HomeMy WebLinkAbout08-13-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~ U n~ ~~ r I a /l d COUNTY, PENNSYLVANIA
Estate of Ge ~ I ~ y d e ~ ~~ P /~ (~'r~t '~`F l ~ S File Number ~ I ' ~~ ~T (.`0
also known as
Deceased Social Security Number ~~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(CO/ti1PLETE 'A' or 'B' BELO!•Y:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~7 C~ ! e named in the
last Will of the Decedent dated ~P {wruv i (, ly YO and codicil(s) dated
(State relevmtl 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 Administratio
(lfapplicable, enter: c. t. n.; 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 spouse (if any) and,heirs: (!f
Administration, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) t~~
In-Y g Su~c ~4 ~,-°o g
Decedent, then ears of a e, died on at (7- ~. C7 U Y/1
Decedent at deatl~ owned property with estimated values as follo.vs:
(If domiciled in PA) All personal property $ ~ ~~ ~ Q U ~ U d
(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: ~ 't I -2 S't-p1 ~ C
Form R4V-0? r~,~. lo.t3.oe Page 1 of 2
(COtY1PLETE IN ALL CASES:) Aftach additional sheets if necessary._ C~?
., ..
Decedent was domiciled at death in Cv rv1 h rr I cr ~'lCt County, Pennsylvania with his /her last principal residence at i-/ ~l
~je,-~Fl~ t! t~ ~"}+'P ~ ~ S ~tM-y/l t r d of f r ~~~ ~ 7~ rl
(List streel address, town/city, township, count), state, zip code) ~-
Wh ner(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:
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~ ~~tit ~-PV-IQ vt C
SS
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are hue and coned 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. ~ r
Sworn to or affirmed and subscribed -'~
Signatur er nn Representntive ~ t^7-_'.
r_
before me the `lam day of -"~~ •:
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~G~___ ~ ~~'0 Signature ojPersonnl Representntive
4 .~-~~-
J For the Register Signature ojPersonalRepresentative =e
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File Number: ~I Ud ~ VO ~~`
Estate of Gerfirude ~ lIP!'1 CnQFFtu,~ ,Deceased
Social Security Number: ~ ~ ~ Date of Death:~~ ~~ ~ " ~~
AND NOW, '(~ld~ , ~U
having been presented befo3~ e~T I~~ EC~tEErD that Letters
are hereby granted to `~~~r-~--~~~S-~y
in consideration of the foregoing Petition, satisfactory proof
nn in the above estate
and that the instrument(s) dated o~- l _ ._
described in the Petition be admitted to probate and filed of record ansnth~e~hast Will (and,^~Codhicnil(s)) of Decedent. .
FEES \ ~. LCX-1 t.L•'~ ~(,1,~' ~X..rC ~ - \ ---
Letters ............... $_~ Register ojWills tCJp/~
Short Certificate(s) ........ $ a'~.L ~ ~"
Renunciation(s) .......... $
~'U~t~ ... $ 45.D~
yC~ ... $ I+J.UC~
f~ui~rn~fi i c"v~ ... $
... ~
... $
... $
... $
... $
... $
TOTAL .............. $ ~„
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
rorni Rw-o' rev. lo.r3.or Page 2 of 2
LOCAL REGISTRAR'S CERTIFICATION OF DEA1~H
'WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ Fec for this certificate, $6.00
P 1~-54716
Certification Number
I i43 REV t1Y20p6
E / PRINT IN
ERMANENT
SLACK INK
This is to certify that the informatio^ here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will he forwarded to the State Vital
Records Office for permanent filing.
~;-~` ~ ~-~ JUL 1 ~ 06
Local Registrar ~~~Date Issued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
1. Name of Decedent IFrst. middle, last, suHixl 2. Sex 3. Social Security Number 4. Date pl Death (Month, day, year)
Gertre~e E. Graffius Female 167 - 14' -8439 June 26, 2008
5. Age (Last Birthday) Under 1 year Under 1 day 6. Dale of Binh (Month, day, year) 7. Birthplace (City antl stale a for eign country) 6a. Place of Deem (Check only oneJ
86 Monrlrs Days Hours Minutes
11/22/1921
Harrisburg, PA Hospllal: Other:
vrs. ®Inpalient [] ER! Outpatient ^ DOA ^ Nursing Home ^ Residence ^Other ~ Specify.
Sb. Counry of Deam Bc. City, Boro. Twp. of Death 8d. Facility Name (lf not Instnutbn, give street and number) 9. Was Decedent of Hispanic Originn ~ No ^ Yes 10. Race. American Indian, Black, While, etc.
Cumberland
East Pennsboro Twp.
Holy Spirit Hospital (If yes, specity Cuban,
Mexican,PUedpRican,ela) (Specilyr
White
11. DecedenYS Usual tion Klnd of work d one d ur most of wo IHe. Do not stale retired 12. Wes Decedent aver In the 13. Decetlenl's Education (Specify Doty hgnast gratle comp leted) 14. Marital Status: Married, Never Monied 15. Surviving Spo use (II wife, give maitlen name)
Klntl of Work Kind of Business l Industry U.S. Annad Forces? Elementary! Secondary (012) College (1-4 or 5+) Witlowed, Divorced I Speciy)7
Bank Teller Peoples Bank ^re¢ ®Np 12 Widowed
16. Du<edent's Mailing Address (Street city I town, slate, zip rnda) Decedent's PA Did Decedent
East Pennsboro
sale Live in a 17
Aclusl Residence 17a
®V
D
4 04 N . 4th S t . .
c.
es,
ecedent Livetl m
Twp
T°wr,aniD?
Cumberland
rid. ^ N°, D¢c¢d¢m w¢d wnnin
cou"ry
77b
Summerdale, PA 17093 .
Ad"alumnae
City / Boro
t6. Earner's Name (First, mitlMe, lass, suffix) 19. Homer's Name (First, middle, maiden surname)
Amos Graham Gertrude J. Convey
20a. Informant's Name (Type I Pnnp 20b. Informant's Mailing 0.tltlress (Street city! town, sate, zip code)
Jeffrey W. Graffius 30 West Broadway Red Lion, PA 17356
21 a. Metnod of Disposition ~] Cremation ^ Donation 21 b. Date of DieDeeitl°n (Month, day. year) 21c. Place of Disposition (Name of cemelePS crematory or other place) 21 d. Locaton IChy /town, state, zip code)
^ Banal ^ Removal Irom Stale ~ Was Cremedon or Donation Authadzed
^Otner-Spe°iy: '; by Medical Examinerlcorpner? ves^NO
June 30 2008
Hollinger Crematory
Mt. Holly Springs PA 17065
22a. Sgnature of Funeral SfrV nsee (or person acting as such) 226. License Number 22c Name and Address of Facility
~ FD 012774-L Richardson Fl3neral Hare Inc. 29 S. Eno1a Dr. Enola, PA 17025
Complete Items 23ac only when certitying 23a. To st of my knowledge, deal unetl at the lime, tlate antl place staled. (Signature and line) 23b. License Number 23c. Date Signed (Month, tlay, year)
pnysiaan i5 not available al lime of death to
Ih /~ / -'7 ~ ~
I ' 1
t~ ~ ~ b 1 L
li - ~ L~ C~ ~~
cenity Wuae of death. 1 . I,J - -
Hems 2446 must ce Cpmpleletl by person 24. Time o/ Death ~. 26. Dale Pronounced Deatl (Month, day, year) 26. Was Case Relerretl to Medical Examiner /Coroner for a Reason Other than Cremation or Donali°nn
who Dronounces death I ~ M. / ~ _ ~~ ~ ^ Yes [~No
CAUSE OP DEATH (See instructions and examples) r Approximate interval. Pan II. Enter other significant conditions tonlr 6uC to tleaN. 26. Dld~baccp Use Contn6ule to Dealn?
Item 27. Pan 1: Enter the chain of eyen6 -diseases, m)unes, or complicatans - Inal directly caused the death. DO NOT enter terminal events such as cartliac anesl, Onset to Death but not resulting In the underlying cause given in Pan I. Q Yes ^ Probably
respiratory angel, or venlncular fibnllalien wnheul ehpwirg the etiobgy. List only one cause n each line. ~ ^ No ^ Unknown
IMMEDIATE CAUSE Fin
l di
1
~
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sease or -
}--~x
a
condtian msutiing in f~am)
~ e5 p t l~o: I v ~ I vn '(L , 29. II Female.
~
_~ a r ^
Du
e to (or as cnnsequer~ce oQ: r Not pregnenl within past year
f
Sequentiatiy list conditions, if anY, b. L v. +N o, ~- n n C.-p-r
leafing to the cause listetl on line a
r ^ Pregnant at hme of death
.
Enter the UNDERLYING CAUSE Due to (or as A c[hsequerrce oQ: r ^ Nol pregnant, but pregnant within 42 days
(dLSease or injury that Initialed the c v j of death
events resuting In death) LAST.
Due to (or as a consequence o0: ^ Not pregnenl, bw pregnenl 43 days to 7 year
d before deem
^ Unknown II Dregnant within the pest year
30a. Was an AMOpsy 30b. Were ANOpsy Fintlings 31. Mann r of Death 32a. Dale of Injury (Hoorn, day, year) 326. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory,
Pedomred? Available Prior to Completron
Natural ^ Homicide Office Building, alc. (SperiyyJ
of Cause of Deatn~
^ Yes Q No ^ves ^ N° ^ Accident ^ Pending Investigatron 32d. Time of Injury 32e. Injury at Work? 321. If Transportation Injury (Specity) 32g. Location pl Injury (Street city /town, slate)
^ Suicide ^ Could Nol fx± Determined ^ Ves ^ No ^ Driver! Operator ^ Passenger ^Petlestnan
M Olher~ Speedy:
33a. Certifier (check Dory one) 330. Signature antl
Tt
le
of Cenilier
• Certltying physician (Physx;lan cenifying cause of death when another physician has Dronounced death and completetl Item 23) /
'
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(n.,~ti~-~,~-.~1 ~~ ~~
To the best of my knowledge, death occurred due to the cause(s) antl manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ / ~i
• Pronouncing and certitying physican ;Physician bath pronpuncing death and certifying to reuse of tleath)
7o the best of m
knowled
e
death occ
r
etl at th
ti
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t
d
l
d d
f
th
d
^ 33c. License Number 33d. Date Signetl (Month, day, year)
y
g
,
u
r
e
me,
a
e, an
ace, an
o
ue
e cause(s) an
manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
D
• Medical Exemirler! Coroner M (~ ~ ^ ~ ~ ~ ~ ~ y ~ ~
J L
1 . \ ~
On the basis of examination antl / or investigation, in my opini n, death occurred at the time, tlate, and place, and due to the cause(s) and manner as sletetl_ ^ .
~ Name and Addres=. of P¢rson Wbp Completed Caus¢ of Death (Item 271 Type; Print
35 Registrar's,~~,~~wre antl Disf
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OATH OF SUBSCRIBING WITNESS(ES) ` ° ~~ -J
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REGISTER OF WILLS , . '~=
y~tn b P c~ ~ ~ ~- d COUNTY, PENNSYLVANIA
Estate of 2 r ~ r y ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ t L' ~ ,Deceased
~v-~; a,
~~dk
(each) a subscribing witness to
J (Print Name/s)
the Wil ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she /~ they a~ were present and saw the above estator Testatrix sign the same
and that she i ie they signed the same and that she / he /they signed as a witness at the request of
the Testator Testatrix in er his presence and in the presence of each other.
(Sig~iature)
(SU-ee! Address)
(City, State, ZipJ
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
of
Deputy for Register of Wills
~~~_ o~~C
(Signature)
(Street Address)
~l ~r'~-lr,~Lc>/CS Z3 u12~ y°~4 l' ~D ~ G
(City, State, Zip)
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Executed out of Register's Office '~
m ~ ~
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Sworn to or affirmed and subscribed
~ ~,
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~ m~ ~ ~ ~
before me this day
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o ~~
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Z
Si p~n
N ~ <
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No ary Public x
My Commission Expires:(~~ ~ ~l~-
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Com mission.)
day
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.
FormR6V-03 rev. !0./3.06
_~j-~.)~-U~3~
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OATH OF NON-SUBSCRIBING WITNESS(E~~.~; ~ = ~ ~~ ~.
<.
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REGISTER OF WILLS - cs_~
D A ~P i-~ ~ N COUNTY, PENNS~'LVANIA =_ -
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Estate of ~ j f~r~.U~~ 1~ LL~ ~ Gf~.I~~F( (..~.j ,Deceased
~i ~3~A ~ ~ ~. ~~~N D
and
(each) being duly qualified according to law, depose(s) and say(s) that she l he /they wa /were well-
acquainted with ~ ~= (~IZ ll~ Q ~ ~= ~-~- ~ N ~-~~(= Ft V .S and am/are familiar
with the handwriting and signature of the decedent, and that the signature of ~-? BIZ 1 r~ ~ L7 F r~LL r~ (J~h1 ~F/u,
to the foregoing instrument/purporting to be the Last Will and Testament/Codicil of
~~=(~( ~U~[ ~~-Fl~ ~l(~FFIUSis in his/her own proper handwriting.
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i~nature)
~~~ Fr~~(7 (ft~~t-ot~.~ (~UA~
(Sfreel Address)
tf7`}~(~ (S~(-12Cs ~~ I ~7 I (Z_-.
(City, S'tnre, Zip)
Execceted in Register's Offcce
Sworn to or affirmed and subscribed
before me this r~~ day
of ~ ,2~a~ .
~~~ ~ ~
Deputy for Register of Vi11~
(Signature)
(Street Address)
ily.
Form RW-04 rev. 10.13.06
~~/ - C ~ -C~~S`"
OATH OF NON-SUBSCRIBING WITNE5S(ES~~`.~
-,
~;_~~
REGISTER OF WILLS ~=
YORK COUNTY, PENNSYLVANIA
File No. 67 "~--
_;
Estate of
~P~~ ,
~t~'_ ~1/~ ~i1v~ /' `' ~- Q-~'~~--wand
.~
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rv
r.;
Deceased
.-{~eask)-being duly qu~lifi d according tofl~a~,w, de ~se/~(~s) ands y(s) that sh 1 he /they was were well-
acquainted with i~~'Z~~G`~C_ ~~-~~~ 2~- ~ and a are familiar
~~
with the handwriting and signature of the decedent, and that the signature of ~y ~ P9~~t~~
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~ ~ /sJil ~c~
is in his/her own proper handwriting.
(Signature) '~ //
(Street Address)
6~,~~~ p~ ~~3 5~
(Ciry,'State, Zip
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this f ~ ~ day
of _~ , _~~
6~~--
u o R,Er ister o ills
REGISTER OF W-LI__S YORK COUNTY
MY COMMISSION EXPIRES
FIRST MONQAY IN JANUARY 2012
Form RW-04 rev. 10.13.06
(Signature)
(Street Address)
(City, State, Zip)