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HomeMy WebLinkAbout07-08-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland Estate of Gertrude G. Burkholder also known as Deceased COUNTY, PENNSYLVANIA File Number ~~ ~ ~~'~ Social Security Number 198-22-9134 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: ~ `'~ c- (COMPLETE 'A' or 'B' BELOW.) `_' ~ °° - -j -t-, ~ ~t ; .., _,~~ _. A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the = ~~ t-' narrFe~ in l~e last Will of the Decedent dated and codicil(s) dated :~_;~-,;- m __ (State relevant circumstances, e.g., renunciation, death of executor, etc.) -~ --t t~ - r -- Except asfollows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instruru~,rtt(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: B. Grant of Letters of Administration (If applicable, enter: e.t.a.; d. b. n. e.t.a.; pendente liter durante absentia; durante minoritate) 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 Administration, e.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Name Nancy Grissinger James Burkholder Deborah Brunner Daughter Son Daughter ~a~~rr ~a:^k~,~ ~otr~ SA., (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in (List sb•eet address, town/eiry, township, county, state, zip code) Decedent, then years of age, died on Value of real estate in Pennsylvania at Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County situated as Form 1ZW-02 rev. 10.13.06 316 Residence PA 17257 66 West Main Street, Newville, PA 17241 2813 Breker Street, Pittsburg, PA 15214 /~/~ /6'05 ~ County, Pennsylvania with his /her last principal residence at $ 14,000.00 Page 1 of 2 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: Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COLJN"I'Y OF Cumberland 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 affirmeQd ~.,nd subscribed before me the 8 day of )t , For the Register 5ignhture~rsonal Representative Q r-.a Signature of Personal Representative ~ ~ ~' -~ ~ ~ ~ t"' Signature of Personal Representative ~~ F ~ ~ ~~~ C. J (~ (-~ ,~~y.} Sy ~ ';~ 11 _.,~ w File Number: d~` ~~ 61~~ ~ ~ Estate of Gertrude G. Burkholder ,Deceased Social Security Number: 198-22-9134 Date of Death:August 21, 2007 ~. C.'. -T~_Y "i i -:. G. 1 -~ i AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to Larry Burkholder and that the instrument(s) dated July 8, 2008 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ..... ~~~~... $ lS2b Short Certificate(s) .... ~ ... $ Renunciation(s) ..... y.... $ 6 _ ... $ ... $ S ~' ... $ ~~ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ in the above estate Regist ~ Wi Attorney Signature: Attorney Name: Duane P. Stone Supreme Court I.D. No.: 85715 Address: 8 N. Baltimore Street Dillsburg, PA 17019 Telephone: 717-432-2089 Form RW-02 rev. 10.13.06 Page 2 of 2 I(15 gQ5 RE[V rt11 /0?i - LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certifiicate, $b.00 P 1377458© 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 Office for perman filim~. ~~ ~~ ~ - c• egistrar Date Issued n C ~ ev c~-a 4~.Y ~2~ r --- ~ rn :., ° cn ~ ~ CO N1C 1 \~ __ _ .. _. ~T ~ ~ O v~, ~ C-7 ~7 ~~ :~ O -n s" vPE/~iNTIN~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS (~ ~ PENK CERTIFICATE OF DEATH ~_ ~ ~ (See Instructions and examples on reverse) STATE FILE NU • 6 }- bi 0 0 r,.~ ~: f~ t - z ~ - -~ "- -'T-t _ -rt ~ ~, -T'-, r'-1 1. Name d Deaden (FlreL rMedle, kw, uMa) 2. Sex 3. Saiw Sacuriry Number 4. Date d Deem (Monet, tleyy~r) Gertrude G. Burkholder Female 198 _ 22 _ 9134 August 21, 200'] 5. A{p (last &rltday) lhdu 1 year Under 1 ley 6. Date of Bidh (Moreh, ley, 7. BiMrplece (Ciy ant stele a lore n country) 8a. Pbce w Dwm (Check ady one) 91 Mona Dan rtours kewm Sept®ber 26, 1915 St. Louis, MO. anec Vre. ®InpedeM ^ ER / OmpetieM ^ OOA ^ Nursing Home ^ Resuknw ^Oder - Speay: eh County d Death &. Ciy, Boro, TMD. w Deem fid. FadNy Name (tl rid nellulon, gNe skeet and wmberj 9. Was Dewdenl d Hispernc Origkr? No Y% 10. Race: Anpriwn HxBan, Blerdc, Wnne, etc. ClmberlalYl 50Rtt11 MiddletOtl ZS~. (tl Yom. sPectlY Cuban. , •(y~Y•l i rcl p (u~jjy~l r(,p~~yr Mexican, Puerro Ftican, etc.) ~i~ 11.OacedeM'a Usual Kind d wok doe Burin moll w ae. Do not stele 12. Wes Decedent ever m the 13. Decedent's Eduction (Speoly Doty highest grede wngieledl 11. Marital SMtus: Married, Never Merrietl, 15. SurvNirg Space (If woe, gwe meitlan name) ease / IMu6py. of Ubrle U.S. Armed Faces? Elementary /Secondary (0-12) College (1d a 5a) w' Divorced ~ 04if1 h(~ ^vea ®No 12 tll Wfd4wecl 16. Dewdent'sMeNng Address (Sheet MY / wrm, amts, z4 code) I)~edenl Pd 66 West Mein St. Newville Pa. 17241 . ~ Aclral Reeitlerce 17a. 9ek 17c. ^ Yea. Decedent lisedm Twp. Toerahip? 17b. Caxdy Q~IaFK-{ rid. yp No, Dectlent Uvetl wiUin ;'~j~le AakM L:Mrs a 16. Pedlar's Name (FUsL midge, lest, erdhx) 1d. Momer's Nuns (First, nadNe, medal aumeme) Walter F. IIswidc ~;~ar,A+r, Ba7-~y~ 20a. INarwnt's Name (Type /Print) 20b. fMamenYs Mming Address (Sheet, dry /town. slab, zip cotle) ~'~Y R• ~' 316 Llf Ipl 1 i^m Ct. 4+T*~+ t+n+; PA. 17257 21a. tyethod of Disgrailiar ^ Crema6m ^ Donedon - 21 b. Date d DbposNion (Made. day, year) 21c. Place w DiNesition (Name d cemetery, aunalay a atler place) 21d. LawNw (CNy /town, slue, zy Dodo) ® Burial ^ Removal hen Stale Wee Crenetlon a OONfidl AuNalad ^ Other - Speayy: • by MedkN Examiner I CoronetY ^ Vas ^ No Au9~t ~ • 2007 Sj.Yillg H711 ~12teLy $111~HIF.at7l]YTj Pa. 17257 22a. Farerw (a ) 2ffi. Lkerree zAxrOer 22c. Name erd Address a Fogey ~ 014351-L ~elsar~er_ffiidcer Funeral Home Inc. 112 West King St. 5hippensUt3rg Pa. 17257 here 29aK: aiy Mien cedilykig 23a. To the best d my biowkdpe, tlwm accurtee at tle Are, dare end p6ce slwetl. (Sigwltee antl db) 23b. License Number 23c. Date Signed (MOrtih, day. year) physician a not avaNade w tune of dmm to ar6y cause d deem. Mans 24-2d met ba ixxtplwed by person 24. Tana d Dead 25. Deed r) 26. Was Case Rehrtad to ~ Examirer / Coroner br a Reason Oter Than Cremation a DaeNon? Me prwaaxe5 dcth. M, _ ~ / C/C// ^ Yes CAUSE OF DEAn1(See tnaWCtiom errd examples) r Approximate Interval: Pad N: EMU wni ' 2tl. Dul7obacce Use Contribute Deam? Item 27. Pert I: EMU tle ~.g-~ - drawees, lquries, a wmpacaaorw -met direly caused me deatlr. DO NDT aner mmtinel ereMS soh m tartlet erred, Onset co Deem Out M rewlYkp At tlx: undanymg cause gnen m Pan I. ^ Yes ^ Poobab respiratory arreu, a vernddaar fibrllellbn without shoang the wIMW1'. fiat way one was ce wdt lens. i / ^ No nknown Ia111EDFATE CAUSE IFinel dswse a ~ A fi ~ / ;1 1` ccetlNOn n m reatAing ) p ~ g 29. II Fe li: ~• ` _~ e. ( J4..vw..e C_../4~-..~ .X,yY~L`74x•1_ i`..-.,9-P ~ - - - - ..1 ~ " r Due to (or as a conseQuerge wl: ,~ Na pregwM within past year ty 6s1 cendilrons, N erry, b. ~ tl ~ I ~I~ ^ PrepnaM w fete of dwm b e woes listed on line a. pce b (a es 8 conaepuence w): r En UNDERLYING CAUSE r ^ Na pregwM, but rent within 42 de Fred ~ dsatse a kgay mat iMlUled the c r reuAirg m death) LAST. r ~ ~ f a dwlh Due to (or as a sawMluence oQ: r ~ ~r ^ Nor pregrenl, but pregnant a3 to 1 d. ~ before dwm ^ lhnoeam N pregwM Mmw the peel year 30a. Was an Aukpsy 30b. Were Aumpsy Furdngs 31. Mannar 32a. Date w hMaY (Mann, day, year) 32D. Desaibe How Injury Ocwrtetl 32c. Place a hNury: Home, Farm. Street, Factory. Pedomted? a Prior la Carpiwion rat ^ Honkcide ONice ~~• wc. f~ea~4) d cause w Deem? ^ Yes ^ Yea ^ No ^ Accident ^ Peaing Inveslgatbn 32d. Tone d Injury 32e. Irryury w Work? 321. II Trareporlation hqury (Spiry) 32g. Lacwbn w mNry (Strew, dry /tam, stale) ^ Suidde ^ Caad Nd be Delamktsd ^ Yes ^ No ^ Driver / Operafa ^ Pasunrger ^Paksbien M ^Other-Specify: 33e. CeMiu (dreac cey are) 33b. S' Cua' ' CedNying pryskian (Physraan cenilNng ccee w death Mien anaher physiden has praeaced tlwm antl ampleletl Nem 23) A..~ ~ f I To the hew of my knowledge, death occurred due to de auae(s)an0 mennernaleted_________________________________^ v' . • Pronourcing and cerlUying phyelclen (Phyeiden bdh pronWmrg deem and cenNyhg to ause d death) . L' rise r 33d. Dale goad ( Ih, ley, ywr) To tle best w my knowletlge, death oocared et the time, date, ant pie, and due b the auae(s) end manner n eWed_ _ _ _ _ _ _ _ _ _ _ _ • Medial Examiner! Coroner n 23 ( 7/(J~~~72 t On the heals of examination and I a m my opMon, rket the floe, date, and pace, ud due to Ute cause(s) end manner ore stetev_ ^ f ~ 34. Name an tl Address lw Person Who Canpleled Cause of Deem (Nam 27) T / PnM Repislrar's Signature a I 7 I ! I ~ / I .f"- l~ ( Y I 36. Dale Faed (Montt, Oay, year) ' ~ r ~ 1 'x'..1-Y r7"c/l 5 6d - za- o I~ I ~/ / ~ ~ Dlspceilion PartnN Nc. C l/(. / f 6 S J ~~ ~~ ~1~8 C7 r~ _;._ , L -~ 0 ~ _.- _ RENUNCIATION _ ~ ~ . _ ,. -7 ,Ti ~ ,, E ~ ,....,...~ .. -., REGISTER OF WILLS ~ ' ~~ ,~~? s~ - CUMBERLAND COUNTY, PENNSYLVANIA (-' _ a Estate of GERTRUDE G. BURKHOLDER I, NANCY GRISSINGER (Print Name) DAUGHTER Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to (Date) .~ , (Signature) ~ / ~ ~, . (Street Address) (City, State, ) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purpos~stated within on this day of J ~ r `~(,, o No ry Public M ommission Exp' •es' (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) CO - NV'J~AL•`~~1 C3P P~F~AFSY~.VAP1lA Notarl8! $eEtl ~g ~, Grc~s~ry, Notary Public ~u~,ry ~odc l3oro, Huller County My tomrrtir~ion Exp-raa Od 90, 2011 p(ratllbMr, ~~nneylVr+nle AsaoclaUon of Notaries RENUNCIATION REGISTER OF WILLS CUMBERLAND Estate of GERTRUDE G. BURKHOLDER I, JAMES BURKHOLDER (Print Name) SON COUNTY, PENNSYLVANIA ~ \ o~ ~~ 1~ f~ ~o ~ - , ~ ~~ _ ~;, %~ . ,~~ ~ ' ~ -~, ~ ~ ,~ c ._ . Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to (DafE:) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~'`~'~T' day Deputy for Register of Wills Form RW-06 rev. 10.13.06 .; ~ ~~~-- fore) ~./ (Street A ess) JU~.w~~ ri-~ P~ . ~ ~ ~N > (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this as day of ~ wJ ~ ~d o K No Publi L~ ~ ~~ ~ My ommission Expires: ~ ~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notar;'s Cemrzission. j M NWLALTH OF PENNSYLVANIA Notarial Seal N (Axrnd County My Comntiasion Expros Actg. 6, 2008 Member, Ptennaylvania AssocBation Ot tdotaries a,~ o~ 0118 ~~ RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA ~, ~© m ~ : -~ - , ~ ~_,. .E :,~~ ~ -_ .> -~ rz-, ; ~ _~ , ,, = ,~~ , . ~ t~ - . ~ ~ ~ ~,. .~ Estate of GERTRUDE G. BURK_'~-TOLDER I, DEBORAH BRUNNER (Print Name) DAUGHTER Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ,, J U , (Date:) X. (Signature) (StreetAddress) ~ ....i (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of _ , Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunc' ti n for the p • oses ated within on this day of , Deputy for Register of Wills Form RW-06 rev. 10.13.06 Notary Public My Commission (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA Notaria- Seal Mary J. Salvatore, Notary Nuntic City Of Pittsburgh, Allegtterht County My Commission Expires At,g. ~ 9, tot 0 Member, Pennsylvania Association of Notarise RENUNCIATION REGISTER OF WILLS CUMBERLAND Esta±e of GERTRUDE G. Ri.TRKHOL,DER SON COUNTY, PENNSYLVANIA ~: ~ ~ ~ ; ~ t ---; .n -, j ~- - ..a , r Deceased I, BARRY BURKHOLDER (Print Name) in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills ti~~ (Signature) ~~ ~~ , (Street Address) ~ ~G~ ~ lOd (City, to e, Zip) Executed out of Register's Office Before the undersigned personally appeared the parry executing this renunciation and certified that he or she executed the renunciation for the purpo~~tated within on this "~ f~ day of ,J V 1"~'~(i ~ ~~~ No ° ry Public ommission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Fonn RW-06 rev. 10.13.06 COMMON`~~',,;~ ~NNSYlVAN1A Nc1tNd>9~1 wry public ~ A. Cm~Y, € ~or+~~ ~uUOr ~ X011 81ip~1+ ~; ~fhl€+ ~~ ~ ~ Notaries ~~ F @R~~~yania Assoclatlon of