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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
COUNTY, PENNSYL VANIA
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!ll-W- 0002-
Estate of Theda J. Horner
also known as
File Number
, Deceased
Social Security Number 165-24-7237
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
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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 ~he instrum~s) otteit?d;~),
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated and codicil(s) dated
Ii] B. Grant of Letters of Administration Bradley D. Fetrow, d.b.n.c.t.a
(Ifapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
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 d.b.n.c.t.a., enter date a/Will in Section A above and complete list a/heirs.)
Name
Delno R. Horner, Jr. ( died October 2, 2007)
Relationshi
Husband
Residence
137 Salem Church Road, Mechanicsburg, P A 17055
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in Cumberland
137 Salem Church Road. Mechanicsburg. P A 17050
(List street address, town/city, township, county, state, zip code)
County, Pennsylvania with his / her last principal residence at
Decedent, then 78
years of age, died on December 27, 2006
at M.S. Hershey Medical Center
Decedent at death owned property with estimated 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 County
Value of real estate in Pennsylvania
$
$
$
$
6,372.00
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:
ture
Bradley D. Fetrow
Form RW-02 rev. 10.13.06
Page 1 of2
COMMONWEALTH OF PENNSYLVANIA
Oath of Personal Representative
SS
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 ofPetitioner(s) and that, as personal representative(s) ofthe Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the
day of
(] ,0 A 2
L(117/lJ 1iin.P
File Number:
Estate of Theda J. Homer
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Form RW-02 rev, 10.13.06
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Signature of Personal Representative
Signature of Personal Representative
(2/ -() 7-- (){)02
Supreme Court LD. No.: 6351
Address:
Telephone:
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, Deceased
Market Square Building
Mechanicsburg P A 17055
717-766-3172
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STAn OF MARYLAND
DEPARTMENT OF HEALTH AND MENT Al HYGIENE
CERTIFICATE OF DEATH,
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REGIS TRAR
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7. DATE OF DEAlIi .",NIH
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10, CITY OR TOWN OF DEATIi
1~, CITIZEN OF WHAT COUNTRY?
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170, USUAL OCCUPATION 17b, KIND OF BUSINESS OR
iP'P! 01 Wo.KfO"M)?!t'~WOlI{HGI.fl INDUSTRY
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"b, SOCIAL SECURITY NO,
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IS, MOTHER'S MAIDEN NAME
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11, INFORMANT
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II, CAUSE OF DEATH IEnter only one (ou.e per line for 101, (0', and Ie', I
PART I. DEATH WAS CAUSED BY, ( ::; Pit c... ~ n I
IMMEDIATE CAUSE la) ... 1"- rz..- I J
DUE TO, qR AS A CON~EQUENCE OF P Ij 1L-f}-L-t, n (,.
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DUE TO, OR AS A CONSEQUENCE OF E Ai ~ S1t}.-~
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Conditions, if any, which
gave rise to immediate
couse 101, stating the
underlying couse lost.
PART 2. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RElATED TO THE TERMINAL DISEASE OR CONDITION GIVEN IN PART1'a'
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c( 190. DATE OF OPERATION I 19b. CONDITION FOR WIiICIi OPERATION WAS PERFORMED
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210. ACCIOENTWASUNDfRlYNG .0
OR CONlf1I8UHNG 0 CAUSE OF DEATH
llf EITHER. NOHFY MEDKAI eUMINUI
(at- I (J-} 1JP>11 -
71b, TIME OF INJURY
HOUR A,M, MONTH DAY YEAR
P.M. 19
710, PLACE OF INJURY
(AT HOME, SfRHT. 'ACTORY, OffICE. FARM, ETC.)
700, AUTOPSY?
70b. IF YES, WERE FINDINGS USED
IN CERTIFYING CAUSES OF DEATIi?
C '('oJ TJ n r YES 0 NOm- YES 0 NO 0
lie. HOW INJURY OCCURRED (ENTER NATURE Of INJURY IN ITEM II. ,...., I OIt~"ar 21
71d, INJURY OCCtJRRED
711, LOCATION
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CITY OR IOWN
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, 19 , to , .hat I" (wella.'
. and that in (my) (our) opinion death occurred on the dote and hour and 'rom the COu\e\ stated
7]., BURIAL, CREMATION, REMOVAL
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74jUNERAL DIRECTOR:
t~ (~NS~~J-fiS (ft
ATTENDING / 4DICAL STAFF
pliYSICIAN B'D'iRECTOR 0 PHYSICIAN 0
170, ADDRE SS '
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77<. DATE SIGNED
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REGISTER OF WILLS
COUNTY, PENNSYL VANIA
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RENUNCIATION
Cumberland
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Estate of Theda J. Homer
, Deceased
I Adeline Toranto
,
(Print Name)
Contingent Residuary Legatee
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Bradley D. Fetrow
4/ct lot
(Date) I
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1 ~. . . Mr eo.. '1111 ... Oct 2UI11
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"'" ,., ~ TllIauglt NIlIDnIJNaIIIy AIM.
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(Signature)
878 Oak Wood Drive
(Street Address)
Executed in Register's Office
Sworn to or a~ and subscribe~
before me this day
of~ ,~.
Melbourne, FL 32940
(City, State, Zip)
Deputy for Register of Wills
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
, p~o~es.s~ted within on this ~ day
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My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. IO.l3.06