HomeMy WebLinkAbout03-19-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF (] lLln Iu r /rril d
COUNTY, PENNSYLVANIA
Estate of
(;-.
A I }~f/L;
G- trt i ,5- h 0-.-/ 1
. Deceased
File Number ~ 1- 0 :f - 0311
Social Security Number I? Y. -dO -- f.;l CJ (;,
also known as
Pctitioner(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 j - Y - :;Lo~ and codicil(s) dated
,
~ x.ec'ufr;)(
named in the
(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 bom or adopted after execution ofthe instrument(s) otlered
for probate, was Ilot the victim of a killing and was Ilever adjudicated an incapacitated person: -17. (}--
o B. Grant of Letters of Administration
(If applicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite: durante absentia; durante mmuntate)
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 db.nc.t.a., enter date ofWi/l in Section A above and complete list of heirs.)
Namt:
Rdationship
Rt:Sidt:n""
(COMPLETE IN AU C4SES:) Attach additional she
u...m
s if. n,ecessa".. .p ().
rl Cl 71/1 - d-U
. County. Pennsylvania with his
r . j 3
91~~t principal residence at
l..L r TI
rnbuJh'1d
Co
Decedent.. then
'7 9 ~'ears of age, died on
.1 - 1- of'
at
//tJV Am
Decedent at death owned property with e,,1imated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in Count~.
Value of real estate in Pennsylvania
LJ 9 I o-tKJ
,
$
$
$
$
situated as follows:
Wht:rt:tort:, P"titiont:t{s) r"sp""tlully n:qu"st(s) tll" probat" of lit" last Will and Codi"il(s) pr"st:nwd willt litis P"tition and tll" grant ofL"tlt:rs in th" appropriat" form to
tll" und<:rsignt:d:
L/s
T,.
FurmRW-U2 rev. 10. 13.1J6
Page 1 of2
PETITION FOR PROBATE AND GRANT OF LETTERS
(] lLtn/u r I Q. 11 d
COUNTY, PENNSYLVANIA
REGISTER OF WILLS OF
, Deceased
File Number ~ I - 0 8' - 03//
Social Security Number /? Y- -.;)0 -- i:l 9 (p
Estate of
(5- .
A Jr fJv
(J-!J -t t~-h 0.-11
also known as
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 1- Y - :J--o#J and codicil(s) dated
,
~ x.ec'uf-r;X
named in the
(State relevant CIrcumstances, e.g., renunclahon, death of executor, etc.)
Except as lollows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the instrument(s) ollered
lor probate, was not the vic.tim of a killing and was never adjudicated an incapacitated person: -'Il (J--
o B. Grant of Letters of Administration
(If applIcable, enter: c.t.a.; d.b.rl.c.t.a.; pendente lIte; durante absentIa; durante mmontafe)
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
Aclministra1ior~ c.t.a. ur db.nc.t.a, cnter elate ufWi/l in Sectiun A abuve and cumplete list ufheirs.)
Nam"
Iklationship
R.,.idl.'11""
(COMPLETE IN ALL CASES:) Attach additional she
lL.tn
s if. n,ecessafY. .P a
rft\?\O - fJ./
. County, Pennsylvania with his
r . J /3
mbu.j~ild
CD
Decedent, then
'7 7 years of age, died on
. 1 - ?- of'
at
/,'0-0 Am
Decedent at death owned property with estimated values as follows:
(I f domiciled in P A) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
LJ 1 J trtKJ
I
$
$
$
$
situated as lollows:
Wh.".dor", P"titiontor(s) r"sp"ctfully requ"st(s) tit" probaw ofth" last Will and Codicil(s) pr"st:11wd with this P"tition and th" grant of Ldwrs in tit" approl'riat" form to
tit" und=iglloo:
r,. 00 or 'nWd nam" and residt:11""
L/s
FormRW.()2 rev. IfJ13.1)(j
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
SS
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 bellef of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and tmly
administer the estate according to law.
Sworn to or affirmed and subscribed
+k.J
before me the ~_ day of
x ~ 'z. iLt~
Signature of Personal Representallve
d. OOr;
':)~
Signature of Personal Representative
F" th, R,gi"" ~gM'",' 'f ?,"'MI R,p'~""""
File Number: t.~ 1- () K' - () <3 J (
Estateof I..Jd. (Jl1()Q~ ) ,el:f()lf~11 i1_
Social Security Number: i I Lf - db - 9' l~q 0; Date of Death: '3- -, - O~
AND NOW, ('(\oxcL \ q , c1(f::J'~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters _~+tCl fYl€l\JT?l R--~
are hereby granted to. k\ 'Sc,,- Q f-lx:L~\"'\'eJ....)
, Deceased
in the above estate
and that the instrument(s) dated \ - q - ci.CCx::::::>
described in the Petition be admitted to probate ami filed of record as the last Will (a
Letters
Short Certificate(s) .
Renunciation(s)
\..f,u
]lp
~~.,Tf'I
TOTAL
Funll RWO] rev jO.13.06
, ~
FEES
~
$9D,DD
$~
$
$
$
$
$
$
$
$
$
$
$141.{- .DO
Attomey Signature:
--;
Attol11ey Name:
I 5 . (j.::J
i D . (::J.~
S',OO
'-~.';
Supreme Court J.D. No.:
Address:
Telephone:
Page 2 of2
II j(J'i':-\(l~. l<L\
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
1,,'I(~\.1"'[El,t-----_
,l~Y ~J'..,.-."
It~*~ ~\
!~/ .._.~' \~~
~B:I' -11;1,' -Ji:~
~ \_ . 'icj ,'",
~ * ''R~., ~~.'." "... '.'/ * $
- a.~~~' I~ ~
\.",,-~,," /~,/'
- -YI;~ ---u.,\.'r I'
"'"..... IMENI1\ ",~.'l
"""""""HIIJlJlIII'
P 142187:3b
Certi fication 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 f r permanent filing.
60'
Date Issued
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H10!>.1.... REV nr2Q06
TYPE ! PRINT IN
PERMANENT
BLACK INK
I NIfM 01 Oecedlilnt (Firsl. middt, last, kAt)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS (--,
CORONER'S CERTIFICATE OF DEATH c.:,
(See Instructions and examples on reverse) STATE FILE NUMBER
2. Se. 3. SociII Searty H,,",,* 4. o.te 01 Death (Month, day, 'fN/1
Aileen Gottshall 174 - 20 - 8296 March 7, 2008
G.
~. /1tqe lLas! Birthday)
6.0'1' ot8ll1h(MclnIft.
7. ~1Ct IC' and_leor
2/24/1929
79 v~
Ill. County 01 Death
Dauphin
Susquehanna
Id.FdIy_I...._.aiYo_...."""'*!
1701 Linglestown Road
11. Oec:IdIr1rsUsual
Ku<l~_
Clerk-Typist
moIC 01 iN. 00 ~ tta1J rtltir
Knl~_/Ind",""
state Gov't
12. Was 0ectdM: IYW in 1M
U.S. AnNd Fettes'?
Oy" mHo
. 16. Decodonr.....inO....... (Shoc. OIly 1-. _.l~ eXldol
1123 Atland Drive
Mechanicsbur PA 17055
~~17a.9IIlI PA
17bCwlly Cumberland
ono)
QIhor
Hospice
000lt>0<._
10. Race' Atnerican rMian. ~ WM-. ,:.
1-
White
.........9aIu1....<riod,__
W_, IlNot<od (Spoc:iI)ol
Widow
Oil_
Uoe~.
T"""""'Pl
!Ipppr Allpn
17..xxy..._Uvod~
17<10 Ho,_Uvod_
AduaJ l.iftI> ~
T..
Cryl!lool
18. F.......' Name (F'nl, mOtI,lul SIolIbI
Lester Kell Pelton
tg._~_IArsI._,__
Mar uerite Ellen M ers
2lIl,_'llliir9_(SInlI.OIIy/_,_...eXldol
1370 Norton Road, Steelton,
PA
17113
201. Infolm,erts Name (Type I pritt)
Lisa Barbush
21<PIlco~~I_~_._"-"-)
Cremation Society of PA
21dl.oaolk>nICllyI_,_.Z,"""1 17109
Lower Paxton Twp.,PA
*
~
-J.
22c. Name .-.d AdlnM d FICilly
Shalonis PH, 206 Maple Ave., Marysville, PA 17053
I"'" 24.26lTU51 be c:ornpItIIdbyperaon
whDprol'lC)JtlCeIdnU'l
25 00Il_1lNd I....... dIy,_)
02:10 A M. March 7. 2008
CAUSE Of' DEATH (s.. Insltuctlono ond .....1'...)
IWn 27. Patt I: EnNt the r.llIIu:t...bIo _........... or oompicaIionI-1MI cittcty auMd the cINtl 00 1<<)1.. teminaI.... ~ AI cardac IIff'IIl,
respiratory ....... 01 ventriQ.Ur fbilltion IfIIiIW sI'lc:lwi"IlJ '" ttidoqr. UII 0flt1 cw-. CIUM (1'\ NCh....
=~~~~)-:;
L Multiple Systems Failure
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b, MVA
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SeqJertaIy hI1 COl'lditionI. J any.
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230. UoINt Numbel
23e OlIO S9*' I"""",, day, JOO'l
26. Wu Cast Rttwred 10 Medcal ExMWw I ColrMr lor a Ruxln (>>wt uw. Crtmabon Of ~1
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Part It. Etw oh,limiicanIl'1YldUlM. rnrriaJMa Kl dwal 28. Did lobacco Use Ca1riv;1I to 1JNtl1
lIIA...redilgft....~'""'"II''''.PalIL 0 Vn DP-
DNo 0-
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ulmonary Hypertension 0 Nol png>ont.........,..,
CHF 0 ~..""'~-
o Nol png>ont, IlIA _ -. <2 '""
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DNol_"'_"Oays~I_
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o """""',png>ont.........""',..,
32c. P\aI2 01 ~ Heme. Farm. SlrMt. F.aory
Str~ BuIO.pc I_I
32g.l.ocaOonol...",I_.OIIyI-._1
Rossmoyne and Westport Drive, Mechanicburg,
JQa. Was an Auklpsy
P-
n.WllttA&AoplyFindW'lgI
A'IaIaiiIPriorIoCoqlleCion
01 Cauat 01 DH#l'?
31.iMmelol OU1h
0- 0__
(2';1_ OP"",,",,"'"_
o Sooade 0 Could Not be Oolomw>od
9:00A",
J2Q. Tmt oIlf1l,.ry
0'" O'~
0'" IZI No
33i c.rut... (ctMdl. cxtly one)
~::::::~==:'~thI~~:=":~..~~_-:'~~~~--_.._-_...._......_--- 0 I~~
Pronouncing ~ ctttlty\ng phy:sidM IPtlyliciatl boll prtlIlDLIlCinQ de,,, and ctrtjying 10 eaUH 01 0Nth) Ul:enM
To It'll best 01 my lcnowIIIdge.delCtl ~..... time. clIO. and piKe. end Gut IoUWCMIM(111ftd NIlMI....c.cL _ _.............. _...... _.. _.. 0
Yedical Eumi,.. I COl'ONf
On bllli. 01 eUfftindon
s:
~
~
l5
I
Patty J Garber, Assistant Chief D"I'
33d. 0olo S9>ed 1_. day.,wl
March 10,2008
34. Name and AdlhII 01 pJ(S(ln Wtv) ~1ed ~UM 01 0.... (IWn 27) 1)'Pt! Pm!
Patty J. Garber
1271 South 28th Slreet
Harrisbur ,PA 17111
~.. c...
LAST WILL AND TESTAMENT
QE
G. AILEEN GOTTSHALL
I, G. Aileen Gottshall of 128 Park Drive, Marysville, Perry County, Pennsylvania,
being of sound and disposing mind, memory and understanding, do make, publish and
declare this to be my Last Will and Testament, hereby revoking and making void all
former Wills by me at any time heretofore made.
ITEM I. I direct that all my just debts and funeral expenses, including my
cemetery lot, grave marker, and all expenses of my last illness, shall be fully paid and
satisfied as soon as conveniently may be after my decease.
ITEM II. I give my entire estate, of whatever nature and wherever situate, to my
daughter, Lisa R. Barbush, of Steel ton, Pennsylvania, provided she survives me by thirty
days. In the event my said daughter, Lisa R. Barbush, should fail to survive me by said
period ofthirty days, I then give my entire estate, of whatever nature and wherever
situate, in equal shares unto my surviving grandchildren. I realize that I have ~daughtert
Jody Seig, and it is my intent that she not receive a share of my estate. S-~ ~ :=::.
,----.-.-, :..-.~
; + (-) ~.._.1
ITEM III. In the event any beneficiary entitled to a share of my estateif~;~or ~
the time of my death, said share or shares shall be held by my cousin, Barbara HcrUo/, of __.,
Marysville, as guardian of the property for said minor beneficiary or beneficiaries.:ootll ::..
he/she/they attain the age of eighteen (18). =.{ -S-
(:-'
CO
ITEM IV. I direct that all taxes that may be assessed in consequence of my death,
of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary
estate as a part of the expense of the administration of my estate.
ITEM V. I nominate, constitute and appoint my daughter, Lisa R. Barbush, of
Steelton, Pennsylvania, to be and act as my sole Executrix ofthis, my Last Will and
Testament. In the event of her renunciation, death, resignation, or inability to act for any
reason whatsoever, I then nominate, constitute and appoint my cousin, Barbara Holley, of
Marysville, Pennsylvania, to be and act as my sole Executrix of this, my Last Will and
Testament. I direct that my Executrix shall not be required to give bond for the faithful
performance of her duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and
Testament this 9 day of January, 2000.
/
J/ t2&A(#/dt/4/
G. Aileen Gottshall
,~~ ,
The preceding instrument was on the day thereof signed, published and declared by
G. Aileen Gottshall, the testatrix named therein, as and for her Last Will and Testament, in
the presence of us who, at her request and in the presence of her and each other, have
subscribed our names as witnesses hereto.
WITNESS:
fdud1M
ADDRESS:
J 07 l(/hg'5 /101-
/J1;JI?Y5u/I/~//l1. /7053
y ~ur f 4'0I!R/
J D 7 1::/115 '5 HWI'
/)1!Jf?15V"/ Ie )~ .
OA TH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
~inkr/t!{77 d COUNTY, PENNSYLVANIA
Estate of G, A/I ee7v GtJ -t-t sA t'A.- /1
, Deceased
'f! /s cc l-). t3 a. R- bulA and '8-e tt'!- H 0 I/..e r ,
(each) being duly qualified according to law, depose(s) and say(s) that c.:9/ he / they was / were well-
acquainted with a, A //~e7L/ c~() -tis ~ tAil and am/are familiar
with the handwriting and signature of the decedent, and that the signature of G. A Ii ~-e 7'J G--(J t (s- her. / /
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of 6-, A I/.fi'~ 6-tJtf.s) tt 1/
is in his/her own proper handwriting.
f ~ ~~ -Nnff1A--
(Slg/'ltlture)
(s~~l!est :t. AI 0 / & f!.-;
Po ~O)( 57;), I Ca.JnjJ N //II?A /700 I
(Clt)', State, ZIp) "
1-- ~2,13~
(SIgnature)
,L ;J /J- /? 11 a.. fl /J a.J h
(Street Address)
/ J ? () Iv' 0 r /rJ;v!2.d) S }eJd-hrv J f If 17(1.3
(CIty, State, Z,p)
Executed in Register's Office
Sworn to or affirmed ~UbSCribed
before me this J day
of ffiOJL~ ,f).OO5s
()
C-:-=t~
" ~ '--J
""'-- Il
, -T-j
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FurmRW-04 rev. JO.13,06