HomeMy WebLinkAbout04-25-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Frederick O. Graves File Number 21-08- bti'll
also known as
, Deceased
Social Security
Petitioner(s) who is/are 18 years of age or older, apply(ies) for:
[ l 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
N/A
named in the
(state relevenat 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 ~ instrument~offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:~-= 'J ~
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[Xl B. Grant of letters of Administration . . ..: 7' ~ ~. f')-)
(Ij appllcable enter: c.t.a.; d.b.n.c .t.a.; endente llte; durante absentia; zkz I ,,, te r11f(!jJrztate)
Petitioner(s) aftler a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if:~) andd:nlirs: (if'
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list oj heirs.) /'
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Anna Ma Graves
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Decedent then
79 years of age died on
11/24/07 at Church of God Home, Carlisle
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.)
(If not domiciled in Pa.)
(If not domiciled in Pa.)
Value of real estate in Pennsylvania
situated as follows:
65,000.00
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 a ro riate form to the undersi ned:
I nature
Page 1 of 2
OATH OF PERSONAL REPRESENTATIVE
COMMONWEATLH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition are true and com
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.
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Anna May Grav s
File Number:
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Estate of Frederick O. Graves
, Deceaseg:-~
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:;01.
c..n
Social Security Number:
Date of Death
AND NOW
having been presented b
are hereby granted to
, 2~_jn consideration of the Petition, satisfactory proof
IT IS DECREED that Letters of Administration
Anna May Graves
in the above estate
and that the instrument(s) dated
described in thte Petition to be admitted to probate and filed of record as the las Will (and Codicil(s) of Decedent)
FEES
Letters &S. Ob ()
Short Certificates
Renunciation
71:10
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Sup. Ct. J.D. No 46397
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Address: 5 South Hanover Street
Carlisle, Pennsylvania 17013
Telephone:
(717) 243-5838
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TOTAL.. .
Page 2 of 2
H 105.905MS 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 m 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.
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Hl05-143 REV 1112006
TYPE I PRINT IN
PERMANENT
BLACK INK
No.
Frank Yeropoli
State Registrar
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
1257041
~t.W ~ (\ 'lOO7
Date
0.[
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
Cuml:Je,rland
Church of God Hane
o Inpalienl 0 ER / Outpatient 0 DCA 6{] Nursing Home 0 Residence DOlher - Specify"
9. Was Decedeot 01 Hispanic Origin? m No 0 Yes 10. Race: American Indian, Black, While, ele
(tf yes, specify Cuban, (Specify)
Mexican, Puerto Rican, etc.) White
2.\ G~ o~l(
4. Dale of Death (Month, c:lay, year)
5. Age (LastB'rthday)
11/24/2007
79
Yrs.
8b. County 01 Death
1 Per-sirmon Dr.
Boilino 50rin s PA 17007
18. Father's N.une (First. middle. last. suffix)
Frederick O. Graves, Jr.
2Oa.. Informant's Name (Type I Print)
Anna May Graves
12. Was Decedent ever in the
U.S. Armed Forces?
IXIVes ONo
Decedent's
Actual Residence 17a. State
13. Decedent's Education (Specify only highest grade completed)
Elementary I Secondary (0.12) College (1-4 or 5+)
2
14. Marital Sletus; Marned, Never Married,
Widowed, Divorced (Specify)
Married
17b. County
PA
Cumberland
Did Decedent
Live in a
Township?
17C. ~ Ves. Decedent Lived in
17d, 0 No, Dececlenl Lived Within
Actual limils of
South Middleton
Twp
City/Boro
19. Mother's Name (First, middle, maiden surname)
Marion Towsley
2Ob, Intormant's Mailing Address (Street, city /town, stale, zip code)
1 Persirmon Dr., Boilj ng 5prjngs. PA 17007
21c. Place of Disposition (Name of cemetery, crematory or other place)
21d. Location (City I town, staie, zip code)
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LeTort Caretery
Carlisle, PA
Funeral
,year)
2007
Approximatelnlerval'
Onset 10 Death
Part II: Enter other sianiflCllnl mnditions cnntriblllinn to death,
but not resulling in the trrdertying cause given in PlIrt I.
~~~':;;su~t~~~ ~~~I~) dise:;..
/
51 C;"jR
Dueto(orasaconsequenceo~:
E",j
C~"Pi)
r""I<AA-< Iv lti y,rl
28. Did Tobacco USELContribule to Death?
o Yo, Ef'P_.y
o No 0 Unknown
29. It Female
o Not pregnant within past year
o Pregnantattimeofdeath
D Not pregnant, but p~ant within 42 days
01 death
o Not pregnant, but pregnanl43daysto 1 year
before death
D Unknown il pregnant wfthin the past year
32c.Placeoltnjury:Home,Fa~.Slreet,Factory
Ofllce BUilding, elc. (SpeCify)
Sequ&ntially lisl camitiofls. il any,
:~~~J':Dci~~II~~~~~: a
(clseaseori~ju')'thatinitiated Ihe
evenlsresultlf"lg In death) LAST.
b.
O\Je to (or as a consequence 01):
Due 10 (or as a consequence 01):
d,
DY" GfNo
DVes ONo
31. Manner of Death
ErNatulal 0 Homicide
o Accident 0 Pending tnvesligaliOll 32d. Time of Injury
o Suicide 0 Could Not be Determined
329. LocatiOll of Injury/Street,cityltown, state)
3Oa. Was an Acltopsy
PerlormectJ
3Ob. Were Autopsy Findings
Available Prior to Completion
of Cause of Death?
33a. Certifier (check only onel
CerlifVing physicilln (Physician certifying cause 01 death when another physician has prooounced death and completed Item 23)
To thl! best of my knowledge, death occurred due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
~;~~:U~~~f~~ ~::~:::~a~~u~:j~ :~I~~:~~n:n~~~c~~ ~~rt~~~~at~h~:~~~:)~~~ manner as stated- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 33c. ~11sejUo J f./ S ~~e
MedIcal Examiner 1 Coroner
On th<~ basis 01 examination and 1 or Investigation, In my opinion, death occurred at the time, date, and place, and due to the cBuse(sl and manner illS staled.. 0
. r~ignalUrea~I:~~~-t-~
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Disposition Permit No, OC", rVl t.\..bL,,:,
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