HomeMy WebLinkAbout08-14-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
Estate of _ //7Ci~ ~ ,~~~ I~ AG~I£"~~ p~ ~ O~j ~'g~' I
~ File Number
also known as
Deceased Social Security Number ~ %
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COttifPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Lettters Testamentary and aver that Petitioner(s) is /are the KP_ v r N i2.. L AGE' R- S a ~ f named in the
Last V/ill of the Decedent dated S'/~/~O~ and codicil(s) dated ~~`f~0 7
(State relevant circumstances, e.g., renunciation, 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
(ljappticable, enter: c.t.a.; d.b.n.c.t.a.; pendente lire; durance absentia; durante mtnoritate)
(List sheet address, towrt/city, township, county, state, zip code) ~
Decedent, then ~ years of age, died on -7 ~ZZ t1$ at C'k ty f ~ lQ ~J 03 tUl ~G.1
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (!f
Admrhistration, c. t. a. or d.b.n.c,t.a., enter date of Will in Section A above and complete list of heirs.)
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 reai estate in Pennsylvania
situated as toll
7. S c~-o , ~,-a
Wherefore, Petitioner(s) respectfully request(s) the probate ofthe last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
or printed name and residence
yJ ,v2/S - .4jP~-e wa-s..., /l,./
Form R6V-0? rev. tal3.o6 Page 1 of 2
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
~s~;
Decedent was d in (~u a+(a•,-r',t>`td County, Pennsylvania with his /her last principal resti~nce at h~
r ..
Oath of Personal Representative
COMtifONWEALTH OF PENNSYLVANIA
~~( /~ SS
COUNTY OF ~ ~ ~~r (~~
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tt~te and correct to the best of
the knowledge and belief of Petitioners} and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or zfi"trmed and subsczibed
before me the _ / 7 _ day of
~a~~~~1, ~~8
r..~
Signature of Personal Representative ~.% -~" --
- - ~-
Cry -
_,_;
Signature ojPersonal Representative '~
s~
r For the Register Signature of Personal Representative ~ ('~
U .. _.
. ~
File Nurnmber: a ~ O8 G U~
Estate of / / lQhac~-~ ~ ~Id~/e _ L~riPr ,Deceased
Social Securit Number: ! ~~ ~ ~ / Date of Death: LLl (, _~~[~L_
AND NOW, l , ~~, in co sideration of the foregoing Petition, satisfactory proof
having been presented before e, IT IS DECREED that Letters ~S ~ `l./ _ _~
are hereby granted to U/Y1 (- U2r"
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 Wil (and Codic~ (s)) of Decedent.
FEES
Letters .....75~'~~ $ ~c RegisterojWilts
Short Certificate(s) .. a . ... $ ~ Attorney Signature:
Renunciation(s) ....... ... $
LR~I ~I $ 15. Attorney Name:
_ ...)C P ... $ to Supreme Court I.D. No.:
1-fiA ~ ... $ J
$ Address:
... $
... $
... $
- • • • $ Telephone:
_ ... $
TOTAL .......... .... $ ~p0
Form RW-0? rev. rv.l3.oh Page 2 of 2
IUi8p5 REV (01/0"7)
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 1464941
Certification Number
H105.193 REV 1112006
TYPE / PRINT IN
PERMANENT
BLACK INK
~~
`~~
V
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
Records Office for permanent tiling.
q.'~ ~u ~ 3 ~ooa
.~
Local Registrar Date issued
P1}
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~3 ~
CERTIFICATE OF DEATH Qom,, Fi7 ~
(See instructions and examples on reverse) ~~,.< <„ ~ ,,,,,,o« f~ ( ('1"y( /'S yY~ I
1. Name d DeceOenl (First, nkddl6, lest, wRlx) 2. Sex 3.5acml Security Number 4. Date d Deets (Month, day, year) v
N'lar ret A. Lauer F 190 - 22 -1619 Jul 22, 2008
S. Ape (Leaf Shdaay) Untler 1 year Under 1 da 8. Date d BIM (MpnM, tle , ar) 7, 13idhpace (City and dale a for a count) ca. Place d Daem (Check on one)
MoMM Dora mans kaMr Hcepml: Other:
79 rrs. 4/ 12/ 1929 hamoki.n F PA t~ Inpatlent ^ ER /Outpatient ^ DOA ^ Nursing Home ^ Rasitlenca ^Omer - Speaty:
Bb. Cwnry of Death &. City, Boro, Twp. d Deem 9d. Faaliry Name Qi m! nstiNlion, gWe sheet ant numMr) 9. Wes Decedent of Hispanic Origin? ®No ^ Yes 10. Race: Amedcan In6en, Stack, White, etc.
CLUnklerland South Middleton pl yes, specify Cuban, (Specilb
.Carlisle Regional Medical Center Mexicen,PUenoRican,etc.l Wh1te
11. Decetlenl's Usual Osc non Kind d work tlone ~ most d work' Nte. !b rat slate rptirM 12. Was Decedent ever in dre 13. Decedent's Education (Specify any highest grade axrglmed) td. Marital Salus: Marred, Never ManleQ 15. Suriwing Spouse (If wife, give maiden name)
Kka of WoA Kind d Business I Industry U.S. Afinetl Forces? Elementary /Secondary (P12) College (1 d or Sf) Witlowed, Orvprced (Spec°yj
~
Registered Nurse Carlisle Hospital ^rea t~1Np 4 Widowed -
18. Decedent's Meting Address (Street, MY /town, slam, zip code) DecetlenYS Did Decedent
Sato PA Live in a 17
611V2r Spring
Aauel Re&dence 17a
~V
d
tl i
D
66 Ashburg Dr. , Apt. 309 .
T,yp
c
es,
«e
eM live
n
Townei'P?
M
r
PA 17050
h
i
b CLmiberalnd
nd.^ Np.Deceaa,tuvedwmn,
1h County
,
ec
an
cs
u AaualUmimof
City / Born
t3. Father's Name (FlmL mi0dle, sal, auffa) 19. Mother's Name (Fst, media, maiden sumeme)
(=alvu) - Martz A es - Fit trick
20e. Informant's Name (Type I PnM) 20b. InromxmYa Melling Address ISreeL city /town, smte, zip cetle)
Kevin R. Lauer 215 Tape Worm Rd., New Bloomfield, PA 17068
2Ja. Memod d D'spoaifion ^ Cremenan ^ Dmanon 21h. Data d DlsposMon (MOMh, daY, rear) 21 c. Place d Dslasitian (Name d cemetery, crernetory a omx pace) 21tl. Laeecn (City / town. smte, rS coda)
~SUisl ^ RemovellmmSate ~ vrosCrematbn«IMrbNOnauMorhW NQ tOn TW
^
spapry: w Medrai Ex.Mner I Coron.r? ^ vea ^ No
7 28 2008
t. Patrick New Catholic Canete p.
Carlisle ~ -FA
22e. Sigreture d F Lkensee (a es such) 22D. Ucen6e NisnMr 22c. Name andAddreea d Faan'ry
_ - FD 012633 L Being Brothers Funeral Hcxne, Inc., Carlisle. PA 17013
CompMe Haire 23ec ony when arepirq 23a. Tome Mel d my Nnowkdge, aaurred at me lime, dam ant pace smted. (Signature eM d0e) 23b. license Number 23c. Data Signed (Monts, day, yearj
physidan s mt avaaable al anm d deaM to
ertlty cause d deem.
Items 24.2n mull M axnpleled by person 24. Time d Deem
~ , I lJ 25. Dem Pronounced Deetl (Month, day, year) 20. Wes Cese Relertetl ro Medical Examiner / Coroner mr a Reason Om« than Cremanan or Donatbn?
cats pmmtmces tleem. ,~ M. ,c„ 2 ~ LcO ~' ^Yea
CAUSE OF DEATH (See instructions arts examples) r Approdmata pderve: Part IL Enl« Dina ' 29. DM TaMco Use CoMnMm ro Deem?
Item 71. Pan I: Enmr Me Men sevens -diseases, apnea, a rnrpNCaMra - mat dkeary caused nle deem. W NOT enter twdnal evems such as cardiac arrest, r Onset ro Deets M na1 msulnrg M Me undedyirg cave given n Pan L ^ yes ^ Probably
resprafaY amea, a ventricular fihNlenan witlaul shoeing me etiology. lla oMy one cause on exh fine. r
/1
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tt
~
~~ ~ ^ UnNnown
~
,
\
1 n
hIMEDIATE CAUSE Final disease a I ,-
tanMan n~ueirg k, ~eM) -' a , ~M1 K t ysy Y'11](,~ Nn 4`t.Y+ I"CO~r,)'1 C JTNGy w~r~ f{+~• i
6r ^ L
`~u w~Q-1'7 7 l,C 1 t ,
1-~r.f ~4i~ 29. M FemaN:
~
Duero (« es a coneequane oQ: i
Iy eu ronaYiara, tl ant, b. r
baMq to the auee IWed an tine a
l 7n~
7~ }v C. ~c..~:.,.u (l~ ~j;, 1z,C. I,nl '-'lI Nd pegnant within pea year
;.I.Ill
µg4 Pregne t e time d deem
n
Due l0 (« as a consequerae oQ:
Eller me UNDERLYING CAUSE
i /~ (~ ,,,sue
I~'~
Cp
(
C h
'
' 'en6 h'n Pragl'aM "AMr' 12 ceYs
(
d
(disease ar Mpry met kallUetl me p
events reeulnrp m deaMl LAST. r s iFw1
u I
• ~+•
c
~
,r.>~~ti Beam
Duero (« as a consequarxxs oQ: r L _ ^
, bit pregnant d3 days to 1 year
d. i ~~ T/'LW 1 1, ~rt II..Jr.l I'l'tl y ~ ~M
^ u,known n pregnam wiein me pest year
30e. Was an Aurotwy 306. Were Auropry Fmdhge 31. Mamer d Deets 32a. Date d Injury (MpM, day, year) 32b. Descdhe Mow Inury OcWired , I^,.;,. , l?~ u.. I Cv.e H~ ~ 32c. Pmce d Injury: Horne, Femx Sired. Feplory,
Pedomwd7 Availab'e Pray to Cmpb9on ^ Homlatle
~Nerorel Vim, ~~~~, ~,~F~~, / f ORroe Buadrg. ea. (Specdyl
d Cause d DeaM7
^ Yea ~NO ^ Yea ^ No ^ Accident ^ Peridng InVesliganon 32tl. Tina d Injury 320. Injury a Work? 321. If Trenaporlanat Injury lib) 329. Location of InA+ry lStred, MY I morn, amts)
^ Sadda ^ Could Not M Detamtlrred ^ Vas ^ No ^ DMer /Opereror ^ Passenger ^PedesMen
M Otlrer-Spedry:
33e. CerGner (Mack only ale) 33b. Siprauxe and Title dCersSer
' CanMYlrq pAYSkmn IPhvsicmn cmnMng cause q Oeem when anotltm phyecian Ms ptorauaetl deem antl complemtl hem 23) C~__
-
To tlN bestMmy laiowledge, seam epaxmd drN to the aroe(e)end mentor ad e6ded_________________________________ ^
' Prarounarlg and axtlty9rtg phyeklm (Physkien bom pronaxxdng deem arts ceMMrre to twee d deem) 33c. License Number 33d. Dem Signs (MOnm, day, YsaY)
io the best d my knowNdge, daatltli ocwned n me nrrle, dam, and lama, and due m the cause(s) and manna w sm1wL _ _ _ _ _ _ _ _ _ .
_ _ _ _ _ _ _
• MedkN Examiner/Carorror
j4i
~31 )'~~ ~`^~"
•~-~- ?'-~~:
On its Msls d exsnsuutbn end / a inweigetion, in my opinbn, seats a«urred at tM time, tlem, end pee, and due m tlw ease(s) ens manner m etetetl_ ^ J
~
.
34. Name ant Address d Pers
on
W
M
COmpkted Cause of Deem (Ilan 271 Tyye /Print -
35. Reg4at ~amre ant D' N * 36 Dem Fded (Mmm, day, year) '
'
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~
C f l l Nii.t S I i•w'~~ f
- . ~ea.>._c~ I d i (I~ I 1 I (5 I 3 ~ C. w insl t-. 12,- i w.;.. ~..._ ~~-~ r,. ~, r:~~i-.1 C.) ~. D~ Odd} r ~a 13
v Dispasiuon P«mit No. ~x~ CC{ ' 1
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LAST WILL AND TESTAMENT = ~ ~ v ~ "
-:~
}IJ
MARGARET ADELIA LAVER '~ ~
I, MARGARET ADELIA LAVER, of Silver Spring Gardens, 66 Hashburg Drive,
Mechanicsburg, Cumberland County, State of Pennsylvania 17050, being of sound mind and
memory, do make, publish and declare this my Last Will and Testament, hereby revoking and
declaring null and void any and all Wills and Codicils by me at any time heretofore made.
FIRST: I devise and bequeath all of my estate of every nature and wherever situate, to my
son, KEVIN RYAN LAVER, provided he survives me by thirty (30) days.
SECOND: Should my son, KEVIN RYAN LAVER, predecease me or fail to survive me
by thirty (30) days, or in the event that we die simultaneously, I direct the following: I bequeath the
rest, residue, and remainder of any and all real and personal properly including any stocks or bonds,
to my
of
State of Pennsylvania.
THIRD: I direct that my Executrix or Guardian or other Successors, shall not be required
to post any bond or give any security of any type for any purpose whatsoever, any law or rule of
court of the Commonwealth of Pennsylvania or any jurisdiction to the contrary notwithstanding.
FOURTH: I name and appoint my son, KEVIN RYAN LAVER, Executrix, of this, my
Last Will and Testament. Should my son, KEVIN RYAN LAVER, fail to survive me or fail to
qualify, or cease to act as Executrix, I appoint my
Executrix of my last will.
to act as Substitute-
FIFTH: I direct that all taxes that may be assessed as a consequence of my death, of
whatever nature and whatever jurisdiction imposed, shall be paid from my residuary estate as part
Page 1 of 4
of the expense of the administration of my estate.
IN WITNESS WHEREOF, I, MARGARET ADELIA LAVER, the Testator, have hereunto
set my hand and seal this ~- day of - 2007.
MA GARET ADELIA LAVER
SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testator,
MARGARET ADELIA LAVER, as and for his Last Will and Testament, in the presence of us,
who, at his request, in his presence and in the presence of each other have hereunto subscribed our
names as witnesses.
/'j~tiPV~/ 2' LAC ~~
WITNESS
--_.-.
WI SS
~/.5' Tea cwa~..w. R./
ADDRESS
L °'' ~er j v... ~~ 1 ~T P 1
~~~~ v,lf c ~ !~~ `rl
ADDRESS
Page 2 of 4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
I, MARGARET ADELIA LAVER, Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my last Will, that I signed it willingly, and that I signed it as
my free and voluntary act for purposes therein expressed.
IN WITNESS WHEREOF, I, MARGARET ADELIA LAVER, have hereunto set my hand
and seal this ~ day of ~ ~ {i..y 2007.
MARGARET ADELIA LAVER
SWORN or affirmed to and acknowledged before me and MARGARET ADELIA LAVER,
the Testator, this y day of ~~~~.~.-ti' 2007.
NOT Y PUBLIC
r,""Oavltiif.;iv;vV?.~r;L i -f ~~~ i--twiv;v.. i J .:"~i,;
r v~oG~riai lei _.__.._~_,
Betty Keebaugh, iVotary f~ubt~c
etterkennyTtn~., t=ranklin County I
¢ My Canmisssc~a~ t"xx~tres Dec. 4, 200? ,
1"~mh~r. Pe!lrSv~ ..:1: c`.ria'in,.. -wt .,r-,~
Sal. '~~` ~~
Page 3 of 4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
17~ G'.'~~ ,/~ ~Ci tfe /1i and ~~q `v f ~ ~
We,
the
witnesses whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw the Testator sign and execute the
instrument as his Last Will, that he signed willingly, and that he executed it as his free and
voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the
Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at that
time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence.
Sworn or affirmed and subscribed to before me by the witnesses, ~f t~ ~'w ~P !~(~E w
a
and ~ ~`'' '`' ~`''~ ,this ~ day of
2007.
PUBLIC
NOT
;.~~~. -~
I Notarial Sea!
Betty i<eebaugh, Notary PuL11ic:
i I_etterkennyTwp., Franklin County
~ My Commission cx;;i; 2s Dec. 4, 2007
.____
~._;
Page 4 of 4