HomeMy WebLinkAbout06-25-08__ JUN-20-2008 FRI 12;24 PM Beckley & Madden FAX N0. 7172333740 p, 02
FETIT~ON FOR FxtOBATE AND GRANT OF LETTERS
REG~STIJR Oh WILLS OP cuMBERt_AAND COUNTY, PENNSYLVANIA
~ ~~~
rstatc of Kathleen A.1~rewf~ ~,~G /~ File NwnUet ~ ~ ~ ~ 4 ~"
also known as
l~crxased Social Security Number 200-32-9741
Pelitio:ner(s)> who is/arc 1 S years of age or older, tlpply(ios) fix:
(COMPLETE 'A' r-r 'B' BBLOW.)
A,. Trobate unJ Grant of i.ctters'I'evtarncntary and aver that Petitioner(s) iti /are the
tact Witl of the llcccdcnt dated and codicil(s) dated
t~wa
e. -_-
~~
mimed in the
r..~ i ~ r ~
(State relevant NrcurNS'tonccs, r.g., remrncratiaR death ajurcutol', ctc.J ., ' ,
~;
F,xeept as follows, llccedcnt did not marry, was not ditrorced, and did not have a child born or adopted after exect-tion ctf tft~tsnumentYs]' offerul
for prabatc, was nor the victim of a killing and wa.9 never adjudicated a<t incapacitated lxrson: -_ ~;; '~' ~ _
t~
)9i. Grant of Letters of Administration r
(~/'applicaD/e, enter: e.t.a.; d, b,n.c,ta.; pendrnteltte; choantrahsentra; d+vrai~teminaritatc~
(COMPLh'TP 1NAl.L GdSES.) Atlatli additional sheets if nec~-;sory.
1)cccdcnt was domiciled at death in Cumberland County, Pennsylvania will hi,s /hot I:~,t principal residence at
~i3 North 3rd Street. Camp Hit . Pennsylvania 1701
(Lisa street address, mwn/ciry, town,Yhip, cawtry slate, ±ip code)
Decedent, then 65 years of ago, died o» APril 25, 2008 ul Holy Spirit Hospital
Decedent at death owned property wikh ertitnatcd values as follows:
(tf domiciled lit PA) All personal ~raperty x 50,OOD_00
(If»ot domiciled in PA) Personal property in rettnsylvuni3 $
(If not domiciled in 1'A) Pcrvnn;il property in County ~
Voluc of real estate in Pennsylvania $
yiluated as foNnws:
Whcrefot'e, Actitionrr(s) revpectfully requcet{x) the grnhate oCthe last W ill and Codicil(9) preseated with this Petition and the grant of Letters in the nppropriatc form lu
thr. undersigned:
~/'L~~~~ ~,~ ~ ~~~ti~~ Lisa K. Baron, 2759 North Charlotte Street, Gilbertsville, PA 19525
` ,~ ,,~~~~~ Mark A. Baron, 449 Devon Road, Camp Hill, PA 17011
C~
F~rr>» itw ua rrv. !U•13.06 Page l of 2
Petili.oner(s) after a proper search has /have aseertauted that Decedent tell no Will and was survivexl by the following sPouac (if any) and heirs: (!f
Adm/nistratinn, e.t.a, or d 6.rr.c.t,a., enter date of Willlrr Jection A above and complete list n(heirs,)
._____ JUN-20-2008 FRI 12:24 PM Beckley & Madden FAX N0. 7172333740 P. 03
Oath of Personal Representative
COMMONWEAL: fH OP PENNSYLVANIA •
SS
COUN'T'Y OF CUMBERLAND •
7'he Petitioner(s) above-named swear(s) or affirm(s) that thn statements in the foregoing Petition arc true and correct to the best of
the knowledge and belief of Petitioner(s) and that, as persona] representative(s) of the Decedent, .Petitioner(s) will well and truly
administer the estate accord%ng to law. ~-~ +~:.
/ t~ ~
Sworn to or afftnncd and subscribed ~'' ~°
.,~ 5i a nfPe nal Rcpiesentative '' - '~~-
r., _~
before ma the ~~ day o ~~ ~ ~~ 2~ - _
~t ~~~ ~ Mature of F'errnnal /teproacnuitlve ~ ~' ~~ j _`^
~ I'Or the Register Sigrtaturr. ujPe>sona! Rcprceetuative F ,t'~
File Number: ~ ~ ~ ~ d ~`
Estate of Kathleen A. $T'oarr-- 13~ r~ n , peceascd
Social Security Number: ~nn_sa-g~el~ T Date of Death: Apri125. 2008
AND NOW, ~ ,_, ~, in consideration of the foregoing Petition, satisfactory proof
having been presented before , T'i' IS DECRF.)~D that Letters of Administration
arc hereby granted to Lisa K. Baron and Mark A. Baron
_ in t<tite above estate
and that the instrument(s) dated
dcseribed in the Petition be admitted to probcUe and filed ofreecpr~ as the~ast Will (~d Codicil(s)) oit'~ecedpnt. i
FEES
1lttornCy Signahirc:
Rc~Cltter of
Lc;ttcrs ..... .... • .. , . $
Short Certificate(s) ... , • , .. $
Rca~unciation(s) , ......... $
... $
... $
_ ... $
... $
+_ . $
_ ... $
... S
. $
... $
TOTAL ........ • .. .. $
Attorney Name: Thomas S. Becklay, Esquire
Supreme Cotut I.D. No.: 770x0
Address: 212 North Third Street
P.O. sox 11998
Harrisburg, PA 17108-1998
Telephone: (717) 233-7691
Forth uW-4? rev. 10.13.x+ Page 2 Of ?
rh xns Kev torn-
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
~ 14~29~~
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 Local Registrar. The original
certificate will he forwarded to the State Vital
Records Office for permanent filing.
/G,~„z, ~ ~ API 18108
Local Registrar Date Issued
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REV 111'2008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~...
uANEM1N CERTIFICATE OF DEATH
rcK INK (See instructions and examples on reverse) O~ , Q [~ ~ ~•Q
STATE FILE NUMBER
Name of Decedent (Rrst middle, last sulfa) 2. Sex 3. Social Security Number 4. D of am (Month, tlay, ar )
1
.
,jli"
Female 200 - 32 - 9741
,
Kathleen A. Baron
5, Age (Last Binhdayl Under 1 year Untler 1 day 6. Date of Birth (Month, day, ear) 7. Binhplace (City and state or fo ' n coum) Bor. Place of Death (Check only one)
prtel: Other
b
s
MIXIe'a Deyx Mars Mnulea F
~
,
/
65 Yra. January 1,1943 Sagamore,Pa ([]Inpatient ^ERIOUtpatient ^DOA ^Nursing Home ^Residence ^Omer-Sperify.
•
80. CounryW Deem &. Ciry, Boro, Twp. of Death be. Fadey Name (If not kMNution, give street and number) 9. Wes Decedent of Hispanic Orgin? ~] No ^ Ves 10. Race', American Indian, Slack, White, etc.
Dauphin Harrisburg (II yes, spegfy Cuban, (SpeciM
Harrisburg Hospital Mexican,PUerroRican,etc.) White
11. Decedent's Usual Ikm Kind of work tlorre tlurm most of world tae. Do not slaw reG t2. Was Decadent aver in the t3. Decedents Etlucation (Speedy oMy highest grade completed) 14. Marital Status: Martied, Never Martietl, 15. Surviving Spouse (If wife, give maiden name)
Witlowed Divorced (Specify)
Kind of Wah K'aM of Business I IMustry U.S. Armed Forces? Elements /
ry Secondary (0-12) College (1-4 or 5+)
4 Widowed
Wall a er Han er Self ^Ves gIr>o
. 18. Decedent's Mailing Adtlrus (Street, city I town, stale, zip cadet Decedent's Did Decedent
Slate Pa . Live N e 17c. [1 Yes, Decedent Lived In TwP.
Aqua) Residence t7a
228 North 23rd Street .
Township?
X
.
Camp Hill ;, Pa 17011 PJ
N
rib. County Cumberland ,7tl. P, Deceae^' LNed within Camp Hi 11
AgWI limits of Ciry I Boro
18. Father's Name (First midila, last, suaix{ 19. Momels Name (Flrsl, middle, meitlen surname)
Stella Bonsky
Joseph Yenkvich
20a. IMomrent's Neme (Type /Print) 2W. Informant's Mailkg Address (Street, city I town, Stets, zp code)
Pa 19525
Charlotte Street Gilbertsville
2759 N
Lisa Baro~.~ Ritts ,
.
21 a. Method of DiaposNion ~ Cremation ^ Donation 216. Date of ~sposirion (Mo th, day, year) 21c. Place of Disposism (Name of cemetery, aemetay or Deter place) 21d. Location (Ca1r /town, slate, zip coda)
^ Renwva"`om State (W
Budal
~
^
s~
aR orit"d
ror
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~
~
W a O Hollin er Crematory Mt Holly Springs,Pa
~
^
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ine
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^Yas^r~
d,
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yMa, Funeral Se ~ ~ a rson acting as such) 22b. tkerae Number
011654-L 22c. Name srrd Address q Facility
M ere-Hamer Funeral Home Inc 1903 Market Street Camp Hill, Pa 170
. ~
Camplet Nems 23ac Dory when cerlilying 23a. Tome best d my knowledge, death occured at the time, dale and pWce stated. (Signature and tale) 23U. License Number 23c. Date Signed (Month, day, year)
physician is rim avaaable at time W death !o
arNry reuse W Beam.
Items 24-28 must be cartgleled by person 2d. Trme of De m
~ ~ ~ 25. Dale Deed (Month, tlay ear ~ ~ 0 26. Was Case Referred to I Examiner I Coroner for a Reason Other than Cremation or Donation?
^Yas
who pranoumes duM. M.
CAUSE OF DEATH (See lnstructlona a examples) r Approximate interval: Pad II: Enter oHrer ckv,~ nl !~diL s gntdhutino to deem, 2g, Ditl Tobacco Use ContnGne to Deam?
Item 27. Pan I: Enter the gain W everlLS -diseases, injuries, or compflcations -that directry caused the deem. DO NOT enter terminal events such as cardiac arrest r Onset to Death but not resuhing in the undadying cause given in Pan I, ^Yas ^ ProbaoN
respiretary artuL or ventricular /ihdllation without shaving the elx>bgy. List Doty one cause on each line. ~ ^ No ^ Unknown
IMMEDIATE CAUSE IRnel disease ar (( ( r
condabn ruukirg m deem)
7. v'~ / ~ "1 ~ e-P c~ ~
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' 2g. If Female:
~
flhin
t
t
t
-~ a.
t
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L.
Duero (or u a Consequence off. r pas
o
Degnan
w
year
^ Pregnant at time of death
g arty
b
r
uendalry qst coMhiore
Ss
,
,
,
q
Isadir~g ro the cause listed r>n line a.
t ^ Not pregnant but pregnant within 42 days
pus to (or u a consequence ~:
Enter gre UNDERLYMG CAUSE ~ of death
(dsease or injury mat mAialad me c
. 1
evens resuNing m deem) LAST.
f
^ N ~agna
m, but Pregnant 43 tlays to 1 year
):
Due to (or as a consequence o
r m
r
d ~ Unknown it pregnan within the past year
.
30e. Was en ANOpsy ilOb. Were Autopsy RrrGngs 31. Manner of Deem 32a. Date n Injury (Monet, day, year) 32b. Describe How Injury Ocanetl 32c. Plats of Injury: Horne, Farm, Stren, Factory,
ONk:e Building, etc. (Specity)
Penomred? Available Prior to Completion
f Death?
e
f C ,_-,~/
~turel ^ Homicide
o
aus
o ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. If Trenspodahon Injury /S,oetyfy) 32g. Location of Injury (Street, city I town, state)
^Yas ~i "~JO ^ Yes [~}'f1o
^ Yes ^ No ^ Drivarl Opemta ^ Passenger ^Padestrien
^ Suicide ^ Could Nq be Detennirred M Other - Spsaty:
33a. Cenlfier (check only ixre) 33b. Signature aM Tale of Ce ~' ~+~,~
• CMNyIng phyaklen (Physician cenayiry cause of tlulh when enomer physician has pronounced death and compktetl Item 23)
________________________ ^
__
.
th occurted due to the cause(s)and manrer as stated
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____
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a
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e
To Nte but o
• Pronouncing and cartNying physigen (Physician bah pronoundng death and cerahkrg to cause of deem)
To the beat M my krrawkdga, duet occurred at the time, date, and place, and due ro the cause(s) and manner u sated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Numoer _
J~~y j1 // IC 2 /
~~~•v(,J T ~J O) 33d. Dale Signed (Month, day, year)
~ /(o
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• Lladiwl Examiner 1 Cororror
On the basis of ezeminetlon end I or Investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner u slate4 ^
~~
~ N /ap/d/Ad~dry'(~/oy Person Cort(~,~W1M a/u~a,, /Death Item 27 a Pr t
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35. Regisl lure and D' u ~ ~ ~ /
L ~ ~~ I I I ~ 38. Date F' (Month, tlay, Year)
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