HomeMy WebLinkAbout04-07-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF 6,~/W
COUNTY, PENNSYLVANIA
Estate of fa. fA. I e. f11 e. C Ittl'e,x
also known as
File Number
1..,\ ()<6 ()~'1~
, Deceased
Social Security Number / (, :2 - /2. - -, '-1/ {:)
Petitioner(s), who is!are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
~ A. Probate and Grant of Letters Testamentary and aver ~at Petitioner(s) is I are the
last Will of the Decedent dated AJOI/ C fl1.6 ~r 1.~1 ~CZoQicil(s) dated
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named in the
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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 of the in,,~"~nt(s) off~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ' '" :j2 () ;:g
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(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absell/ia; durante mino~'!iJ,~i.&- .., ~
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Petitioner(s) after a proper search has! have ascertained that Decedent left no Will and was survived by the following spouse (if~yJ1md heirs:~f
Administration. C.La. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) )5- &-
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(State relevant circumstances, e.g.. renunciation, death of executor. etc.)
o B. Grant of Letters of Administration
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Name
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Residence
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Decedent, then
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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 P A) Personal property in County
Value of real estate in Pennsylvania
situated as follows: &,...,k. (;.cc.t}u-t.s :6 7'), aO lfCA.fo *~,.?, .I roo
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WhereJore, 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:
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ForIllRW.02 rev. 10./3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
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The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and conect to the best of
Sworn to or affirmed and subscribed
bd~Jre me the _L-_ day of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well ar@ruly
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administer the estate according to law.
Signature of Personal Representative
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Signature of Personal Representative
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Social Security Number: 1lJ; 2 12- 7 'i 10
File Number:
Estate of
Date of Death:
, Deceased
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AND NOW,
having been presented before me, IT IS DECREED that Letters_
are hereby granted to '~I cI Fa nde/f e r
, in consid!ration of thj foregoing Petition, satisfactory proof
) t'Sta...mel1 ftL f i
in the above estate
and that the instrument(s) dated }.JvtJe.fY\ftr 22... 20()D
described in the Petition be admitted to probate and filed of record as the last V{II (and Codi il(s)) of Decedent.
Letters
FEES
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$
$
$
$
$
$
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... $
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$
$
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Short Certificate(s) . . $~ . . .
Renunciation(s) ..........
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Attomey Signature:
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Attomey Name:
Supreme Court LD. No.:
Address:
Telephone:
TOTAL
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Form R W-O] rev, 1O.13.06
Page 20f2
11 l{)_'i'{()5 KEY Illlil171
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
Certification Number
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This is to certify that the infom1ation here given i:
conectly copied from an original Certificate of Deal!
duly filed with me as Local Registrar. The origina
certificate will be forwarded to the State Vita
Records Office for permanent filing.
~ /J; ~ MjR 3;2008
Local Registrar ~ate Issued
P 14328402
\ REV 1112006
I PRINT IN
MANENT
,CK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
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STATE FILE NUMBER
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91
Oct.1l,1916
Bakersville,PA
- 12 -7410
Sa. Place of Death (Cl1eck oo~ one)
Hosp;tal:
Inpatienl 0 ER I Outpatient 0 DOA
9. Was Decedent of Hispanic Origin?
(II yes. ~~ Cuben.
Mexican, Puerto Rican, etc.)
14. Marital Status: Manied, Never Married,
WKlowed. DNorced (SpecifY!
4. Date of Death (Month, day, year)
Mar.28,2008
1, Name of Decedent (First. middle, last. suffix)
Paul E.
5. Age (lJl,' Birtl1day)
v~,
6. Dale of Birth (Month, cia, ear
7. Bir1!ljllace ( end"le"
1lb. Coun~
PennsYlvania
Cumberland
widowed
Did Decedent
Uvein a
Townsh~?
10_ Race: American Indian, Black, While, ete
(SpecifYJ
white
eb. Coun~ of Death
Dauphin
ad. FacIMly Name (If not institution, give street and numbe~
Harrisburg Hospital
11. Decedent's Usual Occu
Kind of Work
most of lfe.Donotstater'
Kind of Business I Industry
12. Was Decedent ever In the
U.S. Armed Forces?
JQVes ONo
Decodenf.
Actual ResIdence 17a. State
13. Decoden", Education (Speci~ on~ ~ghesl grade completed)
Elementary I Secondary (0-12) College (1-4 Of' 5+)
12
. 16. Decedent's Ma~ilg Address (Street, city I town, state, zip code)
335 Wesley Dr., Apt.405
Mechanicsbur PA 17055
18. Father's Name (First, rnWe, Ias~ suffix)
17C~ Yes, Decedent Lived in T .()W,::s, r
17d. 0 No, ~I Lived within
ActuaJ Limits 01
l\11",n
Too.
ChylBoro
Dorse McClaren
19. Motl'1er's Name (FIrSt, middle, maiden sumame)
Ada Barela
2Ob. Informant's Mailing ~ (Street, city / town, slate, zip code)
3517 Smithville Dr.,Dunkirk,VA 20754
208. Informant's Name (Type I Prlnt)
21,. Place of Disposifion (Name of cemefOl'/. crematory" ollie, place)
Hollinger Crematory
21d. Local"" (a~ 11own. ...., z~ codal 706 5
Mt. Holly Sprirgs, PA
Musselman FH&Cs,324 Hummel Ave.,Lemoyne,PA 17043
23b. License Number 23c. Date Signed (Month, day, year)
24. Time 01 Death t>
Lf:felrM
CAUSE OF DEATH (See Inab'uctlons an examples)
Item 27. Part I: Enter the ~ - cMseases, Jljuries. or compfications -that direclly caused the death. 00 NOT enter lenninal events such as cardiac arrest.
respirator, arrest. or ventricular fibrillation wilhouI: showing the etiology, UsI only one C8USI on each flll8.
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26. Was Case Referred 10 Metical Examiner I Coroner lor a Reason Other than Cremation or Donation?
DYes jl{No
Approxima..lnfeMll:
Onset to Death
Pari II: Enter other sirRficanl conditions contrhrtina 10 dAath,
but not resulting in the oodartying cause ~ in Part I.
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28. Ok! Tobacco Use Contribute to Death?
DYes OProOably
o No 0 Unknown
29. II Female:
o NofpnlQllOlltw;lhinpastyear
o Pregnant at time of death
o Not pregoanl, but pregnant within 42 days
. 01 death
o Not pregnant, but pregnant 43 days 10 1 year
before death
o Unknown if pregnanl within the past year
32c. Place of Injury: Home, FSIm, Street, Factory.
0If1C8 Building. elc. (Specify)
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Enter u,: UNDERLYING CAUSE
~~.~~e
b. DueIO(Of"~~tL.t..,
Due to (or as a consequeoce o~:
c.
Due to (or as a consequence of):
d.
DYes
DYes ONo
31.Manner~th
~ra1 0 Homicide
o Accident 0 Pending Investigation
o S..- 0 Cou~ No! be Detannlned
32d. TIme 01 Injury
32g. Location or lnjUfy (Street, city I town, stale)
3Oa. Was an Autopsy
Performed?
n. Were Autopsy Findings
AvaHabIe PriortoComplellon
of Cause of Death?
M.
33a CeItifier (check oo~ one)
Certffyfng phystolon (PhysiCian certIIyIng caUsa 01 death when anothe< physiCian has pronounced deafh and compIeled Item 23)
To the best of my knowledge, death occurred due to the caUH(s) Ind manner.. stated... _ _ _ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
=~"':,: =~~'~~~::~=':c.~:~~~::~~:~ manner 81statecL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
= ~=~:.o;: and I or InvflItig8tion, in my opinion, deatt1 occurred It the time. daile, and place, and due to the C8llse(S) and manner 81 statecL 0
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If[clSt ~lflilI Ctlt~ '<1}tgtCUttfUt
OF
PAUL E. lVicCLAREN
I PAULE. McCLAREN, of the Lower Allen Township, Cumberland
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County, Pennsylvania, being of sound and disposing mind, memory ~q ~
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understanding, do hereby make, publish and declare this my Last Wi11a~lg ~
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I direct the payment of all my just debts and funeral expenses as ?oon aftera'
my decease as the same can conveniently be done.
2.
1 direct that there shall be paid out of my residuary estate all estate,
inheritance and like taxes together with any interest or penalty thereon imposed by
the Government of the United States, or any state or territory thereof~ or by any
foreign government or political subdivision thereof, in respect to all property
required io be inciuded in my gross estate for estate, inheritance or like tax purposes
by any of such govermnents, whether the property passes wlder this will or
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T ....;"00 ,100";"00 "'....,1 h,orll.,o",th t..... ....."'r ,o....t;~,o ,o"t",t,o ~,o",l n,o~C'.........",l "'....,1 .......l.v,o.rl ;....
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equal shares to my nieces and nephews as follO\vs: AUDREY LOWRY,
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CAROL lViASON, BELINDA PUGH, DAVID FONDELIER and CHARLES
FONDELIER.
4.
In the event a beneficiary predeceases me, his or share shall not lapse, but
pass instead to his or her heirs.
5.
Lastly, I nominate, constitute and appoint my nephew, DAVID
FONDELIER, to be Executor of this my Last Will and Testament. I further direct
that no bond or other security be required of my personal representative to
guarantee faithful performance of his duties.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~1 "G~
day of November, 2000.
&~~~-L~ (SEAL)
au t. Mc aren
Signed, sealed, published and declared by the above named PAUL E.
McCLAREN as and for his Last Will and Testament, in the presence of us who
have subscribed our names hereto as witnesses, at his request, in his presence and in
the presence of each other.
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OATH OF SUBSCRIBING WITNESS(ES)o
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REGISTER OF WILLS
COUNTY, PENNSYLVANIA
Estate of Paul E. McClaren
J. Robert Stauffer and John M. Eakin
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, (each) a subscribing witness to
(Print Name/s)
the ~Will [J Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she / he / they was / were present and saw the above Testator / Testatrix sign the same
and that she / he / they signed the same and that she / he / they signed as a witness at the request of
the Testator / Testatrix In her / his
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(Signature)
Market Square Building
(Street Address)
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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.)
/' Market Square Building
(Street Address)
Mechanicsburg, PA 17055
(City, State, Zip)
Mechanicsburg, P A 17055
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
Executed out of Register's Office
Sworn to or affirmed and subscribed
1rh
before me this
day
before me this
of
of
~ril
Deputy for Register of Wills
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy ofinstrument(s) at time of notarization.
Form RW-03 rev. 10.13.06
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