.
I give, devise and bequeath all of the rest, residue and remainder of my property,
real, personal and mixed, not disposed of in the preceding portions of this Will,
to My Son, if My Son survives me. If My Son does not survive me, I give, devise
and bequeath said residue to my Daughter-In-Law.
f--'"
3. EXECUTOR APPOINTMENT.
I hereby appoint My Son, JOEL A. CENTRE, as Executor of this will. If for any
reason My Son should fail or cease to act, I appoint My Daughter-In-Law,
:LINDA A. Centre, as EXECUTOR.
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4. WAIVER OF BOND~ FIDUCIARY FEES.
My Executor shall qualify and serve without the duty of obligation of filing any
bond or other security.
IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament,
. sting of this and the preceding one (1) page, this E)-tr. day ofD<cC<ervJ:Je- v , 2003.
i\.0QL-~ ~~~~L)
David Centre
COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF c.>,^,1Y\ b 'C.- 'i \ QV\ 6
)
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SS:
On this, the ~~ day of ~ 'cc~bV\2003, before me, a Notary Public, The
undersigned officer, personally appeared DA VID CENTRE, know to me (or satisfactorily proven)
to be the person whose name is subscribed to the within instrument, and acknowledged that he
executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~~~
Notary P lie
(SEAL)
Notarial Seal
Mary L. Throne, Notary Public
Mechanicsburg Born, Cumberland County
My Commission Expires Mar. 8, 2006
Member, Pennsylvania Association ot Notaries
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