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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
File Number 21-- () I \ \0 ~
Estate of . Gary M. Arnold
also known as
, Deceased Social Security Number
206-66-1640
Samuel S. Zeman
Petitioner(s), who islare 18 years of age or older, apply(ies) for:
(COMPLETE W or 'B' BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) islare the
last Will of the Decedent, dated and codicil(s) dated
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 born or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
00 B. Grant of Letters of Administration
(If applICable, enter: c.I.a.; d.b.n.c.ta.; peaente lite; durante absentia; durante mmontate)
Petitioner(s) after a proper search haslhave 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
James E. Arnold Father 5600 Middle Ridge Road
Newport, PA 17074
Karen Styer Mother 1951 Jericho Road
New Bloomfield PA 17068
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his I her last principal residence at
113 Yates Street, Mount Holly Springs, Cumberland, PA 17065
(List street address, town/city, township, county, state, zip code)
Decedent, then 27 years of age, died on 07/14/2007
at 2200 Block of Route 34, Gettysburg, Adams County, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$
$
$
$
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Signature
Typed or printed name and residence
Samuel S. Zeman 307 North Fayette Street
Shippensburg, PA 17257
Wherefore, Pelilioner(s) respectfully requesl(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Lelte~ appropriate.form to
the undersigned: J. 0
Form
Rev. 10-13-2006
Copyright (c) 2006 form software only The Lackner Group, Inc.
Page 1 of 2
Oath of Personal Representative
} SS
}
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
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.
Sworn to Olr affirmed and subscribed
before me Ihis I ~ t/1
~~. JOo
l;J)c:Lf ~ l
!
day of
Signature of Personal Representative
Signature of Personal Representative
o
File Number:
21-- t"\ \ \ D~
Estate of Gary M. Arnold
NKJA
Social Security Number: 206-66-1640
AND NOW, lLeU} f2 LJ/{.I L
,
having been presented before me, IT IS DECREED that Letters
are hereby granted to Samuel S. Zeman
, Deceased
Date of Death: 07/14/2007
, ~Y]P
, in consideration of the foregoing Petition, satisfactory proof
of Administration
Attorney Name:
in the ~ve estate . ..
co T'e
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C-' J
and that the instrument(s) dated
described in the Petition be admitted to probate and filled of record as the last Will (and Codicil(s)) of Decedent.
/Tl
FEES
Letters................... .......... ............... $
fv~OD
2 f2{)o
Short Certificate(s)........................ $
Renunciation(s)............................. $
$
$
$
$
$
$
$
$
$
Supreme Court I.D. No.: 01624
Weigle & Associates, P.C.
Address: 126 East King Street
Shippensburg, PA 17257
Telephone:
717/532-7388
TOTAL.................................... $
(p1.')-, () U
Form RW-02 Rev. 10-13-2006
Copyright (c) 2006 form software only The Lackner Group. Inc.
Page 2 of 2
H105.905 REV.(6/06'
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records 1TI accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
/7.J r d
C4(5 ~ (f~YL trVl0f~L
No.
Frank Yeropoli
State Registrar
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
4329108
APR 04 2008
Date
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STATE FILE NUMBEW ::0
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1. Name of Decedent (First, 1'I'liIiIIe, last, suIfix)
Gary ~l. Arnold
6 Date 01 """ (Monlh, day. yearl
-1640
~68~~
, ':")
Hl05.144 REV 1112006
TYPE { PRINl' IN
PEFl'MANEN'T
BLACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See instructions and examples on reverse)
o
Bb. County of Death
Adams
8d. Facility Name (H nol instituliofl, gWe street and nurTtler)
2200 Block of Carlisle Road
I. -,
27
Yo;
May 27, 1980
Camp Hill, Pa.
Sa. Place 01 Dealh (Check ooIy one)
........" QIhe, hioh
0_ DERIOuIjoo.... DOOA D_Home DR.-oce ~W~1y
9. Was Decedent of Hispanic Origin? IZI No 0 Yes 10. Race: American Irdan, Black, White, etc
=~:~,etc.) ~hi~e
5.Aqe(laStBirthdaYI
Pa.
14. Marital SUltus: Marr'led, Never Married,
WKlowed.ONoo:ed(_
never married
[);dlloc<ldenl
Uveina
Township?
He. 0 Yes, 0ece0enl: lived irl
17d)[] No, Decedent lived within
M~~oI Mt Holly Sprin9s~l_
Twp.
113 Yates Street
Mt. Holly Springs, Pa. 17065
18. Father'sNarne (Fii'st, middIe,lclst, suffill)
12. Was Decedenl ever in the
U,S. Anned Forces?
Qv" DNa
Decedent's
ActuaIResidence Ha.Stale
17b. County
13. lloc<ldenl'sE_tioo(Sl>eci'i"""___od)
Elernentary I Secondary (0-12) College (1-4 or 5+)
12
James E. Arnold
("llmherlQP~
19, Mother's Name (First. mi<kie, maiden surname)
NK
Karen Potter
203. Intonnant's Nan'll! (Type I Print)
2Qb, Informanfs MaU'lg Adl:tess (Street. city IlOWn. state, zip code)
5600 Middle Ridge Rd
21c. Place of Disposition (Name 01 cemetefy, Cfemalory or oCher placel
Home Ne rt, Pa. 17074
2311. License Number 23c. Date Signed (Month, day, year)
26. Was. Case RefmM to tI.edicaI Examitlell Coronel lor a Reason Other \han Cremation or Donation?
I!I V" 0 Na
Part M: Enterolhefsimillcanto:ndltions CIlI'IIriIuti1a In death
bUt not resUlinginthe undlIrIyingcause giYenin Part I.
28. Did Tobacco Use ContribtJte to Death?
o V" DP-
.No 0-
Sequentialylislconcilions, if any,
IeadinQwlhe cause listed 00 ir.e-a.
Enter the LN)ERLY'ING CAUSE
(liseaseorilpythatinitiatedlhe
_oesull>ig._IlAST.
b.
fY\U'~ D \W\1 to\(.t
Doe to (01 liS a 01):
MD b- If tth>\t Me ;d,C^ \'
Due to (or as a consequence of):
-rrrlu,(h(!.....
I Approximate inteIVaI:
: Onset to Death
.
,
.
,
,
,
.
.
,
,
,
,
,
,
.
29. If Female:
o Not"..",.,."",,, pest.,..,
D_altime<Jl_
o Not P"",,,". "",_-,,days
01"'''
o NoI_,,,",p_43..,.IO',..,
before_
o -'''''''''''-'''''pestyea'
32c. Place of Injury: Home, Farm, Street, Factory,
OlfioeB_"'.(Spoci/y)
='~~~)~
Due to (or as a consequeoce of):
d.
Dv" III No
Dv" DNo
31. Manner of Death
0..."", D-
Ill- 0 P""'''9''''_''''''
Os.- DCooklNotbeDe""""'"
O(!' 'l31lM
32b_ Oescrtle How Injury Oc:cuned
c. c. ~{ 's 1r'c..L!t.:1' ',r-Ci( I(r'
"T"",S(Xl<1a""" ~ (Spoci/y) 32g.locatiOO <Jl""", (Slreo\, city 11<""'. ..,.)
11""""- Dp_ 0- ;;;Cc'i)""~ c~e/Jr/i.>/( ;(:\:)
""".Spoci/y
33b. SigOallJfe andTrlIedCertifier
~E:: r ~,.
(l~r(r ~(l..
JOa. Was an Autopsy
P-
:lll>W",_F_
AYii\abIe POOr'to Completion
01 Cause 01 Oealh?
33a.Ce<1ilIec("""'"",onel
Cettifytng""_I_"otiIyingcauoeol__"""""_has"""""",,,,,""~""'_"em23)
To the belt 01 my Icnowfedge,..... occ:unedduelolhtCMlSl(s) and "*,,*_IIItecL...... _ __ ___ _... __ ___ __... _ _ _ __... _ __... __ _... 0
==~=~,,=::::=-,..."':.,,:,=,.IO~~:"""""""""______________m 0
= =:- ex: and I or klvesUg.uon, In my opinion, dHth occurred at the time. d*.and P'ace, IIld duelo the GaUSIl(s) n I\\II'IIWlf as Mnd.. .
34. Name and Address of Person Who CornpIeted Cause 01 Dealtllnem 2n Type I nt
'f;'A.v,,> j;)...~1oI .:I\Z
'j<; {'Api"" e,(\l ~'o'/<
6<. j, r (l 73~~
33c.licenseNlJnber
Disposition Permit No.
tJ //~d200