HomeMy WebLinkAbout05-07-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CL{mhe'~ !tU/c{ COUNTY, PENNSYLVANIA
Es e of ^~ Ie t~){l. (' I r;
also knovm as
PXttOr-)
File Number
:Ll 0 <0
o<~D
. Deceased
Social Security Number 2 ((; - - J-:~ - >:r L/ () '3
Peti ioner(s), who is/are 18 years of age or older, apply(ies) for:
(C PLETE 'A' or 'B' BELOW:)
-4
o A. Il'robate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last ill of the Decedent dated and codicil(s) dated
named in the
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(State relevant circumstances, e.g., renunciation, death of executor, etc.) <;:;; 0 ; ,c;:, ;L~
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t as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution 9f};li~rumentf.;) om-re~()
obate, was not the victim of a killing and was never adjudicated an incapacitated person: '~L:;: 93 ~ ~=Ti ~-g
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(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durinte~noritate) =
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Peti ioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following ~use (if any) ~ heirs: (If'"
Ad inistration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
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. Glrant of Letters of Administration
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ecedent was domiciled at death in
'7 '2 ( C"
(Lis street address, town/city, township, county, state, zip ode)
County, Pennsylvania with his / her last principal residence at
\ elf
e~edent,then 10 ye~ofage,diedon Arlll 2-;), 'dOo(( at C (ttt'of'm'''1!- A~(/~)in(j rk.)11C - locH')
L\.f f IV) CYl-t' {..:.d. L {V I i <., Ii'.... PA- /7 0 I ~ 7
ecedent 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 PA) Personal property in County
Value of real estate in Pennsylvania
situ ted as follows:
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2.3 y'-t{
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((trY' r H; II / P A
$
$
$
$
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Wh refonl, 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 ndersigned:
T ed or rinted name and residence
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Page 1 of2
Oath of Personal Representative
MMONWEAL TH OF PENNSYLVANIA
SS
illlTY OF
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L'llrn IJ-{ ( (C( vlti
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
t e knowledge and belief ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
a miniister the estate according to law.
S orn to or affirmed and subscribed
r7
_ day of
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tl1 dt,;;:c y-:. i?J a,2 (J1
~atur.~~W;;:al Re7~a"" e ,,\:i.. ~
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Signature of Personal Represen ative :..::-J -i> r-
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Signature of Personal Representative ", (-) ..,
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File Number:
2\ oCV O(~\O
Estate of nIl r L'Ctc' I 12. Kc\ ~- 0 n , Deceased
Social Security Number: 2 10 -.;; 8' - T5'Lf G -; Date of Death: [.-/ J;.J :s j.;(,,( ;-;
I J
AND NOW, 1Yh.11 7 , 2f])8 , in consideration of the fore~oing Petition, satisfactory proof
ing been presented before the, IT IS DECREED that Letters c..{ Ac'\ In I n ,St 1-4.'/ I dl'l
hen~by granted to fA tll' ~ A. f:6. ;' ["'It Li ... J?l k.. .Rtt I (7"1-1
in the above estate
an that the instrument( s) dated Ai ,j N E-
de cribed in the Petition be admitted to probate and filed ofrecor
FEES
ers .... .l1:~.CPP $
rt Certificate( s) . . .f;;, . . . $
unciation(s) .......... $
P ... $
,Lie> ...$
...$
.. . $
...$
.. . $
...$
.. . $
.. . $
3oro -6':e&-
OTAL . . . . . . . . . . . . . . $ .
Fo RW.02 rev, /0,/3.06
lliD
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Attorney Signature:
Register of Wills
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Attorney Name:
Supreme Court J.D. No.:
Address:
Telephone:
(717) ~~J- 769/
,
Page 2 of2
HHI~~05 R.FV i1li/()'
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this c rtificate. $6.00
P 4329870
Certi ication Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
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Date-Issued
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CD
REV 1112006
PRINT IN
MNENT
::K INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
2'
O't.~ OS'\O
1. Name 01 Decedent ( rst, middkl, last, suffix)
Miehae R. Baron
5. Age (Lasl f'rthday)
6. Date of BIrth (Month, day, year)
Colver Pa
ad. Facility Name (If /lOt institution, give street and number)
Twp Claremont Nursin Home
12. Was Decedenl ever in the
U.S. Armed Forces?
iZIYes ONe
Decedent's
Actual Residence 17a. State
13. Decedent's Education (Specify only highest grade completed)
Elementary I Secondary (0-12) 4 College (1-4 or 5+)
Pa
Cumberland
17b. County
-28
4. Date of Death (Month, day, year)
8403 A ril 23 2008
8a. Place of Death (Check only one)
Hospital: Other:
o Inpatient 0 ER / Outpatient DooA. XJ Nursing Home 0 Residence DOther. Specify:
9. Was Decedent of Hispanic Origin? No 0 Yes 10. Race: American tndian. Black, White. etc
(If yes, specify Cuban, (Specify)
Mexican, Puerto Rican, etc.) Whi te
14. Marital Status: Married, Never Married,
Widowed, Divorced {Specil}1
Married
Kathleen Yenkvieh
Did Decedent
lMl in a
Township?
17c. a Yes, Decedent Uved in
17d. ~ No, Decedent Uvedwilhin
Actual Limits of
Twp.
Camp Hill
CIty/Boro
19. Mother's Name (FirsI, middle, maiden surname)
Mar aret Welsko
2Ob. Infoonanfs MaHing Address (Slreel, city I town, state, zip code)
228 North 23rd Street earn
Approximate interval:
Onset 10 Death
Due to (or as a consequence 01):
Due 10 (Of as a consequence of):
d.
3Oa. Was an Autopsy
Periorrned?
31. Manner of Death
r;a1iewral 0 Homicide
o Acciden' 0 Pendklg Investiga'On
o Suidde 0 GOOd No. be D~"""ined
M.
n. Wllre Autopsy Findings
A.vailable Prior to Completion
01 Cause of Death?
o Yes 0'No
[J Yes 0 No
32d. Time of Injury
Pa 17011
Pa
Pa 170
t'CJ~
Part 11: Enter other sionificant condl!ons contribulino to death,
bul not resu"ing in the underlying cause given in Part I.
28. Did Tobacco Use Contribute to Death1
o Yes 0 Probably
la1'o 0 Unknown
29. II Female:
o NoI pregnant within past year
o Pregnant at lime ot death
o Not pregnant, bot pregnant within 42 days
01 death
o Not pregnant, but pregnant 43 days to 1 year
before death
o Unknown if pregnant within the past year
32c. Place 01 Injury. Home, Farm, Street, Faclory,
DlficeBuilOng, ~c. (Specify)
32g. location of Iniury (Street, city I town, state)
one) 33b. S1gl'l8ture a
Iclan (Physician certifying cause ot death when anoIher physician has pronounced death and completed Item 23) ...
my knowledge, death occurred due to the ClUse(I) and manner as staled-.... _ _ _.. _ _.. _ _.... _...... _.. _ _ _.... _.. _ -......-",W
and certtrylng physician (Physician both pronouncing death and certifying 10 cause 01 death) 0 33c. license Numbs _
To the best my knowledge, death occurred at the time, date, and place, and due to the cause(l) and manner as staled- .. - .. - .. - .. - .. .. .. - .. .. - .. - fi1 D 0 q 1 Cj (p J:-
~~ ~a ~":~~= and I or Investigation, In my opinion, death occurred at the time, date, and plate, and due to lhe cause(s) and manner as stated- 0 34. Name and ~ddress of Person Who Completed CaU:f Dealh (lIem 27) Type I Print
m.rict Nu~ ~
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