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HomeMy WebLinkAbout07-30-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~~,~ vti`~~" ~ ~~~~ ~ COUNTY, PENNSYLVANIA Estate of ~l1 ~ ~'~ ~ ~ 1 V~ ~- ~ ~ - S ~'Q r File Number ~ t Q ~ ~~~ y also known as Petitions:r(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 gyrfted in the last Wi[I. of the Decedent dated and codicil(s) dated ~? ,``.~ ~-_a .,, r~ -.7 (Stnte relevnnt circums(ances, e.g., renunciation, death of executor, etc.) ~' -= ^' r t..~~ r'!_l Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of tfie in"sty~nent(s~ffered '~•' for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ? `~, Tk» ~~ ~. _, TT --, ~ _ ~B. Crant of Letters of Administration ~ ~. ~, (ljnpplicnble, enter: c.t.n.; d.b.n.c.t.n.: pendente lice; durante absentia; durance minoritateJ tD Petitioner(s) after a proper search has /have ascertained that Decedent ]eft no Will and was survived by the following spouse (if any) and heirs: (If Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) 7J ; S ~ ~~SS Decedent was domiciled at death in L~ (List stra~el address, town/city, lownskip, coungr, state, zip Decedent, then years of age, died on ~~ - ~-~:loo~' at ~~ r t ~S ~~ Q2~j iDti`~i I ~S ~t ~~ ~ CGty" ~ ~ SIQ ~~- 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 Value of real estate in Pennsylvania situated as follows: $ ~C~~ . ~~ Wherefixe, 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: -t' 33 ~,.~. S; „~-.psi... ~~-, rne~~~ ~„ ~sb~~ . nom, -? ~ ~ S cti County, Pennsylvania with his /her last principal residence at L. rU ~~ 1~~5~ or printed name and residence Forst R6V-OZ rev. 10.13.06 PagE I Of 2. (COMPLETE IN ALL CASES:) Attach additlona! s/ieets if necessary. Oath of Personal Representative COMiviONWEALTH OF PENNSYLVANIA COUNTY OF ~ ~~~~ (<^'~` SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are title 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. Sworn tc er affrme nd subscribed before me the day of ` a~ i` or the Register Signattre of Persona! Representative r+a Signature ofPersonnl Representative - I r~ mot" Signature of Personn! Representative ,, -; -'-~ - .~ :.~ File Num`berU: _ ~ ~ b g O ~ °l C~ Estate of ~c~.~V ~-C' ~r~ ~ _ ~~ S~''1~.'r ,Deceased t_._ - r-- .1 ~.'^~ c-:.~ °a° - je~ "I O Social Security Number: ~~ ~ ~`l S Lo S°I~~ Date of Death: Ji-~--1 H `a ~~R .AND NOW, , o~~ , in consideration\oftpe oregoing Petition, satisfactory proof having been presented before me, I IS DECREED that Letters ~`(Y1 \'(1 ~S"~-f' ct , ~~ are hereby granted to '-T~n ~ ~m..5 ~_ ~ ~C~.C'~.~j 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 (and FEES Letters ....~ .~©~~~--... $ y5 Short Certificate(s) . ~ .... $ 8 Renunciation(s) ..o~ ...... $ ~ ~~ ... $ 5 ... $ ... $ ... $ ... $ ... $ ... $ ... $ 00 TOTAL .............. $ yI~ Attorney Signature: Attot7iey Name: Supreme Court I.D. No. Address: Telephone: of Decedent. Register of Wills F~,,n Rw-na rev. l0.13.or Page 2 of 2 105.805 REV (01/07) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 ~' 14649173 Certification Number ,,Y./~~~~"""~~---._ This is to certify that the information here given is t4tttt,~,~p~ZH OF pfy~ : correctly copied from an original Certificate of Death - `pr=, duly filed with me as Local Registrar. The original g _ - ~ `_ z certificate will be forwarded to the State Vital ~ _, ~ yam- a~ Records Office for permanent filing. * ~ ~ *: O -- ~: =_`S° _ 4 _ p~r "99TMENT oF~~' JtJ 1 4 2008 """""""j°Ylltrrkf Local Registrar Date Issued ~; c-= ~ ;~., =~ ~ ~`' c-7 ~ ,. :~ ~ r ,.~,.~ _ ~ _ >=;-~ ~, -> ' ~ i _ ~{ ~ ~ :. T t~ 0 H105-143 REV 11/2006 TYPE / PRINT IN PERMANENT BLACK INN I `~ I~ `~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) .,_.__ _.. ~1 nR ~~~~ 1. Name of Decedent (Bret, midde, last, sdfix) 2. Sex 3. Social Security Number 4. Date of Deam (honor, tley, year) Ca_th_ erine__B,. r^^i.sher Female 477 - 56- 5944 Jul 12 2008 5. Age (Las': Birthday) Under 1 year Under 1 day 6. Dale of Binh (Month, day, year) 7. Birthplace (City and smte or foreign coumry) 8a. Place of Death (Ctxsck Doty ono) IAwwa Days Hours MMUws Hospital: Omer: 7 6 Yra. Nov . 2 , 1 9 31 New Roche 11 e , NY ~J mpa6ent ^ ER /Outpatient ^ DOA ^ Nursing Home ^ Residence ^other. Spedry: 60. County of Deam &. City, Boro, ~ of Death tld. Facility Name (If not insmlWOn, give street and number) 9. Was Decedent of Hispanic Odgin? ~ No ^Yes 10. Race: American Intlian, BMCk, White arc. Cumberland So, Middleton , pt yes. specify Cuban, (SPep;M Carlisle Regional Med. Center Maxlcan,PUertoRican etc.) , White 11. DecetlenYs Usual KiM of work done most d fife. Do rpf scare refired 12. Was Decedent ever m the 13. Decedent's Education ISpedN Dory highest grade wmpleted) 14. Mahal Satw: Marred, Never Monied, 15. Surviving Spouse (If wife, gh'e maiden name) KiM d Work Kintl d Business I Inmistry U.S. Armed Forces? Elementary /Secondary (0.12) Cdlege (1-4 or St) Widowed, Dwomed (Specify) Admin. Secretor Architect ^Yes ENO 1 Widowed tfi. Dewdsnrs Mamng Atltlrese (9beeY, coy / trwm, stare, zip gel Decetled~e Did Deceaem P a 229 Senior Drive Adual ResidcMe 77a. Slate _ Uve in a 17c. ^ vas, Decedent lined in T T h ? ~' Shi b owns ip n6. spumy Cumberland nd. ~ No, Decedem lived wdMn Shi ensb - ens ur P 1 pp AdaalLenASpf _ urq Cory/Bpro 16. Famer s Name (First, mi0dle. last, sMix) t9. Mottrers Name (FIrsL mitlde, maiden sumeme) Frank Bennett 20a. Infomtant's Name (Type / Prinq 20b. InformanYS Mailitg Atldress (Street, cHy /town, state, zip code) Thomas P Andrews • , n 21 a. Memtxl d Dispwitron [~Cremetbn ^ Dortedce 216. Date of Dspbsitkn (honor, day, year) 21 c. %ece of DisposAion (Name d cemetery, crematory or doer place) 21tl. Location (City /loom, stale, zip code) ^ Burial ^ Removal from State ~ Was Cremetlon or Donstlon Ant ^ahet-spedry: t6yredkalE.amin.r/caml,ar?~e~^Yaa^Np July 15 2008 Hollinger FH/Crematory Inc. Mt.HOlly Spgs.Pa.17065 22a. n )u d Funeral Service ' ( rsan uch) 220. Licerwe Number 22c. Name aM Address d Fedlity 501 N. Baltimore Ave - FTC-011932-L . Hollin er FH/Cremator Inc, g Y Mt Holl S rin s Pa. 17065 Items 23ac mty when parlilying 23a. Ta ate best d nowbtl9e, tleam occurred al me time, dare and place stated. (Sigmaxe and title) 236. License Number 23c Dale S' tted (honor tle ear) physAmn is not aradabk at lime a dwm ro . 5 , y, y worry wwe d deem. Items 2428 must 6e catproted M person 24. Time a Deam 25. Date Prenatncetl Dead (Mmm, tley yam ) 26. Wes Case Referred b Metlical Exemirrer / Coidter for a Reason Omer then Crematron or Donatbn? v4ro pmwutwes death. ~ 1 t 1Q ~ M. y ^ V (Il.l ~~. c~0 ~ ^Yes ~o~ CAUSE OP DEATH (See fnetruostons antl examples) t approximate Interval: Item 27. Pad I: Eder ate chain d evens- dweases, injures, a -mat Directly caused th death. DO NOT emer terminal events such as wmiac artasl, Onset k Death t t m Pan IL Enter Omer ' but nd resJling h me untlarryirtg wuw given n Pert I. 20. Did Tobacco Use Cmrdhute ro Deam? Y e s Preba ^ rssprre ay anen , a ve dwlar (mriNaem wiltwd stxrwkg the atbbgy. List mry cee wtae on eam Are. r ~ ! , ^o ^ Utrkrgwn IMMEDIATE CAUSE Final disBeee or 1 rh 1.. ` LS ~ • O ` ` ~ '" ~ wn0itien resdeng m ~am) --- a lJ 1(\ ` C ~1 e Ors t- t \ \ ~ r 3 W-c.rpy~ 29. If Femek: ~ Due to (or u a cronsequanw oQ: lol pregnant wnhm pall year Q Se9Al' ~ con6A0ns, d an% b. ~ 10 Uw canoe Aatetl m Ana e. ^ Pregnant et time of deem Enter UNDERLYING CAUSE Due m (or as a ronsepuence oq: ~ Nd nt but pregnam within 42 days ^ (OWeae rx sywy mat kdtkte0 me C. events resul9ng m Beam) LAST. d 4a~ Due to (or as a porseequence oD: ^ Nd preytam, Wf pregnant 43 days k 7 year d before dWm ^ llnknown q pregnant ralhm me pest Year 30a. Woe an Autopsy Perlormetl? 30b. Ware Auhgsy Findings AraAaNe Prior m Completion 31. M d Deem 32a. Date of Inlury (Mmm, tlaY, Year) 926. Describe Mow Injury Occurretl 32c. Place d Injury: Home, Fattn, SIreeL Factory, d Cause d D eam ? NeNrel ^ Fkmidde OR~ce &ldditg, ek. (Specity) ^Yes ~ ~ / ^Yes LK~ ^ Axidarrt ^ Pertdxp avesngNron 32d. Tana al Injury 32e. Injury at W o rk? 321. If Trenspodation Irryury (SpecrM 320. Location d Inlury (Sheer, dry /lam, slate) ^ Suictla ^ CauW Nd be Determined , , ~ ^Yes U no ^ Dmar I Operator ^ Peewrtgar ^Petlestrimt M aher ~ swdh: 33a. Cendiar (sheds only one) ' Certltying Dhysicun (Fhysid~ carttyag cause d deem when andher pAyskien has prongmcetl deem and comPleletl Item 23) 336. s naW I rtilier q CTbev~lore QE2k ,•wt p~ To the best of n0'ImwAedge, death occurtM tlue to the caueatsl erM menrleru sated__________________~______________ ^ . - • Promurtcing end wdhying physklen (Physidan boor pronounatg deem antl cerAying ro cause of deem) To the beet of my Wtowkdge,tlath orxuned at the lime,dek, end pkce, and dcerothe wuae(a)arM manner as staled 33c. License Nu m her 33d. Data Signetl (honor, day, year) __________________ • Mstlkel Examiner I Coroner .• y ~j 1• Ar,D V~4 ~p ~o ~ ~ f ~ jr Z[i C~d° On the hula a sxsmmelion and /or inveatgatkn, in my opaaw; tlmm «cwred et the time, date, antl YASce, end due to the sepse(s) and manner as stated_ ^ 34 Name Nttl Address d Person Who C+vnpbled Cause of Death (Ite m 27) Type /Print 3s. Del Sknature - ~ ~ I ~ I a I ~ I ~ I re Filed ( m, tley, earl d ~ ~ ThCoAturc @£2k, wL0 .~y,~ 1 ~ 1 ie XAU+ d Er ~ pr,,.r,,~ ~l ~ C4r 1 i S k p/~ I ~1 J ~.3 Disposition Permit Na. ~ a ~`a~{ Reset Form ~, 1 0~ b-1~1 ~ ~ ~ ~_ o <_ ~ ~- RENUNCIATION ~ ::~Y-, ~; :_ ~. .. _~ ,_.. -. - , ., i4 REGISTER OF WILLS -- ~ ~ ' ' ~.. ~. Cumberland COUNTY, PENNSYLVANIA ~~ J~` w .. Estate of Catherine Bennett Fisher ,Deceased I, Jane Elizabeth Stiffler , in my capacitylrelationship as (Print Name) dau hter of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Thomas Philip Andrews o?~-~ (Date) Executed in Register's Office Sworn. to or affirmed and subscribed before me this of day Deputy for Register of Wills Fnrm RW_OFi rav 1/I 11 /X C" t (Street Address) ~ ~~ /~ ~'~- . f C~~~y~ (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 renunci do for the purposes tate within on this ___~~~ day of Notary Public My Commission Expires: ~" ~3~ ~pCa (Signature and Seal of Notary or other official qualified to coi~~~~M ~13owP~atg o~Y~pva~tio'n~of Notary's Commission.) NOTARIAL SEJ1l. BETH DERMES. PubNc City of Harrisburg, by Conwnission Expires Feb. 23, 201 RENUNCIATION ~..~ c7 ~ - -- ,~. REGISTER OF WILLS ~ ~ ~=- ;; r= - Cumberland COUNTY, PENNSYLVANIA : ~; ~,., - -= ~ _ ~_ . . _ ; , ..., - _... _ . - __, ~s~ ~} '== c.f~ a Estate of Catherine B. Fisher ,Deceased I, Robert B. Andrews , in my capacity/relationship as (Print Name) son of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Thomas P. Andrews July 25, 2008 (Date) E !itate of Calitomia, County of ~, Srbscribed an sworn to (or it ed) b tor~e3m on t is c~~day 20~$ by proved to me o th basis o satisfactorb to denc~e. io be the person who ap. h . -~ l~ ( gnature) 4306 W. Ward Ave. (Street Address) Ridgecrest, CA 93555 (City, State, Zip) 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 renunciati for the purpos s s ted within on this c~.J`~ day of , oZ,O~ `t~ Notary ublic My ommission Expires: ~ -~-.~~ ~ 1 c~- (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) t„•.. JANIS BOTTORFF ~ COMM. #1787141 .~ NOTARY PUBLIC • Cf+LiFCftNLA +n KERN COUNTY n ,~ ~~ COMM. EXPIRES JAN. 20, 2012 ~