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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~H 1M B~Lft?Jb
COUNTY, PENNSYLVANIA
Estate of W0~tJ \ ~qe1\~ - ~~~~ ~,
also known as U .Q..t'lc\ f' -~ () L
File Number
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, Deceased
Social Security Number 110 8 ~ 4- L} ~"\-y
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 o~ih~strumen~ offere&.
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ -l .. i "J ..-.)
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.tJI A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is I are the
last Will of the Decedent dated and codicil(s) dated
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(State relevallt circumstances, e.g., renunciatioll, death of executor, etc.)
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rd B. Grant of Letters of Administration
(If applicable, ellter: c.t,a.; d.b,n.c.t.a,; pendellte lite; durallte absentia; durallte minoritate)
Petitioner(s) after a proper search has I have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
Administration, c.La, or d.b,n.c.t,a., enter date of Will in Section A above and complete list of heirs.)
Relationshi
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unty, Pennsylvania with his I her last principal residence at d.. ')-
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Decedent, then
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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 PA) Personal property in County
Value of real estate in Pennsylvania
$ dO)S45 .lo~
$
$
$ 0 . Q.;O
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:
Form RW-02 reF. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
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SS
COUNTY OF
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
/if
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Signature of Personal Representative
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Signature of Personal Representative
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Estate of
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Social Security Number: / (0 Y
AND NOW, ~ /1
having been presented before me, IT IS DE
are hereby granted to f I
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the f}>T, egoing Petition, satisfactory proof
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in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record '!P the last Will a
FEES
Letters .,. ~~~1~ '. r.pl..f $
Short Certificate(s) . . .3. . . $
Renunciation(s) ........,. $
JcP $
Puw ...$
$
$
$
$
. .. $
.. . $
... $
TOTAL .............. $
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Attomey Signature:
Telephone:
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Attomey Name:
Supreme Court J.D, No.:
Address:
Forlll RW-O] rev jO,13,06
Page2of2
HI05.E05 REV [(1/1)7)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 14235322
This i.s 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
Fee for this certificate, $6.00
Certification Number
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STATE FILE NUMBER
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Date Issued
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H105.143 REV 1112006
TYPE I PRINT IN
PERMANENT
BlACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
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6. Dale 01 Birth (Moolh, day, year)
7,1ll_IClyand_or
- 3998
4. Dale of Death (Month, day, year)
April 24, 2008
1. Name of Decedent (First, midcIe, last, suftix)
Werrlell E. J?ennabaker
5. Age (l>stlllrlhday)
Other:
56
Januazy 14, 1952
Blain Pa.
OOthel. Specly'
10. Race: American Indian, Black, White, etc.
(Spsci/J1
\'ati.te
Sb. County of Death
QJlberJ..arXI
8<1, Fociflly Name (II no( _ution, give"'" and 0I.<Ilber)
25 Q1tshall Rd. ~ Pa. 17257
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11. Decedenl's Usuel ion KJId
Kind of Work
Assa1bl.er
mosl of life. Do not state
~~~~us1&.
12. Was Decedeol ever in the
U.S. Armed Forces?
DYe, KJNo
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Aclual Residence 178. Slate
17b.County
13. Decedent', Education ISpeCify on~ t;ghesl grade _ed)
E~nla'YI Seconde'Y 1()'12) Col~ge 1'-4 or!;>)
12th
14. Marital $atus: Married, Never Married,
Widowed, Divorced (Spsci/J1
Married
. 16. Dec::edent's MailingAdchss (Street, city I town, slate, 4> code)
25 Q1tshall Rd. Shi~ Fa. 17257
Fa.
QJlberJ..arXI
Did Decedent
Live in e Hc.f] Yes, Decedenl Uved. Southampt.cn Twp.
Township? 17d. 0 No, Decedent Lived within
Actual Umi1s of
CY
Cly I Bore
18. Father's Name (First, middle, 1Ht, suffIX)
EJmer P. J?ennabaker
19. Mother's Name (First, middle, maiden surname)
Madeline M. Wilanan
2Oa. Informant's Name (Type I Print)
GloriaJ.Pennabaker
21a. M01hodol Disposition
. 1&1 Burial 0 Removal _ Slala
o Othel' SpeciIy.-
228. raI
200, Informant', Meiing Addms I_', city 1_, _, z\> code)
212 North Prince st. Shi~ Fa, 17257
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21c. Place of DIsposition (Name 01 cemetery, crematory or other place)
QJlberJ..arXI Valley MaIDrial Gardens
21d.looslion(Cly/_._,zipcode)
Carlisle Pa. 17013
17257
23b. License Number
12 JJ 0<. '3(b003 L
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26. Was Case Referred 10 Mecical Examiner I Coroner tor a
Dyes ~No
1 "21'( 1'2.11 1&1
Approximate interval: Part II: Enter other sioniIicant conditions contrhJlino to death, 28. Did Toba<:co Use Conlribule 10 Dealh?
Onset 10 Death but no1 resuIli1g in the underlying cause given in Pari I. 0 Yes 0 Probably
DNo DUnI<-
29. HFemale:
o No! pregnant wtil pas! year
o Pragnantallimeofdeelh
o NoIpcegnanl, bulpragnan1 ,.;u;n 42 dey'
oldealh
o Noi pregnant. buI pregnant 43 days to 1 year
baloredealh
OUn"-Hpragnanlwifhinlhepaslyear
32C'==~~~S=jStreel,Faclory,
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SequenliaNy Iis1 condi.Iioos, " any,
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b.
Due to (or as a consequence of):
c.
Doe to (or as a consequence of):
d,
OYesUo
n. Wefe Autopsy Fintings
AY8ilablePriofto~
of Cause 01 Death?
o Yes ~o
31,MeJ1llii-"DeaIh
~roJ O_de
o Accidenl 0 Pendng hwasllleIiorl
0- OCouldNolbeDetennined
32d. Time oIlnjUfy
3Oa. Was an Autopsy
Periom1ed'?
M.
330, Ce11ilief (ched< only 000)
Cet1IfyIng physlcum (Physician certifying cause of death when another physician has pronounced dealh and compIeled ~em 23)
To the best of my knowledge, death occurred due to the cause(s) and manner IS swted.. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
=~~:..: :~h=~~=~ ~I::::n::~~ an~~~~ca:~~~~ manner as statecL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
:~::~s~":~ Coro:~ a , dealh OCCUfred at the lime, date, Ind place, and due 10 the cause(s) Ind manner as stated.. 0
Disposition Permil No.
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