HomeMy WebLinkAbout04-21-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C Ll'n1heJand
EstJklfrta.xlhu..- (;C b ~ Y7
COUNTY, PENNSYL V Al\:IA
File Numbel~i - 0 g- -IJ is ~
also known a,
47~
, Deceased
Social Security Number /65 - 09 -dj If--) 3
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Petitioner(sl. who is/are 18 yeats of age or older, apply(ies) for:
(COMPIErF 'A' or '8' BEl. 0 W:)
~ A. Probate alld Crant of Letters Testamentarv and aver that Petitioner(s) is / are the t 'x ~ c u.+a y: C.
last \\111 ,)f th.: Decedent dated JJe\ I r l> ('11'U and codicil(s) dated
I I
named in the
(State relevant circulllstances, e.g.. renullciation. death of executor. etc.) ,......,
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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 o~SS1stll.lmen~offer~-d. .
for pl'Ob:.Jle, was not the victim of a killing and was never adjudicated an incapacitated person: 'J ~ p ;g ;..~'.'
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(Ifapplicable. enter: c.t.a.; d.b.lI.c.t.a.; pelldellte lite; durante absentia; durwttg)'@i'ifi'lte) ::J::
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following s~s-eiif any) a~eirs:
Adlllinislralioll. C.I.a. or d.b.ll.c.l.a., elller dale oj Will ill Section A above and complete list oj heirs.) )> en
N
o B. Grant of Letters of Administration
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Name
Relationship
Residence
(COMPLETE IN AIL CASES:) Attach additional sheets if necessary.
'a with hi~ her last ~rincipal residence at~c;rf
/.', , f) fl (V7
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
$ 9 ~ c: c;-', ct;;'
$
$
$
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:
Signature
Typed or printed name and residence
1'l()/3
ForI/! R W,O] reI' I () /3/)6
Page 1 of2
Oath of Personal Representative
COI\Hv[ONWEALTH Of PENNSYLVANIA
COUNT'{ OF 1lun~A(l(d
ss
The Peri :,IC\;Cni I at"),, ,:'.,IU:: \,~j ,'," C::ll(S) l)r \\ 'Tinn(s) that the statements in the foregoing Petition are true and COlTect to the best of
the k,:,;\', kd:,(e JI!J hdid' of Pditioncr( s i aml tbt, as personal representative(s) of the Decedent, Petitioner(s) wilt well and truly
administer the estate according to law,
Sworn to or affirmed and subscribed
before me the ~ I Sf- day of
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Estate of /f':' /f'/2-77r4- C;;~6/:4 ,De~~ ~ ,', ;;-~
Social Se~itYNunlber: /~ (~- c>9-.2Lf~3 Date ofDeath:~(.L,y;Z.'1 ]>4/ 2C'~
AND NOW, U.pJ' ~ , c/C6), in consideration of the foregoing Petition, satisfactory proof
having been presented before n~e, IT IS DECREED that ~et\ers r~7'79n1eQV J7'}IC it'
are hereby granted to ~ c;r~"'..o ::Z:-. GO'/S...-'V ~-j V?::, 6, B U~{'f"&L~~/L
SigllUlllre a/Persolla! Representative
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File Number:
in the above estate
Short Certificate(s) , , . . . . . . $
Renunciation( s)
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A;Y./~~ S', (7JP9A/eLS
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and that the instrument(s) dated /!/'C/V c?n&e"z_ / ~~ ,
,
described in the Petition be admitted to probate and filed of record as the last Wil
U
Attomey Signature:
Attomey Name:
Supreme Court LD. No.:
Address:
Telephone:
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Form R W-1J2 rev i U. 13,0.6
Page 2 of2
HiO.'::;.kO'1 RI.\
'2/-08 -Oll5~
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Certification Number
This is to certify that the information here given l'
correctly copied from an original Certificate of Deatt-
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing,
Fee for this certificate, 56,00
P 13889038
~. ~~~~~ 7/2008
. Local Registrar Date IssLled
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Hl05-143 REV 11!2006
TYPE I PRINT IN
PERMANENT
BlACK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
8b. Cwmy 01 Death
"t, J . Cumberland
11. Decedent's Usual
KlndofWorIt
6, Date of Birth (Monlh, day, VElar)
1. Name ofOeted8n( (First. miItMe,lasf, sutfilC)
4. Date of Death {Month, ~.par)
Jan. 4, 2008
92
V~.
oOlhe<.Spedfy,
10. Race: American Indian, Black, White. ele.
1-
White
College (1-4 or 5+)
14. Marital Stalus; Mamed, Never Mamed,
_0_1_
Widowed
Decedent's
AcluaIResidence 17a.State
1lb. Coon~
PA
Cumberland
Did Decedent
livein. 17c.(1gVas,o,c_"''''in S. Middleton Twp
Township'? 17d. 0 No, Oecedeot Li\ted within
Actual Umits 01
r.".
18. FaIhEf'S Name (RBI, midcle,lasl, suIIix)
Charles W. Earle
208. Informant's Name (Type I PI'int)
Cilyl&ro
19. Mother's Name lFirst, mil:kIe, maiden surnamel
Matilda Stunkard
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19
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2Otl. Informant's Mailing Address (Street, city I !oWn. state, ~ code)
315 Avon Dr., Carlisle, PA 17013
21c. Place 01 Disposilion(Name 0# cem8I9Iy, t'18Il'I8k:fy or other pIaoe) 21d, Location {City I town, state, zipCOdel
Westminster Memorial Gardens rlisle, PA 11013
219
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Due 10 (or as a consequence rJf.
Approximale interval; Part II: Enter olher sicIlificant cordtinns tonIriI:ItJlnn to death 2.8. Did Tobacco Use Contribute to Deatfl1
Onset to Dealh buI no! redIng In the uOOerlying cause given in Part I. 0 Yes 0 Probably
o Un_
oVas oNo
31. Manner of Death
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0'\'''''''" 0 -.gl....ligalion
oSocide oeou.NoIbe__
29. It Female:
o NoI__pasljea<
o P_a1timaaldaa~
o NoI_,but_wilhin<2days
ofdaalh .
o NoI_,butfll1lllll8lll43dayslolyoar
belonldaalh
o -'__"'pasljea<
32<:. == :'is;:;j Street, Faclory,
=:laByiat_, 'any,
t.olhe calI8llsled on ~nt a.
_ UNDeRLYING CAUSE
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b.
Due to (or as a consequence of):
Oue to (or as a consequence 01):
3Oa. Was 1/1 AIAopsy
Pel'formed?
d.
3Ob.__F__
AYaiablePriorto~
of Cause of Death?
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32d. T"",ol~
32g.Localionol~(Streel,cily(loWn,Slale)
M.
338. CE~ (Check only one)
Certifying physician (Physician certifying cause of death when another physician has pronounced death Bod completed Item 231
To the best 01 my knowledge, dtlth oceurred due to the caUBe(I' and INInneras st8IBcL................ _................................... _...... _.....................
~=~:='~~~~:~:~anddea~~=~:~= manner as stated.._ ..... __ ___ ____.._.._.. 0
:c::- bae:':t~~= and J or investigation, in my opinion, death occurred at the time, date, ana place, and due to the cause(tJ and marmer lIS sfated.. 0
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~, MARTHA L. GOBIN, of the Borough
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of Carlisler N
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Cumberla~c County, Pennsylvania, declare this to be my last will
and revoke
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any Wl~~ prevlous~y maae DY me,
- devise and bequeath al~ of my estate, of every
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nature and wherever situate in equal shares to such or my adult
f:)-( .~~ ;',,~,;: ...L.. 1,
children, RICHARD I. GOBIN, and JOY G. Hooke, as shall survive m
by thirty days.
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Should my son, RICHARD' GOBIN or my daughter, JO
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G, HOOKE, predecease me or die on or before the thi~tieth day
following my death, I devise and bequeath the share or such cnl~
to his or her issue per stirpes living on the thirtv-first day
following my death; and should eit~er my said son. RICHARD :.
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GOBIN, or my daughter, JOY G. Ho6KE, leave no such lssue living
on the thirty-first day following my death, I devise and bequeat
the share of such child
, . ~ ~ ' . .. ., ' .. .
to my otner cn:lQ or to nlS or ner lssue
per stirpes living on the thirty-first day following my death.
III.
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
part of the expense of the administration of my estate.
IV. I appoint my son, RICHARD I. GOBIN, and my daughter,
JOY G. HOOKE, co-executors of this my last will.
I Il..[,; ~l?~ ;.i{ t j
Should both or
my said children fail to qualify or cease to act as executors
, t
appoln ,.
THE FARMERS TRUST COMPANY, of Carlisle, Pennsylvania as
executor
0: this my last will.
V. I direct that my executors shall not be requlred ~o
give bond ror the faithful performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this
/~i<< day or /7Jr"-c~,.<- f',-c'L ,1990.
f L ~
", 77' .~, .'. , /
1/ / tl ~/t;'R/ ," . .' ~-z{-
MAEtTHA L. GOBIN
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The preceding instrument, consisting of this and one
other typewritten page identified by the signature of the
testatrix, MARTHA L. GOBIN, was on the day and date thereof
signed, published and declared by MARTHA L. GOBIN, the testatrix
therein named, as and ror her last will, in the presence of liS,
who, at her request, in her presence. and in the presence or each
ot1:er have subscrj)o1~a:our names as witnesses hereto.
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REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat , sign the same and that signed as a witness at the
request of testat_ in h presence and (in the presence of each other) (in the presence of the
other subscribing witness( es)).
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS O.Q.{'/.1;7~/~'''-cOUNTY
OATH OF NON-SUBSCRIBING WITNESS
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~ a subscrib~r hereto, (yaCfi) bei~g. dul~ qualifi~d according to law, depose(s) and say(s). th,at
,~ L /. >" famIhar WIth the sIgnature of #7/j-/? 77,1//7- c; c- 0.... J(.j ,
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testat~ of (one of. .the .Jiuh<;l'rihjng witnesses to) the will
that
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presented herewith and
,odil'il-
believes the signature on the will is in the handwritil}i"of
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knowledge and belief. -~:r R :::'0
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C~/ .r{ (Address) fJFJ-j!,t =j-?/ e
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A "r-
to the best of I
Sworn to or affirmed and subscribed before
me this r!)t :JI day of
qff;l<~ct~~
(3 Register
(Name)
(Address)
OATH OF SUBSCRIBING WITNESS(ES)
/ REGISTER OF WILLS
~h-/~-../' COUNTY, PENNSYLVANIA
Estate of
/??~~.,I/} C~~;J
, Deceased
Ad~~ ~ ~.;q.-e>(I'/&S; Ci>~~ , (each) a subscribing witness to
(Print Name/s)
the ~Wi1l 0 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
/
/
c:1Cnature)
presence and in the presence of each other.
(Signature)
t."V''t'P' /~'.n-.r~-' ~
(Street Address)
(Street Address)
9R~,v..,.,.S; ;?/9-11-3 Z-jIJ
(City, State, Zip)
(City, State, Zip)
Executed in Register's Office
Executed out of Register's Office
Sworn to or affirmed and subscribed
day
, /1oof.
before me this
day
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Notary Publicg~ ~ 32
My Commission Expires: '~p~ -0 r
(Signature and Seal of Notary or other ~~quahfied tcrx
administer oaths. Show date of expIration ,..1$Jotary's C~llsslonJ
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To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.
of
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NOTE:
Form RW-03 rev. 10.13.06