HomeMy WebLinkAbout06-23-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA
Estate of Geraldine O. Smith
also known as
Deceased
File Ntunber ~ / - ~~~' ~ - ~ /7°j
Social Security Number 204-03-4442
March ] 9 2008
Petitioner(s), who islare 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
rv
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the C7 tamed in the
last Will of the Decedent dated and codicil(s) dated = ~ °°
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(StAte YeleVant C2YC21mStanCBS, e.g., renltnC7atiOn, death Of eS¢CtltOr, etC.~ ~ -! G7 _,
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Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the fiit,~tnttirent(s~ffered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: `~ ~,
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~~
^/ B. Grant of Letters of Administration n~
(If applicable, enter c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante minoritate)
Petitioner(s) aRer a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
Administration, c. t. a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
Nicole L. Snell Grand Daughter 34 W. Keller St. Mechanicsburg, PA 17055
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
(List meet address, town/city, township, county, state, zip code)
Decedent, then 91 years of age, died on March 19, 2008 at Carolyn Croxton Slane Residence, Suusquehatuta Twp.,
Dauohin Countv
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 6,500.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania S
situated as follows:
Form RW-02 rev. 1 D.13.06 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
SS
COUNTY OF ~C/lLJ'Y(,ai~Slx L~i~~ ~~~~ ~~ ~~ ~~~ ~J~
The Petitioners} above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true anti ~p~e~~o the best of
~,4._~ y~-~
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petition~i~~t~vhl_~tAi),y~,
administer the estate according to law. ~~~~` ~~ `
Sworn to or affirmed and subscribed
before me the ~~ day of
r'~ ~? ~~
For the Register
Signature of Persona! Representative
Signature of Persona) Representative
Signature of Persona! Representative
~l -~~~~ - C~~rl~~
File Number:
Estate of Geraldine O. Smith Deceased
tf /~L~ C
Social Security Number: ~G l ~ ~~ ~ ~ ~ Date of Death:~ ~ 11, ~'~ o
AND NOW,
having been presented
are hereby granted to _
(~1~ ~ , in consideratioln of the foregoing Petition, satisfactory proof
IT IS L),ECIj~ED tl}¢t Letters ~~~in a <) E v~~t~ t~~
in the above estate
and that the instrument(s) dated --
described in the Petition be admitted to probate and filed of record as the last Will jand Codicil(s~jpf Decedent. /
FEES
Letters ............... $ ~ CD
Short Certificate(s) ........ $ ~i~`x-~
Renunciation(s) .......... $ v~
U ... $ S,~
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ S ~~-~~
Attorney Signature:
Attorney Name:
Supreme Court LD. No.:
Address:
Telephone:
Form RW-~2 rev. 1 x.13. D6 Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH ~~ ' ~' ~`'~
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fec fur this ccrtificatc. X6.01)
Certification Number
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l,lll"rq~ZH OF pF~ Thls is to ~ertif}~ that thr information here given is
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructfona and examples on reverse) w„aa„Fp
I. Name dl DeCetlenl fFisl. midge, lass. sunis) 2. Sea 3. Sodal Secairy NurMer 4. Date d Dean (Monet, der. year)
Geraldine Smith Female 204 - 03 - 4442 March 19 2008
5 Age (lass &nhday) Under 1 year UMer 1 tlay 6. Dale of BiM (MOnm, day, year) 7. • (C and state a b cam) F N. Place a Deem ICneck on ate)
ksaan Days Houis MuWas Hospital: Omler
91 Yrs. July 24, 1916 EilOla, PA ^Inpatienl ^ER/Outpatient ^DOA I~Nursing Mane ^Residenca ^gner Spaaly.
Sb. Carry of Oeam Sc. Ciry, Bwo, Twp. of Death Bd. Facilely Name pf rot insMWion, give street and amber) 9. Was Decedent of Hspanic Origin? No ^ Yes 10. Roca: American IMan, BUtli, WMIe, ek.
Dau his Su ehanna
P SQu +..r. Carol Croxton Slane Residence (Ilyas, spaary aeon, r(Speciyy)
}7I1 Meskan, Pueno Rkan, WC.) YYllite
11. Dxedem's Usual Oct lion Kind of work done tlui most a waki Rte Do not slate retired 12. Was Decedent ever w n1e 13. Decetlenl's Eaucafbn (Specity only hghesl grade compewd) /4. Manwl Slaws: Married, Nev r Married, 15. Surviving Spouse III wile, give maiden name)
Kira of Work Kla of Busiiwss / htdustry U.S. Armed Forces? Elementary /Secondary (0-12) College (1-4 or 5+) W'~'^'~~ Dworced (SpkiM
Housekee r Setviaes ^Yea ~Nn 8 Widowed
15 Decedents Mailing Atltlress ISeeel. city /town, slate, zip code) Dacetlenl's Did Deceaem
Penns
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34 West Keller Street y
AcblalReairlence 17a 51a1e
ryw ono ,7~ ^ Yea,Dxaemlwedm ra,
Mechanicsbur PA 17055 nb odor Cumberland ,7d ~ ~~ei`emaen5aalweawnnm Mechanicsburg cny,~p
t8 Famei 5 Name (Fr51. midtlle. Iasl sufnsl Ig. MWhers Name (Nrsl, mitlde, maiden aumame)
Unknown Eckert Unknown
20a Informant's Name IType / Pnnfl ~ 200. Inlwmam's Maikrg Address (Skeet. coy 1 worn, stale, xip code)
Nicole L. Snell 34 West Keller Street Mechanicsbur PA 17055
21a Medwtl of Dispostion i [~Dramatwn ^ Oaialwn 21b. Dale W Disposition (Monet, day, year) 27c. Place of Dispanbn IName of cemetery, aemalay a doer Dbce) 2f d Location ICeY /sown, slate, xip mde)
^ &,iul ^ Removal Irum Slala Wad Cremation ar Donation Aulnorlxed
^OrMr~Spei.~iy OY Matlkal Eaamlrw/CwonerT [?3 Yea^Nd
March 21, 2008
Hollinger Crgnatory
Mt.Holly Springs, PA
22a Sign uneral L (a person acting as such) 22b. license NumOer 22c. Hama arty Atlaress W Facniry g rk~t Plaza W y
- ~ _ _ FD - 014889 Malpezzi Funeral Home Mechanicsburg, P~ 17055
C n c only when rNying
Ilny - Is an ymlable al mna W Beam w 23a u e bsA al knowktlge, seam occwrotl al dw ' ,oats and a salsa. (Sgnalwe and Mbj
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("; j 23c. Dale Sgned (MOnm, day, rear)
cemry tadaa a deem (,`, [,_ ~~-•~ ~
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nama 2425 inua M comgeled by person
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v 25. Dae Prawurked Dead In, tlay, year)
T 26. Was Case Relerred IC Medical Evamber / Coroner br a Reason qMr man Cremalwn w Dwa0a7
wa gorwunces
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CAUSE OF DEATH (S IncVUCylonc artA eaemplas)
r Approaimale nlanal: Pan IL Enter olMr 5jp0aydplL4~4i401B61y0g1q~B3W, 2B. Dq Tobacco Use ComridAe w Deem?
Item 27 Pan I. Enter IM Uam. yl-yyEp15 - tlueases, mryries. a complicalwns - IMI tiredly caused me tleam. DO NOT Dnler terminal events such as cardiac anesl, Onset to Death but not resWlgq b me wWerlyY`q fau5a gven'n Pan 1. ^ Yes ^ ProbahFy
resDaalory anesl a vMiricuur fibipatian wafwUl shdww9 me elwwgy. List Doty aw cause to Bach line. ®~ ^ ~~
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m~itlgio~it esJC1AU$E IFi~aseasew n 1 F•JUVC ~ /1f MINTS
ayn a ) ~ a is tr or X11
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- 29.11Fernela~
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~+ a ~ Na gegnam wman past year
Sequen I51 Cai6nau, n any,
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Enter Eie UXDERLYWG CAUSE b (or a a ^ Nd gegrum, bW gegnanl wMvi 12 nays
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eves resuNag n oeaml UST. d seam
Due fo (or as a consequerke on'. ^ ei7raW 43 ae to f
Na gegnam, bw Dr Ys Y•w
d betas deem
^ Urauwwn I gegnam wane tlw peal year
30a Was an Autopsy 30b Were Auopsy Findings 31. Manner a Death 32a Data of Injury (Monet, day, year) 32b. Describe Few Inyky Occurretl 32c. Plato a IrMM( Ilorna. Farm, SOea, Peccary,
Panormad? Avadaae Prior to amgewn
raW ^ H
micid
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dl Cause W Death? e
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^ Yas ~ Phs ^ Yes ^ No ^ Auideia ~] Peixhig Vnvestiyation 32a. Tana W kWaY 32e. aykry al Work? 321. II Tiansponalaxi Injury (Spicily) 32y. LwaWn of Iryay ISlrea, my I town, style)
^ Suicide ^ Cuuld Nut be Delortnined ^ Yes ^ No ^ Unvar I Oyeialor ^ Pazsenyer ^Pedesbien
M _~gnar-Spaciry
33a eemher Icnuck a,ry onel 330 nature aM role of c -
• Certltymp pnyskun IPhyskian cendprg Cause cl deem wren aiwmec physKXn nes waadaea aoam and comptaed rem 231 _ / ~! V
Ta mI beet of my knowbdgp, death occurred duo to IM wuee(s) entl manrer as sbled_ _ _ _ _ _ _ _ ~ _ _ _ _ _ _ .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ -
• Pronouncing arM cenityinq physltlan (Pnysuan Gah pion~aring duels anJ wnilymg Id cause of dealld
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^ 33c License Number 33tl. Dale S ilea (Month. day, yeah
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Due to IM ceusela) antl manner a9 clatetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• MeditalEaamberyeaanar n^U-0~O22D1,-L 03 za Zook
On 1M Hsu oy eaaminalwn aittl I a investigation, in my upinian, death attuned at me thaw, d'ete, amt place, and due to Ne cause(s) and manner ae abterl_ ^
34. Hank aM Aadruss of Pelson Wlw Completed Gauss of Death Illem 271 Type I Piia
95 Rory
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Disposition Perms Nd. 0193257
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RENUNCIATION
-,-.,, -
lJ(~li~ .~ .+~.. f~lf
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REGISTER OF WILLS ~~i "' - ~' ~1''
~,u,.~~us,,.a~ COUNTY, PENNSYLVANIA
Estate of ~¢.~.+.~~;,.~ ~ Srw- --r.-1 ,Deceased
I ~ ¢.A-C~ ~ , '~-~E,,o,pc ~~ , in my capacitylrelationship as
(Print Nan:e)
~ti~n~il•y~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~~~ ( ~~
(Date)
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w
X /•_~s
(.Signature) / j
7~`~Q ~9~~ si~ /
(Street Address)
~~,<A~S ~~ , L,~ ~~~~
(any, stare, zp~
Executed in Register's Office
Sworn to or affirmed and subscribed
be ~ore m.e this ~ o~ ay
of~~~ ~ ,
Deputy for Register of Wills
Fonn RGV-06 rev. 10.13.06
Executed out of Register's Office
Before the wldersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this ,day
Notary Public ~
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
.=oi~?Y.".~; 3EVEi2LY ORAC€ GATO-NEL30N
=*; *= MY COMMlSS10N # DD670275
:r
'•', osM. EXPIRES May 03, 2011
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