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HomeMy WebLinkAbout07-18-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~Nn b `E' /' ~CX 1'~ ~ COUNTY, PENNSYLVANIA Estate of ~ d 11~ 1'~~ ~ ~ ~1~~ ~ File Number ~ , ~ ~ ~ 1 ~O also known as v/~~'~ ,Deceased Social Security Number y 9 ~ _ ~ r7't Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COM,F'LETE 'A' or B' BELOW.) Probate and Grant of Letters Testamentary end aver that Petitioner(s) is 1 are the ~ x`~ ~ lJl. ~ Y ` `~ named in the ast Will of the Decedent dated ,9~~^ ~ ~ ' ~ ~ <~ and codicil(s) dated (State relevmrt circwnstances, e.g., renunciation, death of executor, etc.) Except ors follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ^ B. Grant of Letters of Administration (Ijapplicable, enter.• c.t.a.; d. b.n.c.t.a.: pendente life; durante absentia; durance minoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spott~ses(if any) and ~e~ rs: (!f Adtrtutistration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) C © cm -• , Name Relationshi ResidericreT ~ ~' ' _ fj~:. ~ '" l n _.." r~C- ~ _~' (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~ 't N `~T ? Decedent was domiciled at death in Countyr Penns ]vania with his /her 1 st rincipal residence at ~ (List screed address, town/city, township, cocrnt)~, state, zrp code) Decedent, then --~ ~ years of age, died on S HIV (~ at Decedent at death owned property with estimated values as follows: i //^^~~ (If domiciled in PA) All personal property $ fT (~(~ ti ~ l-o (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Persona] property in County $ Value of real estate in Pennsylvania $ ~ ~ ~ ~ situated as follows: 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: Si nature Ty ed or rioted name and residence h r f'1~3- 17z~s:~ Farr R 4V-OZ rer~. 10.13. oe Page I o f 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF SS 'The Petitioner(s) above-named swear(s) or affirnz(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, Petitioner(s) will well and truly administer the estate according to law. Sworn io or affrme/d~alnd subscribed before me the `CJ _ day of J~ ( ~OU~ J For the Register Signature oJPersoital Representative ~ o -M ~ r= Signature of Personal Representative -'~; r" ~' f7'1 rr C"` . 'V?~ Q1 ^J` Jam " -, v File Number: a t ~~ ~ ~ ~ ~ '~ -~-t N ~ ~ ,Deceased N Estate of Social Security Number: Date of Death: __~ AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters are hereby granted to and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ...1~`t44U... $ a~ Short Certificate(s) ...~ ... $ ~~ Renunciation(s) ....`...... $ Jr- t J11~ ... $ l~ ~_ JCP ... $ tD ~:~ ... $ s ... $ ... $ ... $ ... $ ... $ ... $ -po TOTAL .............. $ ~ ~~ in the above estate Register of Wills Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: Farm R6V-01 rev. !0.13.0( Page 2 of 2 5.H05 REV l01/0?I LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. 'e for this certificate. $6.00 ~' ~.4!~83533 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 Recor/ds~'Office 'tor pe~r(manent filing. Local Registrar Date Issued n ~O ~ r~ v . ~~n ~? r-- • ~~_~~~.. ~ ~ :=; ~ ~ nlos Ina HEV n,zous COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ T I --'1 - TYPE! PRIN N PERk1ANENT CERTIFICATE OF DEATH n BLACK INK See Instructions and exam les on reverse t P I STATE fILE NUMBER ~.1`I rya w c_... c - r-- 00 -.- ' : - -~ , ._. - N =. rv ~ 1. Name d Decetlem IFusl, rmdde, last sums) 2. Sex 3. Social Sewray Numbar 1. Date d De N, deY. Year) John E. Baker Male 193 - 12 - 8112 June 8, 2008 5. Age (Last &diday) lAder 1 year UMer t day 6, Dale of Birth (kbntn, tlay, ear) 7.13idhplace (City end slate a bragn coumry) 8H. Place d Deam (Crack Dory one) __ _ _ _ _. _- - ---_ _. _ Dater MOSptak ' kwmn Der: nowt kwuuec 1924 HagerStOwl1 MD ^ 12 Feb u t ^ DOA ^ N H ~ Re f a ^Otn S l ti ^ ER / O l i - , / a ome su e c ar pea y Inpa ent u pa e os ng 84 Yrs. - 86. Cuumy d Deab &. Clry, Boro, Twp. of Deab Bd. Facility Name (II not instautbn, give saeel ant nanber) 9. Was Decedent d Hispanic Origin? ®No ^ Vas 10 Race: A,ner¢al bdan. &arx Yyhite, etc. (11 yes, spedly CWan, lsveaM ~ Clunberland Mrachanicsbur 101 S. Walnut Street kawcan.PuedoWCan.eb) _ White __ Decedents Usual Occu tun Kind d want done duy most of wor life. Oo not slate ratxed 17 l6 Survwi,y Spouse {n wile, qw maiden mm~af 12. Was Decedent aver b aw 13. Decetlent's Eduwlign (Specify only hghest grade cmlpbletl) 1e. Medal 9atus: Marrwd Ne er Alarrwd . Kxttl d Wodc KiM of Busmess / Irduslry ~ U S. Arrt,ed Forces? Elementary /Secondary (012) Coaege (1-4 or 5.) W ~~' ~~ (SpeaM • ®Yea ^rb 4 Widowed _. _. _ -.. __ -_ -. _. ~ _ -. _-_- _ - . 16. DeCedela's Ma Address (9rae1, / brm, slate, z mde) ~~ ary p DecetlenYS M T ,.il[lsylvania a e~eaent ,7q ^ Vea Twp Deoadam )wed b b l id t7 S 101 S e Walnut Street . , ta Actua ence a. Res Crpplt Towndup7 17tl 10, No, Decedent liven wiatin Mechanicsburg Glimberland I7b count Mechanicsbur PA 17055 ,1C11a1t;,~d y c B«o m -- _ - __ _- __ _ _. 18. Famd's Name (Fist midne, last saris) 19. Mober's dame (First. midge. maiden sumarre) Delta Mae Koons -- _ _ - -.- _- - - _ 20a. Inbrmml's Name (Type I Pant) 20b. bbrmant's Mailry Atkkess (S6ea1, ah /tam, stale xq code) 101 S. Walnut Streets Mechanicsb~L PA 17055 _ 21a. Mathotl of Disposition ®Crematwn ^ Donator 21 b. Date d Disposition (MonaL daY~ Y~1 21c. Pace of Dispositon (Name d cdndery, crenwtory a newt place) 21d. Location ICgi / own, stale, zp code) ~ ^ Baal ^ Removal from Stale Was Cremation a DorwWn Auatorized 2008 14 er Cretllatoxy Hollin PA Holly Springs Mt ^ gMr.Spacy; DykkdfufExaniMr/COronerT ~vea^NO June , g _ - , . _ -- °-- - a 22a. Syndure d Funeral Servic licensee (« parson actuy as such) 22b. License Number 22c. dame and Adkess d Fadkry 8 Market Plaza Way . j ~ z~• Mal zzi Funeral Home MechanicsburgL PA 17055 _ -- Co,ngek Items 23ac ody n ceralyuq physidan is,al avaaade al Erne d deem b 23a. Tq me Mst of my krbwledge, deem red al tlw time, dale staled. (Synalae arM duel '-~ (~.---. ` ~ 2 . tic/arse NgMer 23c. Dale Synod (Hoorn ,ty~ear}L( r ~ . i ~ K ~/v{! (~~~LICJ cenih cause d deem. . . . _ _ - -_, -- • 25. Dale Pranwced Dead (Mmm, deY• M ad 20 Torte of Deab 26. Was Casa Rol trod b kledcel Examiner /Cagier br a Reason Omer awn Crernaeon a Donatan? Items 20$6 must De cmipletetl by person ~~1 . Q ~ ~~~ lJ 8 ~08 t ~ ^Yes No who praxxmce5 tleam. Y M. U ~~ - - - _ _ --- CAUSE OF DEATH (SN Instruetlona end sxamplea) r Approzmab warva4. Pad N~. FNd dMr ' 29. Dd tobacco Use ControW b Deam7 Item 27. Part I. Enter dw them d events -diseases, iryurles, a CompNCalbns -that tiredly causetl me deem. W NOT enter terminal events such az wrtliac arrest. Onset b beam but rot resWWy b me untledyxy cause 9^'a^ b Pad I. [] Vas ^ Probably respirat«y erect. g venax:dar kDnkaaon wiboul showuy are efrobgy. list gay one cause on each xne. ~ No ^ Unknown 1 DWTE CAUSE Foal dsease g v r EE II NcorNititim resupmg n Oeaml 1 \ ~ 1p]~ rh ~t1/~y~ ~ L~ ' ` " ~ d ~ 29. If FMwle. ^ Na n imm t ear t a -,~ a. Duet r as a consequence o[Q~: _ ~ /V 1r• //~/ ~ ~•~~~ Nsl condtans n arty Uaa Se ue a \~ N h . ~ p y preg an w s ^ Program at txra d deem . y p . D. ] ~ ^~T ~ b the cause Nsted m ire a -- Ie ^ Na pregnant, Dw pragrwrn wivxn s[ ants . Eller ma UNOERLYItN. CAUSE Due to (a as a consequence oQ: r r (dice e o ryury Nat inmaled the c d deem event resupay m donut LAST. ' ^ Iyd pregnant, bW qeg ant J3 days to t year Due b (or as a consequence oil: ~ r belae deem ^ IM~Mrown a ge~am watun aw paast dear tl. 30a. Was an Autopsy 30D. Were Autopsy Flndirys 31 Manner d Deam 32a. Data d Injury (Mono, day, year) 320 Describe How Injury Occurretl 32c. Place d Injury-. home F m Street. Factory, Orrice 0udding. dc. ISpouh) Pedorrtrtd7 Avaaahle Pnw to Canpletwn th? d D C ~-,{ lYJ Nalu,al ^ Fbmsltle _ _ __ ause ea d [] Accbem ^ Penning Inveslyalwn 32d. Tine of Injury 32e. Injury al W«k? 321. If Transpalatuw Injury (Specify) 32g. Lcealxn d kyury (Sued, aty I town, stale) ^ Yes m No ^Yes [] No [-] Driver I Operate ^ Passenger ^Pedestnan ^Yes ^ No ^ Suicitle ^ Goultl N« be Determined M Omer - Spauly: _ _ -- 33a CeniM± (Check Mly one) 33b Sign ant 7~ d Cemirer • Carelying physkfan (Physician caNlyNg cause d tleelb wren ar~elher physiaan Ms Vrara,ncad tleath and completed Item 23) _ _ soled d , _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ manner as To IM Msl of my knowledge, loam accurrad tlue to IM cause(s) an 33c Lke, N e 33d. Date SkywO (MOnm ~ year) • Pronouncing and cenilying physKlan (Physkwn Dub pronounang dodo and cemlying to cause of death) d ~ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ io tM beat of my bwwledge, death occgred d tM time, dale, arrd place, arM due to 1M carrsdal arM manor as stale 0 • W~dinl EZamiMrl Cgoner On IM Mais of exAminaMn and / or Investigation, b my opinion, tlealh occurred at the lime, dale. and place, and due to mw Cause(s) arM manner as ataletl_ ^ - - 3q Na ant Addres P Y Can ad Cause W Deam INem 2?j l~iit P~{'y/ ~ (' a °re 333_ ~l`Irl~lY~f ~'~/P~t nn 1 r~ l. ~ a te Filed MOnIn d ea r) D ~ ~ Y , 1 , f 7, ' 75 Re ab s wwre Di ~ ~ ~ l 'c 1 Y, Y , a I ~~ ~ / ~ ~ ~/ - y ! j i 7r ~tx ~ ~ ' ~ I ~ I f( 9 ; ~ ~ .~d ~Yr" ~ D~aposnion Permit No. 0 2 21 3 9 6 LAST WILL AND TFSTAME~tT I, JUHN E. BAKER, of 101 South Walnut Street, Mechanicsburg, Fennsyl- !".yt''' r' vania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this to be my last Will and Testament, hereby re- yoking any and all Wills heretofore made by me at any time: First: I give, devise and bequeath all of my property real, personal and/or mixed of whatsoever kind and wheresoever situate to my wife, Frances Jane Baker, forever and absolutely. Second: In th a event my wife predeceases me I then give, devise and bequeath all of my property real, personal and/or mixed of whatsoever kind and wheresoever situate to my son, Matthew Eric Baker, h3:s heirs and assigns. My son, Matthew Eric Baker, being a minor I do hereby appoint Cumberland County National Bank and Trust Company to be the Guardian of his estate until he shall reach hismajority. Third: I appoint Frances Jane Baker to be the Executrix of this my last Will and Testament and if she be deceased or incompetent to serve, I then appoint Cumberland County National Bank and Trust Company to be Executor. Fourth: This Will consists of one (1) page. IN WITNESS WHE4~EUF, I have hereunto set my hand and seal this 11th day of May, 1956. Signed, sealed, published and declared by the testator above- named, as and for his Lust dill and Testament, in the presence of us, who have hereunto, at his request, set our hands in his presence, an the presence of each~oj they , .~.i~~.s .~ _._...~.,~ n ~© r -, ~ c ~~~ `` m ~~~ c.%i ~ cxt , ~~ ~- , ~~~? ~ <~ c ~ .:L; -p N N ~ ~ a ~ a ~~o ~~ ~ _ RENUNCIATION ~~~ - `4 ~~ rn ~~~~~ t REGISTER OF WILLS ~~ ~' CUMBERLAND COUNTY, PENNSYLVANIA g ~ ItV Estate of JOHN E BAKER Deceased I, LINDA J. LUNDBERG, VICE PRESIDENT, PNC BANK, N.A. , in my capacity/relationship as (Print Name) VICE PRESIDENT OF PNC BANK, EXECUTOR of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to DEBORAH JO BAKER JUNE 26, 2008 (Darer 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 n ..~ O~a ~ (signature) ~ ti C E 52 ~L-~ ~ D 4242 CARLISLE PIKE, PO BOX 308 (Street Address) CAMP HILL, PA 17001-0308 (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 execut a ren~unciatiorl for the purposes sued v~it~i on this ~ *Y`- day o P bli ~ My Com>! iss Tres: (Signature and Se of Notary of other o~ciat ~ ifie to administer oat~itth~}QRil~aEt2iri 8~ Notarial Seal Denise C. 8ullenberger, ry Public Hampden Twp., Cu nand County My Commission Expires Dec. 1, 2008 Member, Pennsylvania Rsscciation cf Notaries