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Home My WebLink About03-14-08 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA d- \. \) ~ Od-<6Lt Estate of MARY E. HARTWIGSEN also known as File Number , Deceased Social Security Number 193-30-2742 , .....,. Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE j4' or 'B' BELOW:) c.:? 'c':'~ :-cC2 :r_:;:'f. 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 . ~-T-: :':'0 named in the + ~~~~ ~'O! ~-.~ ::'.~~ -., r'j u ......_~ (State relevant circumstances, e.g., renunciation, death of executor, etc) I I-."J Except as follows, Decedent did not many, was not divorced, and did not have a child born or adopted after execution ofthei~trument(s) ~red for probate, was not the victim of a killing and was never adjudicated an incapacitated person: III B. Grant of Letters of Administration (If applicable, enter: c.t.a.; db.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.) I Name Relationship Residence I DONNA KUBIK DAUGHTER 1517 WOODCREEK DR., MECHANICSBURG, PA 17 SUSAN KWIATKOWSKI DAUGHTER 129 BRIARPATCH DR., CARLISLE, PA 17015 (COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his / her last principal residence at 415 CANDLEWYCK RD., CAMP HILL, LOWER ALLEN TOWNSHIP, CUMBERLAND COUNTY, P A 17011 (List street address, town/city, township, county, state, zip code) Decedent, then 69 years of age, died on FEBRUARY 8, 2008 ALLEN TOWNSHIP, CUMBERLAND COUNTY. PA 17011 at 415 CANDLEWYCK RD., CAMP HILL. LOWER Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania 125,000.00 $ $ $ $ 200,000.00 situated as follows: 415 CANDLEWYCK RD., CAMP HILL, LOWER ALLEN TOWNSHIP, CUMBERLAND CO., PA 17011 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: T ed or rinted name and residence DONNA KUBIp<-, 1517 WOODCREEK DR., MECHANICSBURG, P A 17055 Form RW-02 rev. 10.13.06 Page 1 of2 Oath of Personal Representative COMMONWEAL TH OF PENNSYLVANIA COUNTY OF f1:JYl f1' r IcU7d SS 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 ID A~ !fI~) Signature'of Personal Represen ative Swom to or affirmed and subscribed C) l.,::~-l Signature of Personal Representative --=) : -:1:J '~_: () .. r-' j,"--"J n Signature of Personal Representative ..r.:- t..'J File Number: d! 0 ~ O!},'zSA/ ~-J Estate of MARY E. HARTWIGSEN , Deceased Social Security Number: 193-30-2742 AND NOW, having been presented before me, ITIS DECbRE are hereby granted to . > n (i 0.... r< u- ) /Ytty-U^t /^I Date of Death: February 8, 2008 , j11)8'" , in consideration oftl)e foregoing Petition, satisfactory proof D that Letters 111m frl '0-1ro..J7()l-1 in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of recor FEES Letters ..... 3~ .D:b.~). $ Short Certificate(s) . . .(P. . . . $ Renunciation(s) .......... $ JeP ... $ 4v..fv .. . $ . .. $ .. . $ ... $ .. . $ .. . $ .. . $ .. . $ J-W i$Y) -&.ee- TOTAL ........ .. .. .. $ IVT . 300 d;.J Attorney Signature: "-P s- iD Attorney Name: /) Supreme Court I.D. No.: 7047 Address: 126 LOCUST STREET HARRISBURG, PA 17101 Telephone: 717-232-6600 Form RW-02 rev. /0.13.06 Page 2 of2 Hlli))\05 REV' iOI/O-:-) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. r,) 1'. /1 ') '\ "'(" -I"' q 1 -1' I:.....".. \... ._ Certification Number ~//if.,-;ii7iH;;;;;-,,;~ \,"'<.."\.\\\ OF pr;;--___ ,\ol.'\.Y'. ~~{'r". .. /.::...........// ~J'."'--c,. '\\~/ . ~. h~~/ ...~\~~ (!~ ::rE'.' ..... . \.'P~ ~c::.1 ~-' '~~~ ~C,-)I, ~';-,' i~~ ~ \ ' ---- '. . - ~ \" * " . ~ '.,>-" *~ ~~\ - . /~l \""-~, ./~\\\. '---~lMENn{~~,,'III\ ~~IIIIJ)II This is to certify that the information here given i correctly copied from an original Certificate of Deat duly filed with me as Local Registrar. The origin< certificate will be torwarded to the State Vit, " 'OOddlfb~; penmn, t fiI:ng M Local Registrar :r:: ) J.:;". ;;0 +' , C~) ~: "'1 Fee for this certificate. $6.00 \.0 ----------~--_._----~~-----------._.---""-_._~~'---~~--------------~ C'l .~-- =.r- \ . COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (See Instructions and examples on reverso) ~I () 8' Opg. i.l44 REV llf.!OO1 fPE J PRINT .. - IILACK N< #31-211 ,.......-..IfhI.-.....""'l Mary ~""'IUol_ 69 E lIb.COlI\Iy"Ooolh -"--------"-- LO'l.Ver A lien 1Wp. COy/1Ionl /7a5tS 23b. licen&t NImber _2...._.._"_ 2..,,,,,."000lh prx. 25.__"""_da1.lA'! ..._...... 6:'00 P. M. February 8, 2008 CAUSE OF DEATH (See InatruC:tktns and ex.mpI..) .....%7. PlItt: EnWllIsbIDJt.MdI-....... ~ or~-tIII chcIy cal.Ul!h did\. DONOlIfllw"""" nents lUChas caniIc arrest. ~.....or~l:lrIdonwilholJ:ft)wklg"'IIlIoIogy.UstodtOl'llc:lUlfonMChh. 26. Wu Cue Reterr.d 10 MecIc:aI ExlminftJCoroner klI'. RMsonOlhert\anClwnlllonor ~1 r&.. ONo PartIl:EnwothW~~1'NIIrh1llnnIllldulh.. tu not r-*ing In !he UI'IdMyIng '**' ;ven h Pad l 28. Old Td:Iaoco Ute ConrIllM b DMtb? 0""0- o No 0 '""'- 2lI.WFemIII: 0..._-..."" 0_......- 0.....-"'_-...... ..- 0.....-"'_43......,"" o :::..~__......."" 320.==~_'-Y. .OV. J:i(No 321. n_ '*" /S/>dY) 0"""'/_0_0.......... ... """.- 33LCdor_""",,1 ...._...r... . ~~..:.::==.::...c"':"'':=''':~~_~~~~___m_m__m__ 0 ,~ . _..._...-_.......--..."'-........-1 '33<"-_ 33d._Slpd_....-l . ....._..._-........ "........_..._...........-l...-..........-u u____,___u___ 0 February II, 2008 . __,e..- . ;a _.. .._............-.................-....-..........._.1...-............. ..._,..,_~p_....,~.' """'''Jlodo~Z7) !)pol.... M1Cnae~ L. N~rr1S, ~oroner ,... "':1f 6375 Basehore Roadl Suite ill ~() Mechanicsbur . PA 7050 OlO lCo33 0"" ONo 31........dDellh JS- D- O- 0-..- 0...... OCoUd.....- I ApprvbnIIeinIeMI: : 0nIIl100ed\ , , , , ,- , , . .- . , :- , , ~~~=~ ~IIICClIIlIbt.I"", W ClUlllIIIlIonhL EIMI: UNOERLYNJCAUSE =-.:It:.':...!~ Mesothelioma OuIIo(orU'~oI): b. [M 10 (or II I CllllMqUl9l1CI 01): c. XlL w.. 11'1 JdDpIy ......., Dutlo lor..c:onMqUlIf'Il>> 01): .. 3lll.w..__ ....... PrIot 10 CompIIIon d Caute 01 0IIIl1, 32i1.TIMolkpy Coroner d J od o()W RENUNCIATION _.:::J .$:- REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA :..:'j c.~ Estate of MARY E. HARTWIGSEN , Deceased I, SUSAN KWIATKOWSKI (Print Name) DAUGHTER , in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to DONNA KUBIK (Dale) C\5Mthu (Signature) c)( 1JJ1~ 129 BRlARPATCH DR., CARLISLE, PA 17015 (Street Address) CARLISLE. P A 17015 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this day of Executed in Register's Office Sworn to or affirmed and subscribed before me this / ':..t day of mCuCh , .:JOt)? Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. /0.13.06