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HomeMy WebLinkAbout08-04-08PETITION FOR PR/OBA,,-T__E//AND GRANT OF LETTERS REGISTER OF WILLS OF (L~rn,~uCL~ COUNTY, PENNSYLVANIA Estate of -T~~ IC ~ L-Ot2 /L/l/~ ~ypR NE also known as File Number i~L /~ ~~U~~ y~ ~~ Deceased Social Security Number 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 that Petitioner(s) is /are the /-~ R rr1uR ©tx oN ~o iP i11 E named in the last Will of the Decedent dated %~-~ - / ~{ 79 and codicil(s) dated (State relevmU circumstances, e.g., renunciation, death ojexecutor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution. for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ^ B. Grant of Letters of Administration c~ _ _ _~ ,- enRs) offete r~ '~"! fem. ..,.~ ~7QO 3 ` - t U C -_- (Ijapplicable, enter: c.t.a.; d. b. n. c.t.a.: pendentelite; durmue absentia; duAe,'i inaritnte) -• r _ ' _ W ~ ::. ) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any}~'etld heirs: (If , Administration, c. t. a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) Name Relationship Residence (COMPLETE IN ALI. CASF_S:) Attach additional sheets if necessary. Decedent was domiciled at death in C` tLl b " L ,U ~ County, Pennsylvania with his /her last principal residence at ~.L m CRL' f'j /°S ~/ W f~L.N l.t T L3 ~ i 1"O vrl /c ,jolo Eti15 b ~ 2 c, ~ fi4 / 7~ S` ~] (Ls[ahcet add,css, town/uty, township, count),, state, z,p code) Decedent, then ~ .3 years of age, died on 3 ° 7 - Q ~ at C h ~ m ~ t~ .es b ~t r\q /-~C 5~ t ]'~i4 L. Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ % 7~ ~ 7$, C D (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: 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 Signature Typed or printed name and residence R TI~v,P U. I~u,PN~ y 7s ~; ~~o:L Form RW-02 rev. ho.ls.o6 Page 1 of 2 U~- X51 ~, Oath of Personal Representative '" ' "' ~ ~ ... COIv1iViONWEALTH OF PENNSYLVANIA J ~ : ss 2Q08 APR -4 Air 8~ 33 COUNTY OF ./~/Y(~'_/~ ~+~~~~ ~~ 'The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foreg ~I i h~~ { ~ coned to the best of the knowledge and belief of Petitioner(s) and that, as personal representatives of the D~oedent~~ti~oner~s ~Il well an () d truly administer the estate according to law. ~ic~t.~ua-y ~ ~ ~~~~ Srgnnture of Persatnl Representative Signature of Personal Representative Srgnnture of Persona! Representative File Nuimber: ~~- ,y~Clt_~0 ' ~3 ~~ Estate of ~ J~,(s/j/(~,~ 1~~~~ ~~~11e ,Deceased Social Secu/r~ity Number: `~/ Date of Death: ~~c~ ~ "Z~CI`~ AND NOW, ! ,[ .~~ /~ T , ~CXI ~ , in consideration of the foregoing Petition, satisfactory proof having been presented befo e me, IT IS DECREED/th/at Letters ~ = ~~ are hereby granted to L-{ ~~~~(r'~ l /XGi~ ttU~/7f'_ _ in the above estate and that the instrument(s) dated `~ ~(}~ n; ~ p,1 ~~ ,,. K;S~ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Deced nt. ,/ / FEES Letters ............... $ . CQ~ Short Certificate(s) ........ Q$ ~ W ... $ /~ °" f~LC zi ... $ ,Sou $ Address: ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ S. vu Register of W' Is n Attorney Signature: Attonley Name: Supreme Court I.D. No.: Telephone: ,/i . ~G r-~,», Rw-o? rev. 10.13.0 Page 2 of 2 Sworn to or affirmed a~~d subscribed '%`/~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH V1/ARNING: It is illegal to duplicate this copy by photostat or photograph. ~ Fee for this certificate, $6.00 ~' ~~ ~~3~'~ ~ ~~ Certification Number 1105-143 REV 118008 TYPE/PRINT IN PERMANENT BLACK INK J J c. ril This is to certify that the information here given is correctly copied from an original Certificate of Death duly tiled with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for ermanent filing. _ ~~ //~ egistrar E") ~ Date Issued ~_' O c° .y~~ `~ a i ' _ ~ j = r`~.. ~ ` : -~ t ' 7 G ~ a ~ _~ ' Ui~ „ _ raj C7O© Ss ~ ' ~~ - ->O --I Cb F ~; '' `~7 r=7-~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS D CERTIFICATE OF DEATH ,~- , 7 (See instructions Rnd eYamnlns mm xoaze.~eL 1. Nana of Decetlenl (Fuss, addle, last, sullu) Janice L Horne 2. Sax 3. Sodal Security Number m 4. Dale of Death (Month, day, year) . Female 201 _ 18 - 1335 March 7 2008 , 5. Age (last Binhtlay) Untler 1 year Under 1 my 6. Dale a Binh (MOmh, say, year) 7. anhpace (CDy and Sate or foreign country) Ba. Place d Death (Check only onej Mwxns wya Hour xansaa Mospilar. Other 83 vrs. 2-28-25 Path Valley, PA ®lrpalient ^ER/0ulpelient ^DOA ^NUming Home ^Residalce ^01her. Specify: 8D. Cerny of Deam 8c. Cny, Born, Twp. d Deelh 8d. Facilay Name (If nd'nsdaion, give street eM number) 9. Was Decedent d Hispank Origin? ®No ^Yes 10. Race: American Indian Black WNIe etc , , , . Franklin Chambersburg Chambersburg Hospital Pfyea,spedrycuban, (~¢~;,~ M i ex can, Puerto Rican, etc.) whit e ' 11. Decedent s Usual Occu tan (KiM o1'MOrk done tlurin most of work' Me. Do rxz state retired 12. Was Decedent ever in the 13. Decedent's Edralion (Specify ony hghasl grade completed) 14. Menial Slalus, MarrieQ Never MarrieQ 15. SurvNing Spouse (11 wife, give maiden name) Kmtl a Work U S Armed Fo ? . . rces KiM d Business / hWuslry Elementary / Secontlery (0-12) Collage (1 d or 5') Witlowetl. Divorced (Specilyl homemaker ^raa ®NO 8 years widowed 16. Decedent's Mailing Atldress (Street, city / lam, state, Zip cotle) Decedent's Did Decetlenl 129 Walnut Bottom Road AdualReaitlence t79.Slate PA urema nc.®raa DecetlemLivedin Shiopensburu Twp. , Township? TwD. Shippensburg, PA 17257 rib. Canty Cumberland rid.^No, Decetlem Lrvetl wDDin Actml LirnDS a cny /Bore 18. Father's Name (First, middle, last, suDa) 18. Mdher's Name (Fist, nidtlle, maiden sumeme) Basil J. Zeigler Lola Crouse 20a. Irdorrrem's Name (Type /Prim) ZOO. Inlortmm's Meikng Address (Street, city /lows, slate, zy cotle) Arthur D. Horne 475 Eugene Drive, Chambersburg, PA 17201 2/a. Mahotl of DisposDwn + ^ Cremaaon ^ Donation 216. Date d Dispos4pn (March, day, year) 21c. Place a Dapcedon (Name a cemetery, aemelay or dher place) 21d. Location C /town, elate, zip cede) ( nY ® 8unel ^ Remwel Irom Stale ~ Was Cremator a Donstlon Aulhonzetl ^ aher.sperny: ; byMeakalEx.miner/Coroner? ^Y¢s^NO 3-11-08 Parklawns Memorial Gardens Chambersburg, PA 17201 ' a. S tea are d Fjwaral Service Licgoae (or pars ' g as such) 22b. License Number 22c, Nam¢ aM Address of FanAly / S ~ } ~ ) 1 ~ v ~ FD-012984-L Fo elsanger-Bricker F.H. Inc., Shippensburg, PA 17257 Complae Denis 23e< omy when ceNtying 23a. o tlw best a my knowledge, death occurred al Ore tine, date e p slatetl. (Signature antl tills n ~ ) 23D License Number 23c. Date Signatl (HOMO, daY, year) physidm rs rqt avaiade el time a tlealh to ,t" .,. /`~ mnd m a ad m ' ~ ~ ~/ y a e ea . „i+,.-. 5/ (1A159~g7~ 3 7 ~8 plm DY parson 25. Dale nc/ed Dead (Madh, y Yaarl 7 C, Deena 24-26 must De nxn etl 4. Tine of Death 26. Was Case Relerted Metlical Examiner / Corarer fa a Reason Other Ihan Cremation a Donation? who pronounces tlealh. S S M ~ U 7 U ~ . [t / L~ I (~ ^Yes ^ No ) L CAUSE OF DEATH (See InatruMlone antl examples) r Appmxinele interval. Dem 27. Pan I: Emer the chain of evems - dLseases, iryuries, or mmplicatxzls - that drec4ty reused me death. DO NOT enter temiml ever4s suh az mNiac anent Pan IL Emer direr simificent contl lion. rvudn~n 1o th, 28. Ditl Td>accO Use Conlridde ro Death? , Ousel to Deelh msprelory anent, a mmricular libaleion wnlaut showing the elidogy Lisl omy era muse on each Yne. ~ but riot resuMi the urge rig m dYM9 muse given n Pan I. ^Yes ^ Prdabty IMMEDIATE CAUSE (Final disease or / r / / cerrMxm resukm in death ~ / ~ / ~ ~ / ~~ g ) _' a t/ L _J1 ~ r Due to o as s l a 29 1DyFI~ln ta ( r consequence o ): ~ N o LJ^. Pregnant wimp past year Sequemially list mrMilions, D any, D leading b the muse Mad on line a. Due to r (or as a co E t f ^ Pregrant at time of tlealh ): nsequence o n er the UNDERLYWG CAUSE I r (tliseese a in Ih l i di l d th ^ Nol Dregnant but pregnant within 42 days jury e n a e e evems resaling m death) LAST. c' Due to for as a cowe uence ol d tleam q ). ^ Not pregnant, bd pregnam 43 tleys to 1 year d ~ belae tleah ^ Unknown it re nant wdhi th l 30e, Wes an Autopsy Penonned? 30U. Were Autopsy Fintlings Available Pita to Canplelan 31. Manner of Death ~} 32e. Dale a Iryury (MOmh, day, year) 32b. Describe How Irqury Ocmrred p g n e pee year 32c. Place of Irrjay: Hone, Fam, Slree6 Faday, d Cause a Death? BLldaturel ^ Hanicide Ollice Raiding, ac. (SpeciyJ ^ Yes r~.klo ^Yes ^ No ^ Acdtlenl ^ Pending Invesligetim 32d. Time of Injury 32e. Injury et Work? 321. II Trensponalion Injury (Spc v!y) 32g Location of Injury (Street, ply /town, slate) ^ Suicide ^ Cwltl Nol De Detertni N ^ y¢s ^ No ^ m^'ar / Operator ^ passenger ^Petleslrian M ^Olher - Speci/Y' 33a. Cendia Icheck only one) • CMKylrrg phyaickn (Physirran cenilying muse 01 dean when anaher physlpan hey promurcetl death antl axrpkl d Dem 23) To the best of my krwwkdge, death occurred due m the cease(s) and manner as sLletl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~I 33b. Slgnatae a Title a Cenier ~ y-x •/) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Pronounclrrg and cenlfying phyalcfan (Physician bdh porroundng death end cen4yin to cause of tlealh) ''"l g To the best of my knowledge, tlealh occurtetl at me time, tlete, arb plain, aM due to the causuys) end manner es slated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Medical Ezemlrrer / Cororrer 33c. License Der z^ M /1 ~ ~ ~J / L 33d. Dale 5 d ( th, day, year) ~~~ooonnn ~¢ / / I~ On the basis a exeminallon and / anti lion, In my opinion, tlealh ac d el the time, dale, antl plere, and tlue to the cause(s) antl manner es slatetl_ ^ I ' / , O ( ~ J 34. Name antl Atltlress of Perso n,Who Completetl s d Deatn (De p, m 27 ype (PrirlL ~^ n ~ S 35. Reyiszai s Signature and Dislr' um 36 Dale Filed (Month d ~ ~ ~ U ( ~ { ~ ~ ~ O J ` ~ ~ ~' "~/ l/x/LG C.- SS I I / I ~ f ~ I i ~ ~ 5 . , ay, year) ~ ' ' 00g 4 I I R1 UL K~(il D~ v Disposition Permit No. ~+ ` 1 0 ~ ~+ OATH OF NON-SUBSCRIBING WITNESS(ES) REGISTER OF WILLS rm~e~ll~l.~ COUNTY, PENNSYLVANIA ~2 / ~ ~UC~~~ D~ ~l Estate of -~ 14 N (~E ~- 0 K EN E f'f 0 ~ N ~ ,Deceased /~(~' T!-(U2 l~ r I~0 2ND and CK j ST/{ L ~. /~ORN~ (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well- acquainted with Si4,~ a G f/ G • (-tCl R N ~ and am/are familiar with the handwriting and signature of the decedent, and that the signature of ~{}l~ I L~ L ~ f~©R A7 ~- to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~~N f c ~- L~ (~0 2h1~ is in his/her own proper handwriting. (signature) ~-I75 ~ U~Enlp U2. (Sheet Address) ~~~n~b~es6dea.P~ (7~0 ~- (City, State, Zip) Execceted iii Register's Office Sword to or affirmed and subscribed before m this ~ day of _ r ~ , ^ ~ U~ . (Signature) (Street Address) (City. State. Zip) r-a C7 c°a +: ~ ~~~ ~ a ~ 7 ~ ~t- fl~ ~ , :~ rn ~.~ ~ ~ ~9 U~ ~ '~ 1 S ~~ ~ , ~ ` O 70~ ~ _ ~~: ~_~ ~ ~ -= t=:-~ Forrn RW-04 rev. l0. N.06 ~~ -, .7b1 LAST WILL AND TESTAMENT I, JANICE L. HORNE, of Letterkenny Township, Franklin County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this, as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and writings in the nature thereof by me at any time heretofore made. I. I give, devise and bequeath all my property, both real and personal, to my husband, Herman D. Horne, the same to be his absolutely. II. In the event my husband, Herman D. Horne, should fail to survive me, then in that event, I do give, devise and bequeath all the rest and residue of my property, both real and personal, instead as follows: A. I give, devise and bequeath to my husband's brother, Richard Horne, my deceased husband's 30-30 Winchester Model No. 94 with serial number 988672, the same to be his absolutely. B. I give, devise and bequeath all the rest and residue of my property, both real and personal, to my son, Arthur D. Horne, the same to be his absolutely. III. I do nominate, constitute and appoint as Executor of this, my Last Will and Testament, my husband, Herman D. Horne. In the event an alternate or successor Executor be required, I do nominate, constitute and appoint as such, my son, Arthur D. Horne. My Executor and alternate or successor Executor are hereby excused from furnishing bond for the faithful performance of their duties hereunder and are hereby authorized and empowered to sell my real and personal property at public or private sale at such a time and in such a manner as may be deemed wise, and to make, execute, acknowledge and deliver good and sufficient deed or deeds therefore to the purchaser or purchasers thereof. ~ ~Q coo ,:: ~ fix. ~,-.~ -?~t~- ~ ^~ ~ r _.:~ ~O© ~ C - 'a _ ._: ~ ~ ;`1 ~ -- .~" .' IN WITNESS WHEREOF, I, JANICE I. HORNE, the above named Testatrix, have to this, my Last Will and Testament, set my hand and seal this /3 f day of ~©,~~~, 1978. ~~. ~ (SEAL) anice I. Horne Signed, sealed, published and declared by the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, in her presence and in the presence of each other, and at her request, have hereunto subscribed our names as witnesses. r p~~