HomeMy WebLinkAbout06-26-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~ u ~ ~-e ~" ~'`j'y ~ COUNTY, PENNSYLVANIA
Estate of ~Gt. /~/V/7~/~ ~ . /"`~~`~'~
aiso known as
. Deceased
File Number ,_~\ Q~ ~J`>,~
Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the
last'vVill of the Decedent dated and codicil(s) dated
named in the
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the insttument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^ ;B. Grant of Letters of Administration C - T
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lire; durante absentia; dura~trejn:iaoritnte) ~,
Petitioner(s) after a proper search has /have ascertained that Decedent left no Wi11 and was survived by the following spgt (if any) ~d heirs.;( _
Administration, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ ,~ ~
.F,.y `„,
C Name Relationship Residertor;,'~",,~ C7"r
r _ -, _
. ~,y
W
(COMPLETE IN ALL CASES:J Attach//additionafal sheers if n~/ecessary.
Decedent was domiciled at death in C..Ft /hr/~,d/'~A~- °~ County, Pennsylvania with-his !her last principal residence at ~~`~
„ , ~, _ ~~ ~..~. 1~.J r_ a e „.v.:.~ c i7i ~ ~i r/.rcv 7~G..~ _ . C~i/~i~~ri~~.-v1~ ~~'#*._• ~ /q- / ~3 2~{
(List sn~eet address, town/city, township~count)~, state, zip code)
Decedent, then ~ years of age, died on ~ ~ 20 •' O~ at Q/~/Lrt.-t S'GG' /~G/ONl~C. ?~ Gr1~ie/d-L. ~'~]"iZ
Decedent at death owned property with estimated values as follows:
(If domiciled in PA} All personal property $ ~ GGa. GG
(If not domiciled in PA) Persona] property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
Wheretcre, Petitioner(s) respectfully request(s) the probate of the last Wit{ and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Si nature T ed or rioted name and residence
,TjEB ~i lz • F/ZOST
G•g~zy~.~zs ~i9- ~ ~3 2tf
Form R4V-0? re~~. ro.r3.o6 Page 1 of 2
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 correct to the best of
the knowledge and belief of Petitioner(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 aff rmed and subscribed
bef~,ce me the ~ day of
~~J , .~~
_+
For the Register
File Number:
Estate of
Signature of Persatnl Represenintive
~~
Signature of Personal Representative ' -,i}
-l7 ~ `-..
'~
:~~- ~- n~
-{.1 ~'~
Signature of Personal Representative
V ~ ~~~
~'~ ~ -
t7'+
Deceased
Social Security Number: ~ ~ ~ ~U ~~ ~ Date of Death:
AND NOW, ~•' ~- t~ ~ _ _, ~ ~8 , in consi ration of th foregoing Petition, satisfactory proof
~--- ~.
havi~.lg been presented before me, IT IS DECREE that setters f ~ ~~-~
are hereby granted to ~ ~ !~Q
in the above estate
and that the instrument(s) dated d ~~ ~' - ~'-
described in the Petition be admitted to probate and filed of record yes the last Will (a Codicil(s)) of edent. J
F,E~~,Ep~S~
Letters .......~~4~~: $
Short Certificate(s) ...~..... $
Renunciation(s) ..../...... $
... $_ i__,_~ ~~.
... $ t?
... $
... $
... $
... $
... ~
... $
... $
TOTAL .............. $
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
'.a
Register of Wills
Page 2 of 2
Fa'ui RW-0? rev. 10.13.06
105.905MS REV.6/OG
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
Military
Status
H106-143 REV it/2006
TYPE I PRINT IN
PERMANENT
SLACK INK
,~
OI
`~
s
Disppsitwn Permit Na ~
.'I
~.~.
.~.
>....:
~,
o G`~
.,>
- . --r, ~.
-
(, Y
.
r: ~ ,._ .
r 1-1
' ~5 I.
-
` ~; ~ ;
_
-~
r~_,
-_>-;-j r
~,
-J ~)
r~ --{
W
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~,~~ ~ o~
~~
Calvin B. Johnson, M.D., M.P.H. Frank Yeropoli
Secretary of Health State Registrar
1152440
No.
Date
CERTIFICATE OF dEATH 1 ( /~•/~~
(SEC I113Y-UCHORS SfIfI 6XeRIPI@8 011 TE:VETSC~ STATE FILE NUMBER .-/. \ \~ ~ ` 1' l~ \ O
,<1UL 2 02007
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
1. Name d Decedent (Fksl, rtkd0le, Iasi sulfa) 2. Sex 3. Social Searily Number a. Date d Deam IMonm, day,
~Ob
7
.Juanita B. Frost £emal~ 171 - 28 _0853 June 20,
s. Age (L:sst SiMtlay) under t ye.r UMa t da 6. Data d Binh emh, day, ear) 7. BROa@ce ( and Aare ar b ~ country) ~ aa. Ptace a Deem knack o one)
75 Mmm, 4ys MO114 Mkxnn Hndtet. Cher
y,a. April 13, 1932 Needmore, Pa. ~7,npaomt ^ER/D~q.Ibnt ^DOA ^N~rsingHane ^Resider%e potnar~st~dy-.
W. Cpunly a Deam Bs. CM. Soro, Twp. d Deem Stl. Facliry Noma (N nd insmaion, give street and numbed 9. Was Dendenl d Hopanic Origin? ®No ^ Yes 10. Roca' American Indkn, 6taCk, Whge, ac.
' Cumberland South Middleton rrTT~~,~,~
+wL. Carlisle Re tonal Mad Center °'~~'p°`~'/`Ti4an~ Isadr»
g Maxicen,PuedoRican,ek.) white
11. D¢ceded'S Uatnl Kuq d work done moat d ~ Na. Dona Sob retlr ~ 12. Wee Deeedant aver in du 13. DecetlenPa Educetlan (Specify onN Isglteal gnda canpleled) 14. Meribl SblV9: Mauled, Never Married. 15. Swvivhg Spouse IO wile, give maiden name) _
Kill d WoM Nbk d Business 1 IndusUy U.S. Amnd Fdces? Ebmenbry / ndery (0.12) Celle (1-0 or Sr) Wdaved, Diwrcetl l5pecitvl
1~ ~ widowed
homemaker ^Yag ~Nn
_ 16. Decedents Mailrq Address (greet, ogY /tam, stab, zip cdMl Oecetlenrs EJa Ditl Detetlent
uw m a „¢
Deeeaem Lived In Dickinson Twp
C3tYea
R
d
,,
gb
185 Old State Rd. .
.
.
e
ar~e
,.
Adaat
ed
Cumberland Trn,nsMP? 1d~ a`
,7b
p
am
'"'°"N""
Gardners Pa. 17324 .
p
y
,
CiNIOaa
1fl. Famets Nwna (Pint, mkfdle, feel. 9uthx) 19. Mr%Ywr's Name IFlrsI, midtlb, maiden surname)
Maria Straight
Russell Mellott
20a kdomtanTS Name (Type / Print) 206. mlormant'a Mating Addreas (Strad, clY I lam, slate, $ cab)
Pa. 17324
Gardners
185 Old State Rd
Michael Frost ,
.
sk
lon ~ ^ Grematiat ^ Donation
21a MdMd d Dklw 2tb. Dab d gsposlm (MpM, day, year) 21 c. Race d Disposllbn (Name d cemetery, crematory a amer peal 21Q. Lacaliwt ICiry / Mm, slate, zip cadet
r-
t
B°p Rrmwya,hom6rere ! w
' 2007
e 23
J Victory Cemetery
Mt Gardners, Pa. 17324
d,lExm,r.r ^veg^Na
^ r un
, .
' 22a. Sigraiure d Funeral Service Licensee Ia Parson apfig ae such) 22h. lkense Number
FD-012884-L 22c. Name aMAtldress of Fadpry
Pa. 17306
Inc. Bendersville
an Funeral Home
_ ~ ,
,
ppmgeb Oams 23at any v4len cemry6lg 23a the lest d my Iaowleo9e, tlaam oamrea at me thne, tlde and plate soled. l5grebre erM title) 236. I.keree Number 23c. Dale Signed IMonm, tlaY, Year)
phys%bn b M avallede of tlme of deem m
ratty saws d de~m-
Iiwn 2x26 mull be canpMretl by pesos 24. Tore d Deem - 26. Dab Pratormcatl Dead (Manor y, 26. Was Case flefa~ne~0 /tCM~1 oral Examiner !Coroner for a Reason Outer than Gemaum a Donation?
~ wta PranwaxRS deem. ~ S3 ~ M. ~ Z~ O ~ ^Ves L'~'v"
CAUSE OF DEATH (SN In%grrrtlbne urC a%ampkw) r Approximate Idend: PaA II: Eder dlwr ' 28. Dk1 Tcbacm Use Conln6uie to Deam?
earn 2T. Pwt L Eder Ae chain of events- deasses. mom, a cmpMatkxre -mat dkectlY nusetl me deem. W NDT enter bmrvtal events such m ceNiac mrest, pose[ to Dean b0 nd msularg h me untlerrybg nose given n Pen I. ^Ves ^ Pm6ady
nsgntory angst, or venldabr 6bnlta4on okhuut sMwmg the etiaogY. rid anN ore uuee on aacn Ilrle. ~ No ^ Untmoen
7 ,,
'MCaMidtw~' nur~et deaNl
¢'0.r/ ~
in s
~C7(7 ~i rvs` Ohi~i /CA ~pl~'j" al. ~_~_ 9.1Q Na
iltti
rt
t
-~
i
. Due m (a as/~a nsequenx oq: i
SepuenEaOy Ibl caxltlims. d any. b
(/ !L L~ Lz~MO A 1 ~7e
[~ /~
`~'NLC L~ (~ (~°IY.~~ ~ i 5 CPS(' pte3na
w
n pas
Year
^ Pregnant el t e a deals
_ _ _
.
map b Uu4 Huse Xaled m Sne a.
off
n ^ Nal pregnam. ba pregnant whim 4z days
Due tp for a con9eque
n
:
Enbr Bte UkIDaE%RyLYING CalAaUd6E
c
l~
~
as
or
~a of deaN
t uST
etan6
%w0
nlg m
s
._ Due m (a as a ntwequenn d):
r ^ Na pregnant, but pregnant 43 days b 1 year
balsa death
d. i ^ Unlmown if pregnant warns me past year
30a Wag an Adopsy 30b. Wwa Aumpry Fillings 31. Manner d~aem 32a Date d Injury (MOnm, day, year) 326. DescrDe How Injury Oaurred 32c. Pbce of Iryury' Home. Farm. 9veet, Fadory,
ORn Buibity. ek. (SpecAy)
Pedametl7 Avadede Prior m Garyleam
d Cause d Deem? f-y'Rp1u/
nl ^ fiolnitlde
~ ^ Y
~ ^ Accident ^ Pentlag ImresOgedon 32d. Tim¢ d Injury 32e. Injury at Wtuk? 321. N Tnnspataaon mNry (SpegifY) 32g. Lonipn o! Mlury (Street, cgY /tam, slate)
^ Yes [ es
' ^ Suiotle ^ Could Nol be Debml'ntetl ^Ves ^ No ^ Driver! Operator ^ Passenger ^Petlealnan
M. Other - SpedN.
33a CeniRer (check onN one) 33b. Signature Mel Tlae a Cwtif
• Certlrying physiebn (Phys%Yan ter0yin9 sage d deem when andher physaan Has Prormunced dnlh antl completed Ram 23)
death oecumatl due[o the aualsl+nd mennsraatetzd_.___~__________.._______________ ^
knowledge
T
th bgidm , y `/?
.
y
o
• Pronanndng Mel ceriHYN9 pftyekbn IPhYaclan 6001 Pronounntq deem antl c&ilying p cause d tleaml .License Number 33d. Date Sigretl Itgmm. day. Year)
To ~~~~teaamv+a,wwle+'.g..d~mop¢arrednmanm.,eeta.asap)Ke.anddnamlbootee)elammar.rara.,a+.~---------_--'---- /~1~-O 3~!/ ~- 6 2n a~-
• MedInlEAminM/Coroner
On'drs baeb d examlrribn Mel / or IMesdgetlon, In my ognton, dorm occurred et the tlme, Cab, snC pion, arA due b Cte nasals) antl merrnr as sbted_ ^
d Deam Illem 27) Type r PMt
Person Wta Canplat d C
au
se
36 Nam Mdress
an
~
r
R s N NOm60r ~ /, 3fi. Dale Fled (Montlt, °aY~ Yga~ Q
'
~
^
Q
' J)l
e k
f
~ ~ ~~
G.J _Y
~Oy ~~ ~
~
0.
~?/
I-a ii.. Q
V ]
LAST WILL AND TESTAMENT
OF
Juanita B. Frost
C7
-~
-. --r~
_;~
. L ~,
_ ~-
-- rr,
"~~~
~_
- -,
,,
~~
~~
~~:
~__
r-~~,
~:
,.,
-.
~..
I, Juanita B. Frost, of Dauphin County, Pennsylvania, being
of sound and disposing mind and memory, do make, publish and
declare this to be my Last Will and Testament. I revoke any and
all Wills or Codicils I have made at anytime before.
ITEM I - I direct my Executor to pay all of my just debts,
funeral expenses, estate and inheritance taxes as soon after my
death as may be found convenient.
ITEM II - I give all my tangible personal property,
including all motor vehicles, which I own at the time of my
death, to my son Michael William Frost, per stirpes. I give,
devise and bequeath all of the rest, residue and remainder of my
estate, whether real, personal or mixed, wheresoever situated and
from whatsoever source derived, equally to my sons, Robert
Russell Frost and Michael William Frost, per stirpes.
ITEM III - I hereby nominate, constitute and appoint my son
Michael William Frost, to be Executor of my estate. In the event
of the death, disqualification, resignation, refusal or inability
~~
JBF
Page 1 of 2 Pages
of Michael to act as my Executor, I appoint my son's wife, Debra
R. Frost to be my Executrix. In the event of the death,
disqualification, resignation, refusal or inability of both
M:ichael and Debra to act as my Executor, I appoint my son, Robert
Fussell Frost to be my Executor. I would like my executor to be
compensated for his duties with a reasonable fee. My executor
shall not be required to file any bond or other security.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this my Last Will and Testament, consisting of this and the
preceding one (1) page, at the end of the page of which I have
also set my initials for greater security and better
identification this 10th day of December, 2002.
~ ~ ~ , ~,
- ,~ t'~`-,z~. ~. .~~ . =-~ _~~.," ( SEAL )
~. _
J~a'lnita B. Frost
Witness Address
~`
ry
._
Witness- ~ Address ~
Page 2 of 2 Pages
AFFIDAVIT
Commonwealth of Pennsylvania .
. ss:
County of Dauphin .
We, Eleanor L. Hayes and Lacy Hayes, Jr., the witnesses
whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we
were present and saw the testatrix sign and execute the
instrument as her Last Will, that the testatrix signed willingly
a.nd executed it as her free and voluntary act far the purposes
therein expressed; that each subscribing witness in the hearing
and sight of the testatrix signed the will as a witness; and that
t:o the best of our knowledge the testatrix was at that time 18 or
more years of age, of sound mind and under no constraint or undue
influence.
Sworn to and subscribed to before me by Eleanor L. Hayes and
Lacy Hayes, Jr. , witnesses, this ~~ day of ~- ~~iwJ~C.~--~ ,
2002.
Eleanor Hayes
Lacy Hay , J
a
Notarial Seal ~i'^`
Londa R. Coulter, Notary Public ,f ~
Harrisburg, Dauphin County ' ~ /,
My Commission Expires Dec. 13, 2004 ! ,(~
Member: ~'ennsywar,ia 4ssocia++~~ of Notaries ary Publ i
My Commission Expires: SEAL
C:\copied archived files\August 2001 archive dox\Clients-Closed\Frost\Will 2002.wpd
ACKNOWLEDGEMENT
Commonwealth of Pennsylvania
. ss.
County of Dauphin
I, Juanita B. Frost, the testatrix, whose name is signed to
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and
Executed the instrument as my Last Will; and that I signed it
willingly and as my free and voluntary act for the purposes
therein expressed.
Sworn to and a((c~~knowledged before me by Juanita B. Frost, the
testatrix, this ~ V ~~ day of ~--~ 2002 .
Notarial Seal
Londa R. Coulter, Notary Public
Harrisburg, Dauphin County
My Commission Expires Dec. 13, 2004
Member, Pennsylvania association of Notaries
~~~~
J anita B. Frost
N ry Public
My Commission Expires: SEAL
~, \ ~~ 031 ~
Here is the "renunciation" form. Please sign and return to me. Thanks
me
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Juanita B. Frost, Deceased
I, Michael William Frost, in my capacity/relationship as
son of the above Decedent, hereby renounce the right to administer the
Estate of the Decedent and respectfully request letters be issued to
Debra R. Frost.
//! O
Date Signature = Michael W. Frost
185 Old State Road, Gardners, PA 17324
Sworn to or affirmed and subscribed
before me this Z, day of ~uN~ 2008
1
8~~~ t~--~Pr~ ~.sr~ iSt P r n f S~i~~ ~~7 +`•_>
s Q c_~
~~C~ 5~ _ --
~y+~
WRlMIN 8
OMI~NELS r r
? .
..
r~`'
No~aiy t~ubltc ~;
t
C/1RLIBtElOROtKsH, CUIUfBERL,gi~COUNiy - :'~'
~ CorrMrNalon Expkes Oct 19
2008
, ~
. `~
,