HomeMy WebLinkAbout05-15-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
COUNTY, PENNSYLVANIA
Estate of Steven L. Fry
also known as
File Number
<a\ O~ oS~~
, Deceased
Social Security Number 210-40-1440
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
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
named in the
"',J
(State relevant circumstances, e.g., renunciation, death of executor, etc.) 8 g. "7
?,""O 00 '.(""1
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution~~ ~trum~S) off'i€h:~'3
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: . 'J ?j r;; -< ':::::? ",'q
I!2l B. e...."f L""" .f Adml.I....... (If ...'","M'. ,""' '.'.D.' d.b.,.,.,., """"'0 IU" _ ..~""" ~~ri"; ;f; ]
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the followin~m1se (ifanY)'Md hefi:s.~l fiR
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 Relationshin Residence I
Clarabelle Fry Mother 24 Pine Street, Carlisle, PA 17013
Christy L. Sloan Sister 618 W. Pine Street, Mt. Holly SprinRs, PA 17065
Roxanne Ross Sister 123 BiR SprinR Terrace, Newville, PA 17241
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his / her last principal residence at
24 Pine street. Carlisle. South Middleton Townshio. Pennsylvania 17013
(List street address, town/city, township, county, state, zip code)
Decedent, then 59
years of age, died on April 6, 2008
at Forest Park health Center
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(Ifnot domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
$
$
$
$
5,485.39
0.00
0.00
0.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codici\(s) presented with this Petition and the grant of Letters in the appropriate fnnn to
the undersigned:
S i ature
T d or Tinted name and residence
ce~f
Clarabelle Fry, 24 Pine Street, Carlisle, P A 17013
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
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) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
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Signature of Personal Representative
before me the
_ day of
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r the Register
Signature of Personal Representative
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Signature of Personal Representative
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File Number:
a\ 0"6 c~2>~
Estate of Steven L. Fry
, Deceased
Social Security Number: 210-40-1440
Date of Death: April 6, 2008
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of recor
FEES
Letters ..... .Q.~~~~ $
Short Certificate(s) . . .3 . . . $
Renunciation(s) .......... $
.JC{J ...$
/).-A .-f-D .. . $
...$
.. . $
... $
... $
...$
... $
.. . $
TOTAL .... . . . . . . .. . . $
4S
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Attorney Signature:
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Attorney Name:
Paul Bradford Orr, Esquire
Supreme Court LD. No.: 71786
Address:
50 East High Street
Carlisle, PA 17013
Telephone:
(717) 258-8558
'7;) q) .--e:6tr
Form RW-02 rev. 10.13.06
Page 2 of2
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 14394973
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This is to certify that the information here given is
couectly 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.
Fee for this certificate. $6.00
Certification Number
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Local Registrar <:=> Date Issued
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l;UMMUNWt:ALI H U~ I't:NN~YLVANIA. Ut:I'AH IMt:N I UI" Ht:ALI H. VIIAL Ht:l;UHU~
CERTIFICATE OF DEATH
(See Instructions snd examples on reverse)
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l.Nomeol_lFinl_.Io.l.ouIixl
Steven L. Fry
lInder 1 6. Dale d Emh (MonIh, dB ,
5.1qo(Liol"""""Yl
S. Middleton
7. IHlpIBce and stale or
Aug. 31, 1948 Carlisle, PA
Bd FadIly Nome III noI-...n. <j<e _ ond """"'l
Forest Park Health Center
000h0r.Speclfy:
10. R8c:e:__. Block. _....
1- White
59
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Cumberland
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24 Pine St.
Carlisle, PA 17013
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18.FaI1er'S"""(FInll.rridlIe,lasl,suffIx)
19. MoIh8r's Name (Fnl, mIdde, maIdlln 1lmIIme)
Chester L. Fry
Clarabelle McBride
2lX>.I~'mr-~~'~~'N~"f'J, PA 17013
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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.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Local Registrar
Fee for this certificate, $2.00
P 7578103
JUl 2 4 2001
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H105.1'<< Rev. 1191
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
/PAINT
'N
ANENT
::KINK
UNDER 1 DAY
Hours Minutes
SEX
1:1a 1 e
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
3. 174-20-6034
DATE OF DEATH (Month. Day, 'IN.r)
.. July 20, 2001
L
BIRTHPLACE (City and PLACE OF DEATH (Check only one see instructions on other side)
Stale or Foreign Country) HOSPITAL:
Middlesex Twp. 'npa,;en! 0
7. Sa.
FACILITY NAME (II not institutiOn, give street and number)
g'':." 0
Cumberland
Carlisle
Ie.
RACE. American Indian, Black, While, etc.
(Spec."
White
DECEDENT'S USUAL OCCUPATION
(Give kind of work done during most
of wotttlng Il1.li do not ute refired.)
". Custoolan 1. Church
DECEDENT'S MAILING ADORESS (Street, Cityn-own, Slate, Zip Code) DECEDENT'S
24 Pine St. ~~~~LNCE
Carlisle PA 17013 ~"::=f"
SURVIVING SPOUSE
(" wile, give maiden name)
twp.
Cumberland
...
F<rHER'S N~E (F.... M_. "'~)
11. Cllnton Fry
INFORMANT'S NAME (Type/Prinl)
Clarabelle
METHOD OF DISPOSITl9l1
O 8_ ~ 0.."01100 0
- ""'"'-
21..
SIGNAl
11b.
c:itylboto
Removal from State 0
DATE OF DISPOSITION
(Month, Day, 'lMr)
o July 24, 2001
".
LICENSE NUMBER
.... Ol0343-L
,death occurred 8t the lime, date and place stated.
P M.
27. PART I: Enter the diHa.... tn;uries or compt)eatlons which CIIUMd the death. 00 not enter the mode 01 dying, SUCh as cardiec or respiratory arrest, shock or heart lalkJr.,
LiM onty one CIIUH on nc:h OM.
2...
TIME OF DEATH
2', 11:55
DATE PRONOUNCED DEAD (Month, Day, Year)
2.. July 20, 2001
23b. 23e.
WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER?
....~
NoD
Probable M ocardia1 Infarction
DUE 10 (OR AS A CONse~UENCE OF):
I.
I Approximate
: Interval between
lonnt and dealh
i
PART II:
Other significant condl1lon1 comrlbutlng to death, but
not resulting In the Ltndertying cause giYen In PART I.
b.
DUE 10 (OA AS A CONSEQUENCE Of):
DUE TO (OR AS A CONSEOUENCE OF):
d
WERE AUTOPSY FINDINGS
.A\t'\ILABLE PFUOR 10
COMPLETION OF CAUSE
OF DEATH?
DATE OF INJURY
(Monlt1, Day, Year)
TIME OF INJURY
300.
MANNER OF DEATH
INJURY I(T WORK?
Natural
~
o
o
Homicide
o
o 300. Ob. M.
o ~~J~~~~~~~;;t nome, farm, street,lact01'Y, office
300.
Ye.
.... 0 NoJl:1
2". 21b.
CERTIFIER (Check only one)
~CERTIFVINQ PHYSICIAN (PhysiCian certifying cause 01 death when another phySician has pronounced death and completed Item 23)
Tothebettofmyknowiedge,d.athoccurredduetotheca~.).ndm.nn.r...teted.............,.......,."",..".,...."..",.",." ,
.....0
NoD
A"'''''''''
Pending Investigation
S"",Ide
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Could not be determined
SIGNATUR
o
Coroner
"MEDICAL EXAMINERlCORONER
On the b.... of examination and/or tnveatIgatton, In my oplnfon, death occurred.t the Ume, date, .nd pl.ce, and due to the cauH(a).nd
m.nner.....ted.............................................,......................................... .........,.
31..
REGISTRAR'S SIGNATURE AND NUMSE
~\ I~\ iDI
DATE SIGNED (Month, Day, 'lMr)
o 31.. 31d. July 23, 2001
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(ltom27)TypeorPrln'Michae1 L. Norris, Coroner
~ 6375 Basehore Road, Suite #1
i'" 32, Mechanicsburg, Pa. 17050
:E FILED (Mon"', ""y, ....rJ v-.\
~PAONOUNCINO AND CERTIFYING PHYSICIAN (Physician boCh pronouncing death and certifying 10 cause ol de6th)
To the bMt O'lftJ' knowledge, __ OCCurrM at the tkne, date, and place, and due to.... cauH(.) and manner.. atllted., . . . . . . . , . , , , , , . .. . . . . . . .