HomeMy WebLinkAbout07-30-08PETITION FOR PR~jOBATE AND/ GRANT OF LETTERS
REGISTER OF WILLS OF (.: tun ~~ r ~a rJq COUNTY, PENNSYLVANIA
Estate of fl'i~ ,Tr /,o _ f/ t~o~5~ Y~ File Number ~ ~ ~t3 ' ~ ~C~ ~ _
also known as
Deceased Social Security Number ~~ ~- ~~ ~ /
Petitioner(s), who islare 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
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A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the 5~p~i ra L . /yI t.er~e~/S named in the
last Will of the Decedent dated /~- /'7-~/ and codicil(s) dated
(State relevant circumstances, e.g., renzutciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom 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
(Ifnpplicable, enter: c.t.a.; d. b. n. c.t.a.; pendentelite; durnnteabsentia; dura~~oritate)
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spoj~~tny) a4t3heirs (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.) '-° ~~ ~
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(COMPLETE LN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in (; ~ m ~~ r~ i n County, Pennsylvania with his /her last principal residence at
(Lis[ sn ee[ address, sown/city, township, county, state, zip code) ~ ~ L ` /J ~ r r
Decedent, then ~_ years of age, died on at ~D/~~S„Oi/-,~r7et[ r LCt/n,d /Yi ~~
Decedent at death owned property with estimated values as follows
(If domiciled in PA) All personal property $ ~7~ , [7~p
(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:
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Form R6V-0? re~~. /0.!3.06 Pabe I Of 2
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Pztition a nt of Letters in the appropriate foam to
the undersigned:
Oath of Personal Representative
COMViONWEALTH OF PENNSYLVANIA
~ /_ S S
COUNTY OF (i i !Y1 X~~E'-Y'~ »~
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petitiou are true and con~ect to the best of
the know]edge 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 affirmed and subscribed
before me the , ~ day of
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For the Register
Signature of Personal Representative
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Signahve of Personal Representative -_.., ~ m
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File Number: ~, ~'~
Estate of__TV l^~~ >~ ( (~l~`~UJ~ , Dec~~ Q
Social Security Number: I ~~ " f (1 ~ ~ ~Z Date of Death:
AND NOW, _^) U ~ ~ ~~t_i (~ U /~~~ ~ Q~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters ~~° Cr~-P/r~rl ~~ ~ -
. - _ t - -
are hereby granted to
and that the instrument(s) dated
described in the Petition be admitted to probate and fi
FEES
Letters ............... $
Short Certificate(s) ........ $ ~ • ~ ~
Renunciation(s) .......... $
I.J I~ ... $,~ C?O
... $
... $ ~
... $
... $
... $
... $
... $
TOTAL .............. $ ~ • ZOO
l'1~c,-Y} ~~l1V~rPcl'
ojPersonnt Representative
in the above estate
of record as the last Will (and C.odicil(s)) of Decedent
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Register of Wills /-r°~U ~
Attorney Signature: _~-. ~ ~~
Attorney Name:
S,ipreme Court LD. No.:
Address:
Telephone:
r-~,n, aW-o~ rev. 10.13.~r Page 2 of 2
IUi-805 REV' 101/0'i
2 ~ -v~', t7 79~
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P •~ 4542~.~~
Certification Number
This is to certify that the information here given is
correctly copied from an original CertificaCe of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
d`` JUL 3 200
Local Registrar ~ Date Issued
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tv tvzoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~
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NENT CERTIFICATE OF DEATH ,
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INK (See instructions and examples on reverse) srATE FILE NUMBER .~"
t Name of Decedent (Flrsl, mitldle. lael. suHixf 2 Sex 3. Social Security Number 4- Data of Death (Month, tlay. yea0
Myrle H. Colson Female 189 - I8 =6827 July 28, 2008
5. Age (Last Birthday) Under 1 yea+ Under 1 day 6- Dale of Binh (Month, tlay, ear) 7. Blrthplece (CiIY and slate or forei country) Ba. Place of Death ICheck only one)
saurn Days i+^urs Minuses Hospilat'. Other
84 ys October 25, 1923 Harrisburg, PA ~mpadem ^ER/ompauenl ^DOa ^NUraing Rana ^Residence ^omer-speciry
6h. County of Death 6c. Gity, Boro, Twp. of Death Bd. FaciNiy Name (If not insihuiien, give street antl number) 9. Was Decedent pl Hispanic Origin? ®No ^Yes 10. Race. American Indian. Black. While, etc.
(If yes, spaclty Cuban, (Specllyy
Cumberland East Pennsboro Twp. Holy Spirit Hospital MexmanPOanpRican,em) White
t t. peceeenl's Usual Occu tpn (Ktntl of work d one dun most of Me. Do not stale retired 12. Was Decedent ever in the 13. Decedent's Education (Speciy only highest grade completed) 14. Madtal Status. Married, Never Married, i6. Surviving Spouse (II wile, give maitlen name)
Divorced (S
ecif
)
Wldowatl
Kind of WorN Kind of Business I Industry U.S. Armed Forces? Elementary /Secondary (0-12) College (1-4 or 5+) y
.
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Clerical PA Ilept . of Revenue ^ Yea ®N- I I Widaaed
t e. Decedeors Mai<ng Atltlress f8treet. mry i town, slate, fip code) Decedent's PA DId Decedent
Live in a i7c
~ St P nC}YOrn Twp.
Decedent Lived in
®Yes
Sl
t
10) Poplar St . ,
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Actual Residence i7a.
e
Ct3mberland Tpwn5nipl 17tl. ^ No, Decedent wed within
"~ °ounty
SLaaDerdale, PA 17093 Acteal Limns of city,Bprp
Le Father's Name (First, middle, fast, suXix) 19. Mother's Name (First, middle, maitlan sumeme)
Esther S. Harting
Herbert Br per
2Da. Inlomiant's Name (Type / Pdnl) 206, Inlortnant's Meiling Address (S1rreL city 1 lawn. state, zip code)
Sandra L. Mutdis l l I McIintyre Street Blossberg, PA 16912
21a. Method of Disposlion Cremation ^ Donatron 21b. Dale of Dispostlion (Month, day, year) 21c. Place of Dlsposflion (Name of cemetery, crematory or other place) 21d. Location (City /town, slate, zip code)
^ Bunal ^ RemovalfromState '' WasCremaUOnorponatlonAUthodzed ( l/ a
~
J Hollinger Crematory Mt. Holly Springs PA 17065
^ Olner - Specity: { by McMOaI Examiner ! Cororrerl Yes ^ No O
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22a. Sgnature of Fune21 Service L nsee (ar person acting as such) 220. Ucense Number
FD 012774-L 22c. Narne and Address of Facrkry
Richardson Funeral Have Inc. 29 South Enola Drive, Enola PA 17025
~ _~
Complete Items 23at any when certih/ing 23a. 7o ih el my kno ledge, death acurred at the Ytme, dale and place stated. (Signalura antl line) 23h. License Nun>ber 23c. Dale Signed fMOnih, day, year)
physican is noI available at lime of tleath to ~
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cenAy cause of tleaM. I ~
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Items 244fi must De completed by person 2d. Time oFDealh 25. Date Pronounc Dead (Month, tlay, year) 26~W s Case Referred to Medical Examiner /Coroner for a Reason Other than Cremation a Donation+
th
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~ ~~ Yes ~No
who prmartces
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CAUSE OF DEATH (See instructions antl exam les) r Approximate Imerval: Pan II: Enter other sanT ant condil'ons co Crib tin to deaN, 28. Did 7o0aao Use ConlnbNa to Dealnp
Item 27. Pan P. Enter Ne ~ of events -diseases, mjunes, or complications - That direcity caused Ne death. DO NO7 enter lerminat events such as caMiac arrest, i Onset to Deam but not resulting in the underlying cause given In Pan L ^Yes ^ Probably
respiratory artest, or venincular tibnllation wiNOUt stwwing the eliobgy. List Doty one cause on earn line. r ^ No ^ Unknown
IMMEdATE CAUSE ((Final dLSease or 1 r
cnnditron resuatng in dealhl _~ a
~~ Jh/J l - `t s' M I S (~
Lg~ ~~ ~-ti~ 7 "~
~ 29. If Female:
ithi
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Due to (or as a co~~equ~yenc / 1
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~ f j j , year
pregnan
w
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^ Pregnant at 6me o1 death
y
Segaenlially list CorMiaons, it airy, b
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leadsrg to thhe cause listed on line a. ^ Nol pregnant. but pregnant wi(Nn 42 days
Due to (or as a copse t l ~ gq:
Enter the UNDERLYING CAUSE C 1L-
(disease or injury Thal indicted the c
of death
.
events resulting in death) LAST
^ N-I pregnant, but pregnant 43 days 101 year
Due io (or as a consequence op:
belore tleath
d. ^ Unknown it pregnant wilnin the pawl year
Was an Autopsy
30a 30h. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, day, year) 320. Describe How Injury Occurretl 32c. Place of Injury Home, Farm, Slreel, Factory,
.
Pedormed? Available Pnor Io Completion
of Cause of Death?
^ Natural ^ Homicide OAice Building, etc. /Specrty)
~ ^ Accident ^ Pentl'mg Invesigalbn 32d. Time of Injury 32e. Injury at Work2 321. II Tranaponation Injury (Spee7lyJ 32g. Location of injury (S1ree1, elty I sown, state)
^ Yes ^Yes ^ No ^ Suicide ^ Could Nol be Determined ^Yes ^ No ^ Driver I Ope2lor ^ Passenger estnan
M ^Olhar - Specify
33a. CeniM1er (check only one) 33b. Signature acid Ttlle Cerli- // /~
• Certitying physician (Pnyscian cenitying cause of death when another physician has -ronounced death antl completed Item 23)
death occurretl due Ie the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
7o the beat of my knowledge , r 1 f ~_„_____
111
,
• Prorrouncing and certifying physician (Physician both proneuricing death and cenitying to cause of death)
^
d 33c. License Numb6r
^°~ 33tl. Date Slgne (Month. day. year)
L j~
_ _ _ _ _ -
_ _ _ _ _ _ _ _ „ _ _ _
To sire best of my knowledge, death occurretl al the time, sate, and place, antl tlue to the cause(s) antl manner as state
C ~ / ~
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oroner
• Medical Examiner 1
On the basis of axaminatlon and I or investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) end manner as staled ^ of
at
4 (Item 271 Ty i P~in
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34 Name and Adtlless of Person VNho Completed C
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35 Regis r Ignature antl Nye lad (M min, day. year)
36 pal y
V Disposition Permit No. C,/CTO'<7S (7 ~ l~
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LAST WILL AND TESTAMENT _'_,
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MYRLE H. COLSON ~> _
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I, MYRLE H. COLSON of Summerdale, East Pennsboro Township,
Cumberland County, Pennsylvania, being of sound and disposing
mind, memory and understanding, do hereby make, publish and
declare this to be my, Last Will and Testament, hereby revoking
any and all Wills and Codicils previously made by me at any time
heretofore.
+ FIRST: I hereby direct that my personal representative(;
I(
thereinafter named, to pay all my just debts, funeral and testa-
imentary expenses, including inheritance taxes, as soon after my
jdemise as may be practicable.
SECOND: All the rest, residue and remainder of my
Gestate that I own in my own name, I hereby give, devise and
bequeath, equally and per capita, to my two (2) children:
A. FIFTY (50%) PER CENT to my son, MARSHALL K.
COLSOTd, JR. and
B. FIFTY (50~) PER CENT to my daughter, SANDRA L.
i
lMUNDIS.
{ THIRD: I hereby nominate, constitute and appoint my
i
;children, SANDRA L. MUNDIS and MARSHALL K. COLSON, JR,
i
~as Co-Executors of this my, Last Will and Testament.
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FOURTH: The abovenamed persons shall not be required to
post bond or surety in this or any other jurisdiction for faith-
ful compliance of the office of Co-Executors.
IN WITNESS WHEREOF, I hereunto se'~ my hand and seal to this
and one (1) other typewritten page, identified by my signature,
to this my, Last Will and Testament, dated on this the
"~ day of `lit-'" , 19
j' '~`,, ~ ~;~.( ~ !~~ ~,,i,.f;I<,' ( SEAL
MYRLE H. COLSON
The preceding instrument, consisting of "this and one (1) other
typewritten page, identified by the signature of the Testatrix,
MYRLE H. COLSON, as and for her Last Will, who at her request,
in her presence and in the presence of each other, have subscribed
Iour names as WITNESSES hereto.
c
RESIDING AT srj~~ / ~X,,
RESIDING AT
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COMMONWEALTH OF PENNSYLVANIA )
ss..
iCOUNTY OF CUMBERLAND )
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W E , ~'L L' ' ~--t j ~'r-' ~ _.~-'rte _~ ' tX ~ l C
nd ~~~,%;~ ~ ~ r:.~.~`~ The Testatrix and the Witnesses , re-
'apectively, whose names are signed to the attached and foregoing
instrument, being first duly sworn, do hereby declare to the under-
signed authority that the Testatrix, MYRLE H. COLSON, signed and
executed the instrument as her Last Will; and that MYRLE H.
COLSON signed it willingly, and that she executed as her free and
voluntary act for the purposes therein expressed; that each of the
WITNESSES, in the presence and hearing of the Testatrix, MYRLE H.
COLSON, signed the Will as Witnesses, anal that to the best of
their knowledge and sight, the Testatrix, MYRLE H. COLSON, was
at the time eighteen (18) or more years of age, of sound mind,
and under no constraint or undue influence.
~~ ~ :"/ ~
,Witness
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1 '%%/~'r ~-~.. ~J (_~` `'a'il ( SEAL )
MY E H. COLSON (Testatrix)
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Witness
Subscribed, sworn to and acknowledged before me by, MYRLE H.
COLSON, the Testatrix, and subscribed to and sworn,to„-,before me
_ ~
b y t h e W I T N E S S E S :. ~~ LrJ ,- _~~. ~' /~ r-~- a n d ~f~`' ~ -~ ~ ~.Lc,,<_,a~~ ,
on this the day of ~y`~-`'~ , 19 ~,'/
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otary Public
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