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HomeMy WebLinkAbout07-09-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~e'Q f~~ G(~Ot1NTY, PENNSYLVANIA Estate of L~/~ir-.L~~ ~ /-~s~T~ fl~ File Number ~~ ~_~ t~~ also known as ~ ,-~D ~ ~~ _ ~ ~~ Deceased Social Security Number ~ ~ Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the gran[ of Letters in the appropriate form to the undersigned: Petitioner(s), who is(are 18 years of age or older, apply(ies) for: {COtYiPLETE 'A' or 'B `BELOW:) A. Probate and Grant of Letters Test. entary and aver that Petitioner(s) is /are the ~~X ~~~~~f~ named in the last Will of the Decedent dated j and codicil(s) dated (State relevant circwnstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did oat marry, was not divorced, and did not have a child bom or adopted after execution of the instrument(s) offered for pt-obate, was not the victim of a killing and was never adjudicated an incapacitated person: ~"1 c' --. ~.... ~~^-1 ~ s, ^ 13. Grant of Letters of Administration (Ifapplicable, enter: c. t. a.; d.b.n.c.t.a.; pendente life; durante absentia; durnttte ': ate) 1'~ r'';. 7; i ~~ '~ i'r'7 ( ~ --l Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following sgotisri3 any) ~ hetrs (If ~? Administration, c.t.a, ord.b.rt.c.l.a., enter date of Will in Section A above and complete list of heirs.) ? f7 ~ _ - Name (COMPLETE IN ALL CASES:) Attach was domiciled at death itt :~`+ ,, ~'~ with his /-herlast ~}ncipal residence at (Lis't street address, town/city, township, county, state, zip code), Decedent, then ~_ years of age, died on `~//.f~~~! rl at ~1~~~.,ST ~17~~ ~/~~~~~C~ l~/D/~~ Decedent at death owned property with estimated values as follows: ~, (If domiciled in PA) All personal property $ ~~~~ UU~ (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ _ Value of real estate in Pennsylvania $ ~~ 1f..10 situated as follows: Si nature Ty ed or rioted name and residence sheets if necessary. Form R6V-(13 re,~. lo.r3.o6 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA //JJ /l : SS cowTY of L."l1/n~0 GR1C~,paL- The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are hve and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioners} will well and truly administer the estate according to law. Sworn to or affirme _ and subscribed ,~J~ bef e me the day of ~0~' ~~, or he egist ~~~ Signature ojPersonal Representative Signature of Personal Representative N 7 ~ _~ _..l Sigaatur-e ojPersorml Representative ;.r3 ~, ~ ~ r-3 t`r 111- a6o~ - 0"la~ ~' FilenNumber: ,,[~ Estate of lJ~~.~. ,~ S ~' / ~i~T~ ~ ,Deceased Social Security Number:~4 ~- / (~ - Cv / ,~_y~ Date of Death: (p " cX / -' D`l 1 -; t-_ a '; -r - ~-:~~ AND NOW, l~l.~ ,, in consideration of the foregoing Petiriort, satisfactory proof having been presented fore IfT IS DECR_F,1<,D~tters ~ ICi~ are hereby granted to ~C i~ 1 (`~~ _ in the above estate and that the instrument{s) dated described in the Petition be admitted to probate and filed of record s the last Will ( nd Codicil(s)' Decede t. FEES 2~Q ~ Register Wills_ )~a ~ j~ ,~ Letters ............... $ `LJ "~"~- W , Short Certificate(s) ........ $ ti~ o,~ Attorney Signature: Renunciation(s) .......... $ ... $ ~~~ ... $ 5~ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ Attorney Name: Supreme Court LD. No.: Address: Telephone: Furut RW-0? reg. r~.13.Ur Page 2 of 2 IOS.R05 REV (01/(171 ~`6-,~~~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH 1NARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 146489II5 Certification Number This is to certify that the information here given i~ correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The origi(~al certificate will be forwarded to the State Vital Records Office for permanent tiling. Ae Fe,.~..c~.ta~~e.,.~~~~ 3 e~ 2oos Local Registrar Date Issued c7 ^' ~~ ~ ,)~ ~ ++i t ~ ~!, ~ ~ `p '~ , i 1 ~ ~ ~ - ._j ~ zaa ~ ~ ; ~.... ~H105-tai REV 11/2006 TYPE /PRINT IN PERMANENT BLACK INN k 1 a 0 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH ($2E IDS{FUCfIOD3 9Dd EXamDIP3 On rwvarcnl 1. Name d D«edent (First, rtadtlle, last, &oaix) 2. Sex 3. 5«lal Security NomDer V ' ^, L r" 11 V '„ q. Data of Deam (Monet. day year) Dallas J. Paxton M 180 - 16 - 6795 , 6/27/2008 5. Age I Wst Binntley) UMer 1 year UMer I tlvy 6. Data of Binh (Monet, day, year) 7. Binhphx (City aM stale or mrei country) ea, place M Deam (Ch«k only one) Macaw Days lbun Aanwn Mosplhl: Other: 84 vrs 12/4/1923 Carlisle PA , ^Inpalient ^ER/Outpatient ^DOA NursingHOme ^Rasitle«e Omar-Bp«iry: 9b. County of DeatD !k. City, Boro. Twp. of Deam fid. FadNly Name gl rot inslilulgn, give street arrd number) 9. Was Decedent of Hibpank Odgin7 ~ No Q Vas I6. Race: Amentan Intlian, Black, White etc. , pr yes, speciry caban, 15ce~~M Ctnnberland Carlisle Boro. Forest Park Health Center Mexican, Puerto Rican, etc.) White ' 71. Decedent s Usual eon (Kind of worN done tlunn moll a world lets. Dona able talked 12. Wes D«event ever In the 13. D«edanYs Education (Sp«ity Dory hgheat g2de Cdnpleted) 1d. Marilal5talus: Marlietl, Never Marred, 15, Burviving Spouse (II wile give meitlen name) , Kira of Work KkM a Business / Industry U.S. Armed Forces? Elementary / BecprMery (0.12) College (1-q ar St) Wrtlowed, Divorced (Specih^ Pl umber i fitte Naval S 1 De Yea ^Nn g Widowed - tfi. Decetlenfs Mailing gddress (Street, city /lawn, slate, zip code) Decedent's Did Decetlem PA South Middleton 8 Kenwood Ave. Aaaal Reaidame na. stale five Ina 17c.r1+ vas, Decedent ueee in Twp. Township? Carlisle, PA 17013 nD. cpunty Cwnberland rid. ~ No, D«eaenl wed wimm Adual Limits of Clry / lbm 18. Famer's Name (First, middle, teal, suaul 19. Mother's Name IFirst middle, maiden surname) Dallas T. Paxton Ruth T. Blosser 20a. Inbrmam's Neme (Type /Print) 20b. Infomlenl's Mailitg Atldress Isreat dry /town, stare, zip cotle) Arlene M. Fraker 1861 Walnut Bottcm Rd., Newville, PA 17241 21 e. Melhotl of Dispwiaon I ~ Cremaa« ~ Donetbn 27b. Date of DI ~ sP«dnn IM«m, tlay, year) Burial ~ R l f S • 27c. Place of Disp«aipn (Name of cemetery, cremntay a omx place) 21tl. Location (Gry / rown, state, zip coda) emova rom tale ^ aner~speury~ ! byaMadka Examn~°;co°olA»r?""'°r+`adOvaaONp 7/2/2008 ~ estminster Cemetery Carlisle, PA 22a. Bipnature a Fu ice licensee (a parson gas at) 226. Licerse ylurt~bar 22c. Name erM Atltlress of Fadlgy ~ FD 012633 L Ekain Brothers Funeral Hone, Inc., Carlisle, PA 17013 ~ Me Items 2 K Dory when cerotyirq swian rs na arailaae at time a seam to creniry causea seem 23a. To me best of my knowledge, cared al the lime, date aM plea slated. (SigneNre end tale) 0 n R 3"L 23D. License Number 23c. Dale S' nod M y, year) g ( onth, da _ D . ~/ ~ „~ c, ! /)/U J / ~o~ y~ L Tccn e. •=?7 x,1808 Items 24-26 must be completed by parson who pronna«ea doom. 24. Time of Deem 25. Dale Pro«woed Deed (Month, day, year) ~/ ~ 7 `- P T 2fi. Was Case Refaned to Metliral Examiner! Coroner for a Reason Other Than Cremation or Danalion? q M. u,~ a ~ o?OO ~ J ^ vas @y~ CAUSE OF DEATH (See inatructiona and examples) I Approximate Interval: Item 27. Pan I: Enter the ~ d events -diseases, kryunn, rn Compkcelpns - mat dreclly caused the death. DO NOT enter Terminal events such as cardiac arrest Part II: Enter other siaaai =e~°~t but ^ to d ^Ih, 28. Did Tobacco Use C«Whte to Death? , poser to Deam respiralay arrest, or ventricular libnlletion wlllrou win sl o g ale etiobgy. 1151 pnty onone Cause on e t h line. e but rat resultirg in me rxMertying cause gNen m Pen L ~ Yes ~ Probably ''/~ //// ' j diaease // mg$E lFitlhl WD ( / I MOn 1 ~ r / ,/ / ~ No (~ Unknown ) / ~ ~ r - - / Q - o es c de r l ~ / ~~,/ (~ / ~ a. ~~L'r/`~(J yL( /~"~G~q,~/ -~/WVI~(/V`~- ~ 'YS ~ ~/~lf a'( 29. II Female: . dW Due to (rn conse9trence oq~. _ -~-- ^ Na pregrtea wimin pest year Sequsmkaky list «ntltions, N any, b. leading to ttre cause IisleO pn kne a. -~"''~-v~4 '' -'"~~~~~' v ~ Emer IM UNDEgLYING CAUSE Due to (or as off. ^ PrtgnBnf at retie a tleelh ^ N l Idsaase or injury mat ialuled ma o pregnant, but pregnant witlan a2 days events rasWlrng n tleam) UST. c. Due to Tor as a consequence off: of death ~ Not pregnant, b01 pregnanl43 days l0 1 year d_ ; before tleam ^ unknown it pregnant wahin the past year 30a. Was an AWOpsy 30b, Wera aapay Fintl'rrys 31. Manner of Death 32a. Data of Injury (Monet, day, year) 32D. Describe How Injury Occurced Pedomred? Available Prior to Complelkw 32c. Place d Injury: Mama, Farm, Street, Fedory, of Cause a Dealn? ~/Natural ^ Homicitle Oaice Building, elC. /Specity) Yes No ~ Ves ~ No ^ Acotlem ^ Pending Inve5ligalion 32tl. Time of Injury 32e. Injury al Work? 321. If Trensponalion Injury (Specity) 32q. Location of Injury (Street, dry ! lawn, slate) ^ Buicitle ^ CouVd Nol be Delermiretl ^ Vas ^ No ^ Dover /Operator ~ Passenger ^Pedesinen M gher - Speciy~ 33a. CaniC (check Doty me) 33h. Sigrel re and Title of Ceniliar • Camlying physician (Physician certirying cause a tleatn when arlomar physidan has pmrounced Beam and completed Item 23) To the beat of my knowedge, deem «currod due to the cease(s) eM manner ss ahleq• _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~ • Pronounoing aM udilying phyaie{m (Ph sican bosh r rro d tl !h M _ _ - - _ - _ _ - _ -- `- - J ~~7j~~~) ...r y p o un ng en a cenilyutg to Cause a tl6ath) To the ben of k d l d m 33c. License Number 33d Date Sgn Monet da my now ge, e ee «eurred at ma Ilme, doh, and Wxe, end due to the eauaefa) and manner u shted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Medical ExeMner I Coroner Dn th l b f l U / D O . , y year) 6 ~ O G U e as 6 o axam M on Mtl or mVealigationr In my oplnbn, death occurtad ai ale ame, dale, and place, and tlue to the Ceusels) and mender as atdlad_ ^ 34 None ante AdQress of ParSO~m CUmplatB d Gauss a Death (Ite m 27) Type imi 36. -sl~ s Sgnalure~d DK 6 Dale Filed (M th d ` L ~-N4~ 1~4M•ll~.l-5 M,4fl ,}.. ~ ~ I i l ~ l I I O I i~nAa~e 11 • ~LC,t\lae,r F . on , ay, year) 0 6~ 1 { S3 3 1 - _ . 03 11 o, 1-L rtioa~ ~ ll IZO Disposition Permit Na. ~~~5 ~~~ T ~~ -~~ I, DALLAS J. PAX TON, of South Middleton Township, Cumberland County, Pennsylvania, declare this to be my last will. I - I give, devise and bequeath my entire estate, real and personal, to my wife, Gladys A. Paxton, if she shall survive me. i II - If my wife fails to survive me, I give and bequeath to my three children such articles from my home including furniture, furnishings and other i tangible personal property contained therein as they shall amicably agree among ~ themselves, said distribution to be as nearly equal among them as possible, and any articles not so selected shall be sold and the proceeds thereof added to my residuary', estate . III - If my wife fails to survive me, I give, devise and bequeath my entire residuary estate to my three children in equal shares, and if any child shall ' be deceased then to his or her surviving issue by representation. IV - Any share of my estate which shall become distributable to a beneficiary under the age of 18 years shall be held in a federally insured banking or~' savings institution in a savings account, certificate of deposit or other similar investment in the name of the minor and marked not to be withdrawn until the minor attains the age of 18 years or on order of a court of competent jurisdiction. V - I appoint my wife, Gladys A. Paxton, as Executrix of this will, and ifs for any reason she shall fail to qualify or cease to act as such during the ~! administration of my estate, I appoint as alternate Executrix my daughter, Arlene M. Fraker, and I direct that no bond shall be required of either of them for the faithful performance of their duties. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of ~~ jNovember, 1986. C ~ ~.,. ,} ~. _._ (SEAL) Signed, sealed, published and declared by Dallas J. Paxton, testator above named, as and for his last will and testament, written on one sheet of paper, in our presence, who in his presence, at his request, and in the presence of each other have hereunto subscribed our names as attesting witnesses: ~~ ' ~~~ OATH OF NON-SUBSCRIBING WITNESS(ES) GISTER OF WILLS ~~'OLTNTY, PENNSYLVANIA Estate of ,U~.t-,~- As ~ /~Q,~ro~ ,Deceased (~ ~ ~ and l 4(>~) ~~~ ~~ / l~/ C.- , (each) being duly q ified according to law, depose, nd sayO that she / he /they was /were well- acquainted with G and am/are familiar with the handwriting and signature of the decedent, and that the signature of ;' ~' ~,- `,. iS~iafureJ to the foregoing instrument purporting to be the Last Will and Testament/Codicil of is in his/her own proper handwriting. (Street Address) (Cuy. Stale, Zip) Execrcted in Register's Office Sworn to or affirmed d~bscribed before me~this ~ rta~ i ature) a ~ ~ ,.~ (Street Address) (City, State, Zip) >~ c-~ C© v _ --~ ~`~T7 ~ _ _ .. J ,~ it ~ ~ t1~ `h-: `.:_~7 - ' ~ ` i ~ i :~ Form RW-04 rev. 10.13.06