HomeMy WebLinkAbout05-23-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C:n~tk I"' ~ vi COUNTY, PENNSYLVANIA
Estate of
also known as
L'JCif C1 Y)
,;
;11.
II!" V" Y'I S
File Number
j-/- Or -- D5ltJ 3
, Deceased
Social Security Number
cY-/?- Y ~ - If. YO 7
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
o 8named in t?,e.
C:;O =.'.
<- :::n :J!l: . )
~ J " (; ..J;P ,_~.l
(State relevant circumstances, e.g.. renunciation, death of executor, etc.) . , ~ ~ ~ ;:.~; '- j
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executiorro'f~atlUme~s) offet'ed.,.;;~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:j;~ -n 3,_ , .<
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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
w
~ B. Grant of Letters of Administration
(If applicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; dura/lte mi/loritate)
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
A dministratioll. c. t.a. or d. b.n.c.i.a., enter date of Will in Section A above and complete list of heirs.)
Name
/:?'r ~t:: J't; Aj(?"V',,-,~
,
Relationship
[::;..., '+t. f" .,r
Residence
;}'-/ l)tJ e. j)v-, ~4;" //5 Ie
I
flIl17!)/!
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decede~t was domiciled at death in b ,'!a",c./ County, Penn;ylvania witl@l--fterIast principal residence at rll.J ,{)~ e. Or
C?tY'ld/e. k.w~/' Fr?tnk T...... :. io'kber/c.nJ' , (:J/
(List street address, town/city, township, county, state, zip code)
Decedent, then
cJo
years of age, died on /J;&-t/ /, .2.a.1/f at /)r~'t "J;8' /11111 S'B, :I-'8'~ ~.,..~(>n' ~(.// / /J,/l
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
/,. cJOO, 00
$
$
$
$
C)
situated as follows: '');''IVI~5 #O-:c/V'Y\t, Vl~,)/II+~ ':<f.UI1~J W/t-t... P;,'-/t.tf'/
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:
Sianature
T ed or rinted name and residence
Form RW.02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
SS
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and conect to the best of
the knowledge and belief of Peti tioner( 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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Signature of Personal Representative
Signature of Personal Representative
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before me the
Signature of Personal Representative
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(21- ()~ - O'SlPj
Estate of u:aClrl M". NO((I. S
Social Security Number:~ S< . g ~ . LR 8 0 7 Date ofDeath:~ ()q
AND NOW, ;) ?J-~ mV {~MW- , Qj)O ~ , in con2iger~~ion of the foregoing Petition, satisfactory proof
having been presented before me,~C~Letters AAt')'lL(U. c;rra? a~
are hereby granted to _((.1 cheLf d ~ OY ( i ':; ,
c.v
File Number:
, Deceased
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed ofrecor
Letters
$ !), 0. ()()
110, tJO
10.191)
5(){)
FEES
Short Certificate(s) . . . . . . . . $
Attomey Signature:
~r~'tio*), :
:1fu f() nUff {NI / ... $
$
.. . $
... $
. .. $
$
$
$
TOTAL .............. $
Attomey Name:
Supreme Court I.D. No.:
Address:
Telephone:
':5 /. eo
Form RW-O] rev. /0./3.06
Page 2 of2
HIO).R05 REV 101107)
df-C~~OS~'6
LOCAL REGISTRAR'S CERTIFICATION OF DEAliH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Lo:al Registrar. The original
certificate will be forwlrded to the State Vital
Records Office for pe:manent filing.
Fee for this certificate, $6.00
P 14528532
(:\. ~~&.~ MAr 6/ 2008
Local Registrar ~ Date Issued
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Hl05.144 REV 1112006
TYPE I PRINT IN
PERMANENT
BLACK INK
1......"_IF...._...."""l
Logan Murdock NORRIS
~ "" (Last Blnhdoyl
20v~.
ab. Cou\~ " IleoU1
Franklin
COMMONWEALTli OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions and examples on reverse) STATE FILE NUMBER
2. Sex 3, Social SeaI'Ity NlI'Itl8r 4. Date fA Death {Mcnitt, dBy, year)
Male 048 - 82 - 6807 May 1, 2008
~
6. OlllooI-(Manlh.,
7.BIrf1JIace and'*'eor
one
Other.
April 28, 1988 Groton, cr
lid F_ Name(1l"" _. give _and..-r)
24 Lbe Dr.
Carlisle PA 015
,a F_......(Fnt._.....sulIJl
Richard F. No=is
2Oa. Inlormant's Name (Type I PrInt)
Richard F.
Area Of 18 MM - SB, I - 81, Chambersburg, PA
'2. w.. Deoodo....., ~!he '1-' _ (Specify.,.;y ......lI'ldt comploledl
U.S AImed Fcn:os1 Elome<UIy I Secordary ({).'21 College ('" or 5->1
0... iii... 1
-.
ActullResIdence 17LSIIte
lXloe..,SpeciIy
'0. _,_hclan.BlIck._.t1e.
(SpocK)\
CaucasianlWhite
11.0ecedInt'1Uaal
lO""ol_
Student
'7b. County
PA
Cumberland
17~IKIYe1,__~
'7tLO ...___,*,
.......~"
Lcmer Frankford
,..".
ClIy/Bon>
iil
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19. Mother's Name 1Arst. mkktt, mIIchn lIlIrllImI)
Denise - McNeal
2Ob............MoMing........_dlyl__..._1
24 Lbe Dr., Carlisle, PA 17015
21c.PIeoIClIDispoIIIonINwneCllcem8tefy.~orottl8fpleoll 21d.loc8l1on(Clty/IoWn,Slatt,~code)
Cul:wensville, PA
Bane, Inc., Carlisle, PA 17013
230. LJconoe Num.., 230. llB1e _1_ doy. yoo<)
......""'''''''.._..'''''''' "._oIlleoU1 Approx: 2S.lloIo_Deo'_doy,yoo<)
...".,..,....._. 05:19PM, May 1. 2008
CAUSE OF DEATH (See ntructIo.. end .amples)
~ 27. PIIrt I: Enter the ~ - c:iseues,lnjulies, Of compIcdon& - bllitIcIy ClUed the dIatt. 00 NOT enter IIm'hI ewnII such. canIac afllll,
rnpiratoryarTHl.or~fbiIa1Ion witIOIAlhownghlalil:llow li!l onIyone~onlllChliM.
26. Wer. -Cae AefemId ID MelicaI Examiner I Coroner for a Reuon OIher ItlIWl Cremation or 0mati0fl1
IXIv.. ONo
ApploIcmaIe IrUMt Pwt II: Emr ohr tImIficBnI mndiIon!; COI'IfriJuIr.o 10 dMIh 28. Old Tobecco Use ConIrbAe t) Dealh1
OnsettoOK1h buI""lOSUIilg~"'_C8I/SOgivtn~PartI. 0 Yes 0-
IXI" Olkl-
:=9,g~=-:;
lEv" 0 No
IEYes DNo
31. Mawler 01 0eIIh
0...... 0-
L1\I-' OPonmg_
0..- 0"""""'..--
29.' FemaI8:
o ""'''''''''''''-'''''Y''''
OP1ognonlllllmeol_
o NoI""""""....ptegn8Jd_42....
01-
o NoI_""IJI8lII*'l<3....to1 yoo'
......-
O-'IJI8lII*'l-'''''''''_
32L Olllo 01 "'+rt _ doy, yoo<) 320. 000aIle How..., """""" 320....... 01 IrOrf. Homo, F.... _ FdWy,
May 1, 2008 Pedestrain struck by auto while changing tire Int~~f-
32<l.11meollti..., 321..T_"'+rt_J 32g'~""'+rtI""'.dly/"".-1
Oorno../Ope_ OP_ Dp- Area of 18 MM SB, 1- 81, Chambersburg, PA
oe.., _
330._"'"
Sec - Min
L Multiple Blunt Force Trauma
Due to (Of as a COl'\S8q.IInc8 aI):
b. Pedestrian Struck By Auto
1M lo (or as I CCll1S8CJI8f'ICoI):
While Changing Tire On Vehicle
Due to (or IS . consequence 01):
_"'-'1"",
IeltinatJht~lIItedonh..
Emf'" UNDERLYING CAUSE
=-~~~
d.
:lJLWasIrlAutopsy
-
3Ilb.___
.........-.."...,......
at Cat.- 01 0ea",1
5:19 PM.
Conner, Jeffrey R., Coroner, Coroner
33d."""'__,doy,_1
May 3, 2008
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33a.. Certifier(c:hedl:t:/llVfonel
. CertIfying phyakIan (~C8l1ifyi'lg cauM 01 deaIh when nlIher physidIn has pronounced dN1h n ~ IIem 23)
TolhlbMtol my knowIedge,daIdh oc:aIrNd duatobc:aUM(slw __ AdML ___ __ _ _________ _______ ...________ _ 0
. ~=n:,::=:="=:=~and~~~1ou::.~:_:manner...tatML--..----------- ___ D Sk.
:c-:=:- ~ and, or Invedption, In my oplnk>>n, deeth occurred at IhI time, dale, and p6ace, nt _due 10 the ClUM(I} and man...... stItecL IZl
"-""" -.....
34. N8ITl81l'll1 Adlha of Persm Who ~ CaI.M of Death (Item 27) Type I Pm!
Conner, Jeffrey R.. Coroner
1497 Loudon Rd.
Chambersbu PA 17201
I~ II 1.01 I \ 101
';}f - C~~ ~.S-<-R'3
1I10oS0j REV I/Oj .., " I" d from an original certificate of death dul) filed with me as
This is to certify that t~e .mforma~I.?~ here'lglIbvenf IS co~e~t ( ~~~I~tate Vital Records Office for permanent f ing.
Local Registrar. The ongmal certIfIcate WI e orwar e 0
WARNING: It is illegal to duplicate this copy by photostat or photograph.
., .il '"""./ 3 'I 7 r~ O.
:::b ~ = .~. g '>"'00'
No.
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Local Reglst
Fee for this certificate. $6.00
it)
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Date
H105.143 Rev. 2187
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
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TYPE/PRINT
IN
PERMANENT
aLACK INK
STATE FILE NUMBER
,.
AGE (last BIrthday)
SOCIAL SECURITY NUMBER
3. 193-
5. 48 v"
COl'~iY CF :JEA7H
: ~bumbedand
DECEDENT'S USUAL OCCUPATION
(~7;':~~:~,~~r;od~'~:;~r~%r~gt
Homemaker
Re~ldelll;e 0 ~~:~lyi 0
RACE. Ameflcan ndian. Black., V\t11!e e:
(Spec:fy\
10. Whi te
SURVIV;N(; SPOUSE
Ilfwlle. !J"'le'T1~,den r'tame!
290 Middle Road
New~ille PA 17241
t....p
16.
FAn~ER'S NAME (F[r~:Mltfd~. (asl)
18. Lewis J.
IN~ORMANrS NAME (TypefPnnt)
20.. Mr. Richard Norris
METHOD OF OISPOSlTIQN
Bunal 50 Cremallon GemOV81 from State 0
Other (SpeCify)
UNE lS
Newville
::!:yi::crO
McNeal
PA 17241
~
~
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DATE ,:aGNEO
(Monln. Day. Year)
23b. 23c,
WAS CASE REFERRED TO A MEDICAL EX;',MINER tC:)RON:::R,
26. Yes 0 No [19
, Approximate
: interval between
: onset and death
'2 'f try.
PART II: Other slgr:/f:can: t..:Ir:dlhons conlnoulmg te death, au:
:)ot resuttl:lg 'n lhe ur:ctet1ymg CaU!ie gIVen 1:1 PARi I
Sequentieliy bsl concltlOns
jf any. leading to Immediate
. cause. Enter UNDERLYING
CAUSE {Disease or Injury
. thellnitlated evenls
resultIng on death) LAST
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAHASlE PRIOR TO
COMPLETIO;~ OF CAUSE
OF DEATH?
L
flttMv([i~
A--t "?;II--- 'fl v1 ~"1/Uo
MANNER OF DEATH
Natur.,1
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DATE OF INJURY
('.~onlh. O~Y. Yell')
TIME OF INJURY
INJURY AT 'NORK? DESCRIBE HOW!NJURY OCCURRED
Homici::le
o
o
o ~~CE OF INJURY
building. el~, (Speellyl
30e.
DA ,E SIGNE:D (Month, Day. Year)
310. 31d. ~ - Z <a -0 S--
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DE,-; TH
(Item 27jTypeo,Pnnt Timothy Walsh, ~JD
o lUUU N. Fcont 51..
32.
DATE FilED (Month, Day Year)
34. tJu I U 6 c;-
Ye, 0 NO~ Yo> 0
2Ba. 2Bb.
CERTIFIER (Checlt only one)
'if~~J:F:~~tGor~~11~~e,~Wil.Sd~:rh~~~~~~~~: teg iheea~ha~~:~(:)~~3r~~~~~a~s h:t~~~~~::~~.~.~.~~~~ ~~.~ .~~~~~~.~ .i.l:.~ .~:).
,;ccident
Pending Investiga:ior1
NOD
Su~cice
Could not be de!errr.ir,ed
30b.
M
30d.
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29.
'PRONOUNCING AND CERTIFY1NG PHYSICIAN (Physician both pronoun::tng c:leath and certifylr.g to cause Of death)
To the best of my knO'WIedge, death occurred at the time, dale, and place, and due to the causes(s) and manner as stated...
.MED1CAL EXAMINER/CORONER
On the basl$ of examination and/or Investigation, in my opinion, death occurred at the time, date, and place. and due to the causes(s) and
manner as slated..
31a.
REGISTRAR'S IGNATURE AND NUMBER I
33. , G ~'VJ\ lM LJ 11111 / I gll I