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HomeMy WebLinkAbout08-05-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~ u m log r l Ct f7 ~ COUNTY, PENNSYLVANIA Estate of L~(~ i ~,~ 1 Ct. i'-'1 ~• '~t^- ~ C-~ r File Number n,/' ~ Os~ ' C~~~ also known as Deceased Social Security Number ~ $ ~ "`~ ~ - ~''^/.' Petitione-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 ~-;_=~ ~ the last Willl of the Decedent dated and codicil(s) dated ~~ _n = "a (State relevmat circumstances, zg., remmciation, death of executor, etc.) `- U, _... -. Except its follows, Decedent did not marry, was not divorced, and did not have a child tom or adopted after execution of thein<stiunent~ offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: _" ~ -~ ==a B. ~Crant of Letters of Administration ''' Cn (Ijappticabte, enter: c.Ga.; db.nc,t.a.: pendente Itte; dra~ante absentia; durance minoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Wi11 and was survived by the following spouse (if any) and heirs: (If Administration, c.t.a. or aLb.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ ~nt 0. i8~f1/ his /her last principal residence at '7 f ~, 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~rejal estate in Pennsylvania S situated as follows: ~ 1 ~i ~ 0 Wherefore, Petitioner(s) respectfully request(s) the probate of ffie last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: ~s ~ l~. ~Ta o(~e r ForrnRw-oa rev.lo.13.06 Page I oft (COMELETE INALL CASES:) Attach additiotral steels if necesstsy. Decedent, then ~ y~a~ of age, died on ~ U ~~ / 7. ~ L~+C Si' at ~ ~~1 ~rl~p~-t,~'..~ YY~ ~,g,1 o~ - ~o~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA ii__ -- / SS COUN'T'Y OF ~ (~f i'1') lJ~~''(~a nU The: Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition aze true 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. Signatube of Personal Representative =~ C~ `'~' -~ f w ~~ Signadve of Personal Representative ~-i CJ'S _- r ~., Signature afPersonal Represerrt~ive _ - '~~ ~7 _ _t GT7 lJ File Number: I Estate of ~ l ~ i a m ~ ~ri..~C ~ a r"~a- ,Deceased Social Security Number ~ 0 ~ ' ~a ~ 75~ Date of Death: .~i,c ~~t J 7~ .~-(~~~ c~ -°-~-- APJD NOW, , in consideration of the foregoing Petition, satisfactory proof having; been presented before me, IT IS DECREED that Letters are hereby granted to 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 Codicil(s)) of Decedent. FEES Letters ............... $ Short Certificate(s) ........ $ Renw~ciation(s) .......... $ ... $ .. $ ... $ ... $ ... $ .. $ .. $ ... $ ... $ TOTAL .............. $ 0.00 Register of Wills Attorney Signature: At#omey Name: Supreme Court I,D. No.; Address: Telephone: Form RW-Od rev. 10.13.06 Page 2 of 2 Sworn to or affirmed and subscribed 105.805 REV (01/07) LOCAL REGISTRAR'S CERTIFICATION OF DEATH ~$--~~~g WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 p ~4649~00 Certification Number This is to certify that the information here given is ~orreetly copied from an original Certificate of Death 3uly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital [records Office for permanent filing. Q- ~nu-~..c~" JUG 18~ 2008 Local Registrar - Date lssued r-~ r-~ ~ z: r-- © c:~ . ~ ~ _-_ 1 -- - ~ i_i C.J'i -~ , ~.,;.~ - ---( •• - _'~J i' ~ H105.144 REV 17k0g6 TYPE/PRINT IN PERLUNEPn BUCK INK 1131•-311 ;? COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE FILE N(JMRER 1. Name d Deadem (Rrsl, midak, Teat sumxl 2. Sex 3. Soc®I Security NuMer 4. Data d Deem (Mmm, tley, year) William T Pritchard Male 088 - 42 - 8756 July 17, 2008 5. Aga (last Birthday) ldltlar 1 Urroer 1 day 6. Dale a BiM (March, day, r) 7. BiMpgce (C aril sMg w tomiprt mlmby) Ba. Place a Deem (Dheck onl one) 45 ""'"° °°"' "°"' r`""" May 29, 1963 North Hornell, NY "°'P"a °tli~ Yrs. ^Inpetiea ^ERl Outpatient ^ImA ^NUreing Nome ^Residemg ®OdKK-SpedfY /ro. County d DeaM &. , Boro, . d Deem &f. Facility Name (lf not inamutlon, give strati erKl numbar) 9. Was Deradmt d Hispanic pigin? ~] No [~ Vas 10. Race: American Ir~dari, Black, WArce, etc. Cumberland Carlisle 709 N. Hanover Street (d s13s. speaty CUDSn. Mexican,PUeAORican,ac.) IsLeaM White 11. DeadeMS IJeuel tlm Kxg d vgrk d one du' moat d Xle. Do not stile retlr 12. Was Oecedem ever in d1e 13. Decedent's Eduatlon (Specify amy mgheet grade camp lded) 11. MerNel ~tw: Mametl, Never Merced, 75. Surviving Spo use (If wile, 9A* maidxi name) KxN d Wwk Kind d BuaNess I Intluelry U.S. Amgtl Forces? Elementary /Secondary (0-12) College (1d w 5+) WWowed, DNomed (Specify) Professor Coll a ^ves ®Na 5 Divorced • 76. Deadem's MaAYg Address (Smet dty! fawn, state, ap mde) Decedent's Did Decedent PA 712 Hanover Manor, Apt 307 Mwl Rearoence ,Ta. sgle ? "~. ^ Yea' 13ecwknl Uwd in Twp. I Carlisle PA 17013 p nb.cw,nty Cumberland nd.L~No,Dewdeauvedwmkn l Carli , s Aauel umigd e Cdy/Bao 1B Forcers Name (Post, middle, leaf, sumx) 19. Mother's Nang (First, middg, maiden sumalre) William B. Pritchard Ruth Thomas Zoe. hdament's Noma (Type / Pdm) 20b. mlorment's Nosing Atldress (Street dry /rows. state, xp code) Ruthl Pritchard 738 West Diamond Avenue, Hazleton, PA 18201 21a. Mamod al Dhpwgw Cremetlon ^ Doadm e 216. Deg das~ma~ (Mwwh, YaaN July 1Fi 200 21c. Pl,ce d Dlstnsitlon (Name d cengtery, aemalory w Omar pl e) ~ 2ttl. Lacetlan (Clry / twm, state, zq code) ^ Bmkl ^ Remavaltromsgte wncreeletwnwf3wWlonAUmwUM , Hoffman-Roth Funeral Home & Carlisle PA 17013 ^ odgr - spedry: M Medpeat Exemdgr ycarorgY+ ®rea ^ No , 22e. Sgneture a Funeral a or person adkg as auM) 226. License Number 22c. Name and Addmss d Fadfily Hof fman-Roth Funeral Home & Crematory, Inc . • - _~' 219 North Hanover Street, Carlisle, PA 17013 Carpgte dams 23at Dory when cer"lyirg To tlg bast d my knowledge, deem accwmd at me time, date arA pgce eGled. (Siygwre erg title) 23b. license Number 23c. Date Sl~gd (March, day, year) phyaiden k ml avalhbg at time d dwm ro cerlgy cewe d deem. ~ Igea 2426 must be cenNMNd by person 24. lime of Deem PrX . 25. Date Pmnwnad Dead (MOnm, day, y~ 26 Was Ceae Relerratl ro Medical Examiner /Coroner for a Reason Other men Crematron w Donation? ,` ,mo pmnamasseam. 3:00 A. M. July 17, 2008 ~vee ^No CAUSE OF DEATH (Sea Inetructlona antl examples) r Approximeg interval: Pert II: Emer Omer 2& Ditl Tobacco Use CwlibidFe b Daem7 dam 27. Par11: Fsler me tdekl d evards- egeaes, vgurgs, w cpnpxadwg-tlw 6reN/ caused me tleam. DO N0T order lermkgl evems such w cardiac artest Dlgel ro Deam bN rid reauding in me undedYklg auee given in Part L ^ Vw ^ Prohaay respiratory arrest, w varmkagr fareaaon wMga al,owlr,g me eddogy. List anty one caws an each lore. ^ ~ ^ Unkrgwm IMMEDMTE f:AUSE IFeel dlseaee w ~ mndaid, reeagrend~d) _~ a. Exsanguination . r ~~"Pa"'°'~~ Duero w as a l a): ^ Na pregrgnf wsNn pea Year tmcaxdtlmw,rcany, 6. .Laceration of Forearm ^ Pregwitatmgaaeem b ceusa eaed m krg a. UNDERLYING CAUSE Duo to (w as a ameQuence on: ^ Nd preggnl, do preggnt wdNn 42 days (disease w inN71N1.aapalap me a i eve rs reaudkq m Beam) LAST. a deem Due m (w es a consequence old: ^ Nd Dregnant but Tegham 43 days ro 1 year d. betas deem ^ lMknoxn N pregnard wimg me pest year 30A Was w AdoPeY 306. WereAubpay F'Inarps 31. Manner d Deem 32a. Date d Ir(ury (March, day. yar) 326. Describe How Injury attuned 32c. Pgce d Inury: Horce, Feral, Sbear, Faaery, PeAOnmM? AvailedaPtlorloC«ryletlM ^ Natural ^ Ho,niade July 17 2008 Intentional laceration of forearm °~ceBieng~B1(') dcewedDmm? , ^ .# vas DLI No ^ ^ vas No ^ AaiJant ^ Parxdrg InveffiIgedon 32d. rp M d,j«y A rX 32e. Mary a1 Wak7 321. d TraiwpMadon InJ,ny fSpeciy) 32g. Lacetion d Inryay (Street riry 1 roan, sletei T~ ~ ~de ^~dNv16e Dagnn1Aed 3:00 AM ^Yaa (~"a ^Dmerlopamt« ^Paasenger ^Peaea`dan N. anover St. , Carlisle, PA , . Diner ~ SpetNy: 33e. eenmar (dgek only anal 33e. sigwnm and rel. • cemlying phyakgn(PlWeidan aditykp aweddaem wnen amtliar phWkden has Prwlounad deem and mnglaed dam 23) Coroner - ---------------- iotM lrea of my knowgege,euNt occuree ~uebma eawga)ane nlrmnxaaumd----------------- ^ • PnKpunping wg c.mMmg phyaaart (Phyerlen ban ommana,,g dxm and ardA*w ro awe d deem) T l Md d A tl d tl d ^ 33c. Licence Namber 33e. Dale signed (Noah, der. Year) --- -- -- g eeuas(s)ene menrgr es aug o tlg 6agamy mow ge, sam oauretl st t ma,em, rq plea, arld ue to _-------_-- e Jul 18 2008 y , Illtelcal Exemllwl cwaner On. tAe Ga4 a axaminNkn and / w ImmNgalron, In mY opinlwt seem accumee n the tNne, dNe, arrd plats, arW due to the awa(al and menreY as stems. ' 34. Md~dQer6an dmo CanpkltaO ;use~Daem (Ibm 27) Type/PdM a r 3s. Rea signeWre r ,~.. ` ~ ~ FUed(Mwlm,eay,yeer) ' ~ 6375 Basehore Road Suite 111 la I ~ I ~ I - Cap- ~4 I~ I ~ ~~~ Mechanicsburg, PA X7050 Disposition Permd No. ©`~'.~-~`~5..7 1 o~: ~~ RENUNCIATION .REGISTER OF WILLS ~ ~ ,,~ ~ ~ ' COUNTY, PENNSYLVANIA ~- `-~ ~' :J~ t~ { _ _ ~ _ ii " J !' 1 :r Estate of ~~/~lC/~/ ~ ~~ ~~//~~1~ ~eceased I, ~~~ //~~ldh/%S 1r~1~~~`illY~G:r7r-~ ~~~/r//~~~ ~"~~~i my~capacity/relationship as (Print Name `~ ~„.~6~~ ~- ~ ~., , ;/ -~ f~~~- of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~ ~. ~ne) E~eecuted in Register's Office Sworn to or affirmed ar~.d subscribed before rae this ~-7 r1~ day ._ -~~~ Deputy for Register of ~~'ills ~~'.~~ ~_ (Signature) (Street Address) ,~, ~p~ ~t ~ ~?~C~ ~ (City, te, Zip) Executed oitt of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this day of _ , 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.) Form RW-06 rev. l0.13.06