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HomeMy WebLinkAbout07-07-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF C>i ~~ COUNTY, PENNSYLVANIA Estate: of ~£Ig /~ t' - C~ R U V ~ ~ File Number o` ~ ~ U ~~ ~~ also known as ~i/ A t11 ~ Deceased Social Security Number J 7 y - yN "' 7G ~7U 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 Will of the Decedent dated and codicil(s) dated (State relevant circumstances, e.g., renunciation, death of executor, e1c.) ~ i= Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executiort"SSt~ for probate, was not the victim of a killing and was never adjudicated an incapacitated YJ B.~Grant of Letters of Administration (Ijapp/icable, enter.• e.t.a.; d.b.n.c.t.a.; pendente life; durante absen[in; durance miitoritate) (COMPLETE IN ALL CASES:) Attae/: additional sheets if necessary. ~ named int}te ~o -,- rte' ~3 ~ , ,_i 7 t ~f-l'-•t ms(s) off~r-ed`-^-t ~ .u t "• {7 VC? i_... ~--r-t .. ~~ Decedent was domiciled at death in GJ 1v. p~. t ~, -+/d County, Pennsylvania with his !her last principal residence at 1 ~5~ W/ll )~AM,y, (,~(LA..~ Q lad "tsl MCC~M~teSb~nr~ ~_~7C)~~ (List so set address, town{city, township, county, state, zip code) y~,~ Decedent, then L~ ~ years of age, died on wY1 L ~ ~ _ at ~ Q ~'y' ~ 1, ~+iap~_, Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ a2S QyU (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ situated. as follows: Wherefore, Petitioner(s) respectfu{{y request(s) the probate of the last W ill and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: C Signature Ty ed or rioted name and residence ~~~c~~`r" C~i' p~.: ~/ G v v~~R ~. w pit ~~+n ~ ~t ¢ . Form R6Y-0? ren. 10.13.06 P1be I Of 2 Petitioner(s) after a proper search has f have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Adtrtanistration, c. t. a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) Oath of Personal Representative CON[MONWEALTH OF PENNSYLVANIA COUNTY OF ~. ~_1._lY1~~ l0.Y`~ SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are hue and con•ect 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. Swe~'r, ro or a.* rmed and subscribed before me the ~~ day of < ;~ 2.~~ ~ F'or the Register Signature Signature of Personal Representative Signatcu•e of Persaral Representative File Number: ~ ®~ ~ ~ ~ ` Estate of ~C~-Y~1 ~" ~'~Uy{' ~ ,Deceased Social Security+~Number: ~ ~~ ~~ 1 ~ ~© Date of Death: J ~v1~ ,~ 2C~ AND NOW, ,lu~,.,\~~o ~ ~ > ~ in consideration of the foregoing Petition, satisfactory proof bourn€; been rresented before me, ITIS DECREED that Letters rti G are hereby granted to ~t ~.-~C.'~~ UJ C -"IJ~V~I~ ~___ in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of FEES Letter;; ...~~..O~ ... $ ~~ Short Certificate(s) ... ~... $ Ja Renunciation(s) .......... $ ... $ ... $ . . $ ... $ ... $ ... $ ... $ TO"I'AL .............. $ 8~ "~ ~~ , as the last W Attorney Signature: Attorney Name: Supreme Court LD. No.: Address: Telephone: Codicils Register of Wills --- =... `~ °b ~ T , _~- ~ ~ y` ( =~ ~ ,, _, - + r :, ~ ; -z- 7 tlf _ -., ~- , , Form RW-0' rev. 10.13.0( Page 2 of 2 lU5.N0~ REV UI1 /U') LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, X6.00 P 1~~8367~ 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 be forwarded to the State Vital Records Otfice for permanent filing. d Local Registra ~ a Date~~sued co l-) ;~..0 T; ~? S n r-•- ~, ~,~ 7y ~~ ~ ;~ --p --i .. {e Hloslg3aev u,zoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE, PPINT IN PERMANENT CERTIFICATE OF DEATH BLACK INK Q/r~.~, (See instructions and examples on reverse) STATE FILE NUMUER O V O 0 1. Name W Decedem IF'usl. mtltlle, lazl. wNi=) 2. Serf 3 Social Sewrily Number q. Dale of Deam (Month, day year) Jean F Gruver Female 179 - 44 -7940 J 5. Ape (Last BlrtMay) Under 1 year Under 1 day 6. Dale of 8iM (MOnm, as ,year) 7. BiNNaan (CNy and stale a 1 oomEYl !!a. plats W Deam (Check ardy met MonMS wre tears swvaev HospNaL Oilier: 49 Yr: Feb. 19 1959 Havre DeGrace MO (~'Inpaaem ^ERl Outpauem ^OGA ^NUrsug Mane ^Resgtnce ^omar. Spenty w. ewmy a Deem & CM. BorD, Twp of DeaN Bd. FaciNy Name QI rid insNiNgn. qve sued aM anmerl 9. was Decedem d HisParkc Origin? No ^ Yes 10. Race: Amercan klden, BIaU. Wtste, etc CUR'tYerlarrl East Pennsboro l YY {N Ms, spatily Cuban, (~~ ~ Mexican, Puerto F4can, ek.) Whl to It. OaedmYS Usual Occu eon KYq d work dap most d Ids. Do rid stare retired 12. Was m eve Nre 13. Decedent's E ~ (Spaary ady tmghest grade canpkled) 14. MariMl Slates. Marrre4 Never Married, 15. Survivxg Spouse ;N wse. plus marderl rrartkl Kad d Work Kud d Busireu / mArsuy US. Armed Faces? ~ Elemeaary Y Secmdwy (Pt2) Cdlage (7 ~4 or 5.) Wdow'°d~ Diver ©d ISpxvM Plrr~ ~~ ~Y°• "° 4 Married Michael Gruver Is Dec.dem't MaNmq Aaent Isunl, Wty / tDwn, eMW.:ip Doml 15501 Williams Grove Rd L t 151 Daeaanl a Acwal Reeiaera~ 17a. Stale Penns lvania Dd Decedea ,T TyJ Yea. DecedeW ~vw v, Monroe Tw ~ ~ o Mechanicsbur PA 17055 ,7c Camq p ? De~e d eSla veil waan Cltmberland t?a ^ ~ ~ n ~ CdyrBao 1B. FaNwr's Name (FUSE nvddle, last sWhx) 19. MoNar's Name IFirsl. mitltlle, maiden sumanle) J. Fred Wineke Mildred E. Fisher 20a. EsamanYS Name (Tyya /Print) 20b. Wamaril's Mailep Ad~ess (SEeal, city / mwn, slate. zp cotlel Michael W. Gruver 155 Williams Grov R Lot 1 1 Meth is b PA 1705 27a. Meaad W Disposuiai Cremadm ^ Dona4m 216. Date W DaposiNm (Mmm, day. year) 21c. Place W DisposNm (Name W camel cry, awrlabry a oma pleeal 21d. LocaEpn Icily / bwn, aWk, =q code) ^ Burial ^ Flenwval Iran Slate Wn Cremation a Dausibn AuNwl:sd ~/ ^ Omer-soacry: Ey Medcal E=amineryCaorerY lJ Yes^NO JUne 21 208 HDllln 22a $gname W Funeral ;arvice Upensye (a person as such) 22b. licarsa Hummer 22c Name and AtlaeSe W Fatlkry 8 Market Plaza Way ~ - a~ - z' r 1 H i PA 17055 CanplMe Eems 23a<ady when nreiyirg . To me best d my Fnowledpe, deem Donated al the Nme. axle and pace s4aled. (Sigrawre arrtl line) 2~. lkenw NarlOar 23c. Dale Siywd IMorun day rear) phytKwn u not available al bme d deem b , . ceNry cause d cream. Items 2g2a must n cmglmed W persm 21. Tsre W Deem fy 25. Dale Pronounced Dead (Monty, day, year) 26. Was Gass Polerre0 b Medical Exanwrer /Carver Ia a Rnsm Omer man CreAaeon a Dauum? vrM gmourccs Beam. 3. 3 M. ~ ^ Yea ^ No CAUSE OF DEATH (Sae M°UUCUaru end aaamplee) r Approximate interval: Item 27. Pan 1: Enla me GIEIN1N_ellNllle - tieeaws, Ifqurle5, a carpkcakms -mat Erectly caused the deem. DO NOT enter ternwral events such az UrdldC arrest, 1 Onset m Deem Pad N: Emer Omer 1 bW rql resWl n ere lade cause n9 Ms5 even n Pad I. 28. Did ioWCCD Use ComnWle b Deam7 ^ Yes ^ Prc 6 ab ry respkaray arrest a venlflDWer fibrYldllon wdMW Showirg Nle elwbgy list auy one Cause an Bach Yrla. ~ ` ^^ . ~ ___~~~ n ^~ IWIEDIATE CAUSE `Fxwldwasea `^• ~ a.s""~^'^ corgkon resWag n Oeam) -~, a .J f' PS Ij ~ 1 Ja ~ L/ L -~G~NV17/l1~~) 29 N~F~s/n~~aI~e Duero{a asacrose quern dl, Iu clot Dr ml warm egn past year Sequa easy k51 caWrtorrt, if any C. k tome Cause ksted on Nne a r s ~~ , % ~ ~~ ~ m ~~_~. ~ ~ y ^ Pregnant ar krne d Oeem . Enter the UNDEFRYWU CAUSE Due w la az a consequence op'. Id52ase w uqury mat aklialEd tlk c t ~ / N'` ~ ^ Na pr eg1aW. but prepranl wuhm q2 daYs Wdeam events resuaug u. deuml UrST. r O S/ i Y 101 ' Due b Ia ae a conseylwnce oll: l ' ~- Nil prep y year warwu, trot wiu q3 da s W I I d, r aNae seam llnNtgwn d prery~ant wimm me past Year 30a. Was m AWWtY 30b, Were AuWpsy FUMkgs 31. Manrer W Deem 32a. Dale d Injury (Monm, day, Year) 32h. Describe How Irqury Occurred 32c. ~ d kMaY-. Homo. Farm. Sveet Faclay, Pedomwd? Avarlable Rpr to Cmpleum alural ^ Hominae ~ ~~g' ~- (~~) of Cause W Deam? ~ ^ Yes [.~'NO ^ Yes ^ No ^ Acc'dern ^ Pendng Investigalim 32d. Tine of Injury 32°. mpxy M Woh,? 32f. N Trar>SponaMn Injury ISpxdY) 32g. Lacaaon d mpuy (SYreel, dry / bwn, stale) ^ Suicide ^ DDUM Nil be Delermine0 ^ Yes ^ No ^ Dmer l Operate ^ Passenger ^Pedeelrian M Octet ~ Specify 33a Cereba (check ably oar) 376. Sipralae ale relHr • CerElyinp physkien (Physcian ceruNsp cause of deem when arolner phYSkian has prmowced Beam aM canpele6 Nem 231 ~ 4D 7o gu Entamy knowledge, deME Onurred duet tlu nuae{sl end mennanslaled______-'_________________'----___ ^ / Nt>/•- ~•qt • Pronouncing and nrdryinp physician (Physician bom prapuncing deem and ceNtyUg b cause d deem) Ur E T l d kno l a d h d t N li d d ^ 33c. tkersse NurtLa 33d Dale IMauh, day. Marl o rt my w e ga, ed occurre > e ate, an me, place, end tlw to w note(s) aM mama u snte • Medical Eaamilw I Canner d_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , ~ L ~ O I O ~ On Ule wait al nalMnaUOn and / a mreslgalian, in my opinion, death xcurre4 at Nw tune, date, arW pace, aril due to 1M wuee{e) and manner as shted_ ^ j ~, Name Adtlress d Pemm Who Canpleled Cause d beam (Item II Type I Prw ~ ~ 35 Re rs Su/nalure and DIShIC1 Number 36. ale Filed {Month, day, yaar) S 1h'1 ~ ( e A t (b 0.tA, vv-v A s t t o z. n { t n o I o q y J P 1r~1 ~ I o21 1 IC - I S `I~3 N~~ Y,eT $'Fw« o' $u,~0 ) o o J a r ,2ao Disposition Permit No. ~ ~ G ~ 7l>