HomeMy WebLinkAbout03-17-08
Register of Wills of CUMbbll('JiJ"./ D
County, Pennsylvania
PETITION FOR GRANT OF LETTERS
/l, ;enPG,(/J-TO No. ~\ O~ OOP\L/
Estate of
'0
/ G" ~tZ.
also known as
. Deceased
Social Security No. 12 Y *. S Z - crt.; ~ 7
Peooone~s). wno IS/are 18 years ot age or olOer, apPIY(ies) tor.
(COMPLETE 'A' OR 'S' BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the exeClJt_nOJ'.med in the Ia.st Will Qf
the Decadent, dated
and codicil{s) dated
Sloa:l.e ",.-n an::u".=ces, ..~ ,.nunC\alIOn, oealn cl UlOCUIor, ate.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated ino:lmpetent:
~ 8. Grant of Letters of Administration
(db.n.c.U.; penoeme It.; auran,. aos....~; ourante mnornate
Petitioner(s) after a proper search hashlave ascertained that Decedent left no Will and was suNived by the following spouse (if any) and
heirs: r-.;
c;;
WIFG
SOjV
1.'-i D ~ )(C;L. "
A)GW ((.)M/J :;
\\
-J
.//
Name
Relationshio
!)(i;3~14
. j;jJ
:...-\
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~
...;.-..
( :;
(COMPLETE IN All CASES:) Atladl addiDonal sheets it necessaty.
Deced&ntwas domiciled at death in t..O~i:/L ;:Ji..u,;:AJ 701IV1V~H/~ Lvh6liA:i.J4o.ISbunty, Pennsylvania, with hislher last family
:;~~;i;;:;i;::a!res:da~~a:.s'l ])~'I.I~L fl. tU,.::;;W {v,MI.!>t:.JI2.lJP.NO, IA- I/O/V
(list SD'eat. numoer and municipality) HA.,I -'/J.oI../~t.-
Z,CC go J I I . ~,
Decadent, then !; 0 years of age. died I1AIl('ft II , ~---' aI f/rut./s/.>f.)I'l(,.. rr(.'!>f'lrJ4{, I'~
(Locauon)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl An personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Pers<<laI property in County
Value of real estate in Pennsylvania
situated as follows: "S \i t)~~ '(~l pl.... VGw (v.""'!bt:.tlo;:JJVj;) I t:J.
$
$
$
$
/7d 70
5, ntH)
,
~s Qun
,
Wherefore, Petitioner(s) respectfully requesl(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
Form #AW-1 Page 1 at 2
Prepared by the Pennsylvania Bar Association' 991
Oath of Personal Representative
~mmonwealth of Pennsylvania
County of
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.
~Ylf,UJJ> tk.J~-
Swom to or affirmed and subscribed
belore me this _~day of
~c-h ~ i??~
the Register
Q \ 0"6 Oaqy
\~pe{O--{u
Social Security No: \ d. q s: a %lte of Death: 3 \ \ \ ) D8
AND NOW, ~f ch \ l . -1-9,)CDB ,in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 0 Testamentary ~Of Administration Q.b.n.c.t.a.;;>etl<lem8ll1.e;ouraJlleaoserlJa;ouramernnonlala
are hereby granted to ~\ (0\(' If(. '\ €...-N' ~ro---6
Estate of
No.
De ~e ( A
Deceased
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 of Decedent.
FEES
Letters .....qo,QOO.. $
Short Certificate(s)..3 $
Renunciation ............ $
~lD
\~
,~ ~~ ~\'tu~
Register of Wilrs ~. . e.f
Attorney:
Affidavits ( ) ............. $
Extra Pages ( ) ......... $
C-edieit ~L........ $
JCP Fee .L~k $
1.0. No:
Address:
C)
So
._;~, .:
;-"-'
C~'~
e..j
CQ
IS
Telephone:
.' .~~? ;--fJ
-I(;:,",
~.
:;"'J
... ) ,_~::'.~ "-..J
Inventory .................. $ :0"
1.0
Other ....................... $
TOTAL ............. $ .;)l~1
i~)
FOlTT1 #RW-, Page 2 01 2
Prepared by the Pennsylvania Bar Associalion '991
HI05.K05 REV 101/071
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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.
tIJ.'
~, ftl7~7-" MARjl 3 2p08
Local Registrar Date Issued
Fee for this certificate, $6.00
P 14123465
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lEV 1112006
)RINT IN
~NENT
KINK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
52 9687
ar) ea. Place 01 Death (Check only onel
Hospital: Other
50 Yrs tember 20 19 7 Rochester Inpat~ot OERIOutp,li.ot OOOA ONurs'oQHom, ORas~.",. OOth".Spe<:i~
Bb. County of Death 8d. I=acility Name (If not Institution, give street and number) 9. ~~=~f ~~~~niC Origin? KJ No 0 Yes
Da uphin Harr i sburg Harr i sburg Hospi tal Me,ic,", Puerto Ricoo, atc.)
11. Decedent's Usual bon Kind oj wor\( done dun most 01 wocId me. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Speclfy only highest grade completed) 14. Marital Status: Married, Never Married.
Kind 01 Wor\( Kind 01 Business f Industry U.S. Armed Forces? Elemenlary I Secondary (0-12) CoUeye (1.4 or 5+) Widowed, Divorted (Specify)
Painter orman Communit' eaJyas llaNo 12 Married Wehler
1. Name 01 Oecedenl (Firsl. middle, last, suffix)
17b, Cll<Jt11y
PA
Cumberland
Did Decedenl
Liveina
TOWTlSh~7
Hc. KJ Yes. Decadenl Uved in
17d. 0 No, Decedent Uved within
AclllalUmilSol
Twp.
16. Decedent's MaUing Address (Street, city flown, slate, zip code)
34 Drexel Place
New Cumberland, PA 17070
18. Father's Name (First, middle, last, suffix)
Nicholas P. Tern erato
2Oa. Inlorme.nt's Name (Type f Print)
Nicole R.Temperato
r c;tcremation 0 Ool1ation
j ~..~~atlonA?
as such)
Decedent's
Actual Residence 17a. Slate
City/Bora
34 Drexel Place
New Cumberland
PA 17070
21b, Dale 01 Disposition (Month, day. year) 21c. Place of Disposition (Name 01 cemetery, crematory or other place)
21d. Location (City I town, slate, zip code)
BFH Crematory Grantville,PA 17028
22c. Name and Address 01 Facility
stone & Murray F.H.,408 3rd. St.,New Cumberland,PA17070
23b. License Number
23c. Date Signed iMonth, day, year)
26. Was Case Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation?
DYes ~No
=~~a~~~~~~\~~
hJ~JtIVC !",'ibl (ilJ""~{,
Due to (or as a conseqUjn~ o.Q: ,. .. _I/"_ J
b. H1"f::~n~M,JfO/'{
Due 10 (or as a consequence of):
J/ilhOr(lll"..< C
Approximate intelVsl: Pan II: Enter other sianiflC8nt conditions contributino to dMth, 28. Did Tobacco Use ContriblJte 10 Death?
Onset to Dealt1 but not resulting in the undertytng cause given in Part I 0 Yes 0 Probably
o No 0 Uokoowo
29. H Femaie;
o Not pregnant within past year
o Pregnant at lime of death
o Not pregnant, but pregnant within 42 days
01 death
o Not pregnant, but pregnant 43 days to 1 year
before dealh
o Unknown il pregnant within the past year
3Zc. Place of Injury: Home, Farm, Slree!. Factory,
Office Building, ele. (Specify)
s.
~uen~:~~~~cfi~~,~~ a.
Ente~ UNDERLYING CAUSE
~~se~~~rrn~rn7t~~
Due 10 (or as a consequence 01):
d,
o Yes .l8l No
DYes I:!!I No
31. Manner 01 Death
o Nelural 0 Homlclile
o Accident 0 Pending Investigation
o Suicide 0 Could Not be D.\armioed
32d. Time 01 Injury
32g. Location 01 Injury (Street, city flown, slale)
3Oa. Was an Autopsy
Performed?
3Qb. Were Autopsy Findings
Available Prlor !oComplefjon
01 Cause of Death?
M.
338. Certifier (cIled:: only one)
~::~~~r~r~~i~:::d:~~~gcu~::~ ~th::'u:(~n~~:r~: =-~.. ~~h:n~ ~~J~~ ~e~ ~~ .. _ _.. .. .. _.. ...... .. ...... .... 0 ~
~~~~u~:~fa~ ::~=~~:CI::~~~ ~I~=:n:nd~~~:rt~~iol~~a~:~:~~ manner as stated.... .. _ _ .... .... .... _.. ...... .. _ 0
~::" ~=Im~~:~;=:~ and {or Investlglltlon, in my opinion, death occurred 81 the limf!, date, and plaoe, and due to the CBUse(S) aod manner as stated.. 0
-
35. Registrar's
..
IbJI N...f.t.O,Jr k
Wilr~~~
J' A- I~01...
Disoositioo Permit No