HomeMy WebLinkAbout08-14-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Annette Landen
also known as
,Deceased
COUNTY, PENNSYLVANIA
File Number 21-08- ~~
Social Security Number
Ted Trout-Landen
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE A' or '8' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the named in the
last W ill of the Decedent, dated 01/11/1990 and codicil(s) dated
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 born 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
app rca e, en er: c..a.; ..n.c.t.a.; pe en e r e; urante a sen ra; urante mrnon a e
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. or d. b. n. c.t.a., enter date of Will in Section A above and complete list of heirs.)
Name Relationship Residence -
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(COMPLETE IN ALL CASES:) Affach addifiona! sheets if necessary. _'_'I
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residen~~at ~,
5225 Wilson Lane, Mechanicsburg, Lower Allen Township, Cumberland, PA 17055
(List street address, town/city, township, county, state, zip code)
Decedent, then $s
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: None
20,000.00
Wherefore, Petitioners} 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:
Signature Typed or printed name and residence
/~ Ted Trout-Landen 105 Palamino Way
~~/C/.~=%/.]f Red Lion, PA 17356
Form KW-(11 Rev. 10-13-2006 Copyright (c) 2006 tone software only The Lackner Group, Inc. Pa a 7 of 2
9
years of age, died on 06/26/2008 at same address as above
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland } SS
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are 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. ~~,
Sworn to or af8rned and subscribed ~ -~~ 7~~ ~ x---~
Srgna re of Personal Representative Ted Trout-Landen
before ire this ~ .__ day of
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' ~ ; 7~~/ 1<t Signature of Personal Representative ~ .
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r the Register Signature of Personal Representative
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File Number: 21-08-
Estate of Annette Landen ,Deceased
AlIUA
Social Se(,c~urity Numb,(e~r~ ~114/5L-20-1783 Date of Death: 06126/2008
AND NOW, /~` r~f 1~~~~(7;th 'tY.((a)!~ , rr~~_ , in consideration of the foregoing Petition, satisfactory proof
having been presented before r1Se, I S DE EED that Letters Testamentary
are hereby granted to Ted Trout-Landen
in the above estate
and that the instrument(s) dated 01/11/1990
described in the Petition be admitted to probate and filled of record as the last Will (and Codicil(s)) of Decedent.
FEES DO
Letters ............................................ $
Short Certificate(s) ........................ $ ~r!D-
Renunciation(s) ............................. $ J ~~
1 $ ~~J~~~
C $ I~.~(~
pCl .~ ~rYlC~fl ~I'l $ 5 • ~~
$
$
$
$
$
$
TOTAL .................................... $ ~ 1 ~ °
Supreme Court I.D. No.: $7$O$
CGA Law Firm
Address: 135 North George Street
York, PA 17401
Telephone: 717-848-4900
Form RW-O? Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2
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Attorney Signature: ~ _-
Attorney Name: Timothy J Bupp
LOCAL REGISTRAR'S CERTIFICATION OF DEATI~I
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, ~6.OU
Certification Nwnber
I EV 1112006
RINT IN
NENT
( INK
This is to certify that the information here given is
correctly copied from an ori;;ina1 Certificate of Death
duly filed with me as Local Reg~rstrar. The original
certificate will he forwari3ed to the State Vital
Records Office for permanent filing.~~~ ~ ~ 2008
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 NameplnnenlLate le, la~s.nix7 Landen
A 2f emote 3. Social Security Number a. Date of Deeln (Month, day. year)
145 -20 1783 une 26,2008
5. Age (Lass Blnhday) Untler 1 year Under 1 tlay 6. Date of Birth (Month, tlay, year) 7. Birlhplace (City antl state or for eign country) Ba. Place of Death (Check only one)
8 6 ""="na pays w~a, Mimaiaa Ma 4 1 9 2 2
y ~
Fort Th(~mag Hpapaal other
Yra 1"\en tuC k ^ Inpalienl ^ ER / Outpatient ^ DOA ~ Nursing Home ^ Residence ^Other ~ Specify.
Bb. County of Death &. City, Boro, Two. of Death be. Facility Name (jl rwl Inslilution, give street antl number) 9. Was Dncedent of Hispanic Origin? _ R No ^Ves 10. Race: American Indian, Black, White, etc.
Cumberland
Lower Allen
5225 Wilson Ln. (II yes. speciry Cuban, ~~(
MexipanPoenpRi=anal=.) (SpacityJ
bite
11. Decedent's Usual Occu Lion Kind of work d one Burin most of workin life. Do not stale retired 12. Was Decedent ever in hte 13. Decedent's Etlucation (Specify only hghest gratle cpmp leletl) 14. Marital Status: Married, Never Married, 16. Surviving Spo use (II wile. give maitlen name)
KiM of Work Klnd of business! Intl stry U.S. Armed Forces? Elementary I Secondary (0.12) College (1-4 or 5+) Widowed, Dworced (Specfry)
Clerk PA D ]Yea ^Np 14 idowed
16 Decedent's Mailing Atldress (Street. city I town, slate, rip cotle) Decedent's Did Decedent
Ac1palReaidenpe ,7a stale PA Uveina ,7
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Lower Allen
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5225 Wilson Ln. =
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PA 1 7055
Mechanicsburg owns
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17hcounty Cumberland 17d ^ N
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18. Father s Name (First, middle, last, suHlxl 19. Mother's Name (First, midtlle, maiden surname)
Alexander R. Loughborough Dorothy
20a. Informant's Name (Type! Pnnll 206. Inlormanl's Mailing Address (Street, city! town, state, zip code)
Dr. Ted L. Trout-Landen 105 Palomino Way Red Lion,PA 17356
21 a. Method of Disposition ^ Cremation ^ Donation 21 U. Dale of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21 d. Location (City I town, stale, zip tale)
[j{Burial ^ Removalhom ~ WasCrematlonorDOnallonAuthorizetl July3, 2008 Indiantown Gap National Cem Annville,PA
^ Other - Specify: i y Medical Ezaminer I Coroner? ^ Yes ^ No
22a. Sg tur 1 une~al Serv r acting as such) 22b. License Number 22c. Name and Address of Facility
~ 011248 L usselman FH&CS Inc.324 Hummel Ave. Lemoyne, PA
Complete Items 23a<only when cenilying 23a. a be y knowledge, tleath acurred al the lime, dale aril place staled. (Signature antl title) 23b. License Numner 23c. Date Si netl (Month, day, year)
physraan is not available at time of death to ~ /J
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ceniry cause of tleath ry
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Items 2426 must ire completed by Derson 24 Time of Death 15,
~ 25. Dale Pronounce ad (Month. day, year) 26. Was Case Refered b Medical Examiner. Coroner for a Reason Other than Cremation or Donationz
who pronances tleath. `
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f .y~_ .~ ~ y ~~Q ~ ^Ves []iCo
CAUSE OF DEATH (Bee
Instructions and ezamples) r Approximate intervak. Pan II. Enter other sienificant contlilrons coniribulin to ih, 28. Dld Tobago Use Callnbule to Death?
Item 27 Pan r. Erner the cha n of events -diseases, miunes, or complkations -That directly causetl the death. DO NOT enter lertninal evenh such as cardiac arrest, Onset Ip Death but not resulting In the underlying cause given in Pan I. ^Ves ^ Probably
rasDiratory arrest. or ventricular libnlla6on witnoul shomng the etiology. List only one cause on each line.
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^ No ^ Unknown
IMMEDIATE CAUSE (Final disease or
corMUion resulting in death)
f ~ ~ N 1 Z I O ~ ~ `• p rn ~ /i / r\~~
r1~~ 29. If Female'.
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Due (or as a consequent of ^
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Sequentially IIS1 conditions, d arty, b N (
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leadr
to the cause listed on line a fjt,~ ~
~ regnant at lime of tleath
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Emer the UNDERLYING CAUSE Due to (or as a consequence oil:
Nol pregnant, but pregnant within 42 days
(tlisease or injury that indialetl the
events rewAing in death) LAST. ~ ~ of death
Due to (or as a consequence op'. ^ Not pregnant, but pregnant 43 days to I year
d before tleath
^ Unknown J pregnant wrthln the past year
30a. Was an Autopsy 30b. Were Autopsy Fintlings 31. Manner of Death 32a. Date of Injury (Monet, tlay, year) 32b. Describe How Injury Occurted 32c. Place of Intury. Home, Farm, Street, Factory,
Penormed? ArailablP Pna to Completion ~ tural ^ Hominde
~,a Ofli=e BuilOing, alt. (Spe=ily)
of Cause of Deaths la
^ vas ^Ves ^ No ^ Accident ^ Pending Invesbgatbn 32d. Time of Injury 32e. Injury at Work? 321. 11 Transponalion Injury (Specify) 32g. Location of Injury 131ree1, city I sown, stale)
^ Suicide ^ Could Not be Determined ^ Ves ^ No ^ Oriver!Operalor ^ Passenger ^Pedestrian
M ^ Other - Specrly:
33a. Cenifler (check Doty one) 336. Sign
ature antl Title of Genilier
• CertNying physician (Physiaan certifying cause of death when another physician nos pronounced death and completed Item 23) A
non """
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To the best of my knowledge, deem occurretl due to the cause(s) and manner as slatetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ,
I v , V v l , ~•s ~• v
• Pronouncing and certifying phyaician (Physraan both pronouncing death antl cenilying to cause of tleath)
To the b
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• Medical Examiner/Coroner ~ ,z~ ~ 1(JI ~ ~ ~
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On the basis of examination and I or invesilgation, in my opinion, death occurred at the Ilme, date, and place, and due to the cause(s) antl manner as sialed_ ^ ~ ryame and A~ ass of Per
son Who C
leted Cause of Dea
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35. Repislrar
s S~gnat d District Num 36. Date Fi d (M Ih, day, year) " --'
" U~~~3~?
Disposi;ron Permit No.
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?~~st mill ~n~ C~IPSt~mPnt
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ANNETTE LANDEN '`'
_.
I, ANNETTE LANDEN, of the Fiorough of Camp Hill, Cumberl~r~d
County, Pennsylvania, being of sound mind, memory and
understanding, do make make, publish, and declare the following
to be my Last Will and Testament, hereby revoking and making void
all Wills, Codicils and testamentary dispositions by me at any time
heretofore made.
ITEM I: I direct my Executors, hereinafter named, to pay all
just debts, funeral expenses ani: costs of administration as soon
after my decease as possible.
ITEM II: All the rest, residue and remainder of my estate,
real, personal and mixed, I give, devise and bequeath equally to my
sons, HAL M. LANDEN and TED TROUT-LANDEN, their heirs and assigns.
ITEM III: I nominate, constitute and appoint my sons, HAL M.
LANDEN and TED TROUT-LANDEN, as Co-Executors of this my Last Will
and Testament. My Executors shall serve without bond in this or
any other jurisdiction.
IN WITNESS WHEREOF, I, ANNETTE LANDEN, have to this my Last
Will and Testament set my hand and seal this ~ ~`~ da of
Y
January, A.D., 1990.
l~~ 32=~~C'.-Cl.:.- 4'~-rf~~ ~ SEAL )
ANNETTE LANDEN
Signed, sealed, published and declared by the said testatrix,
ANNETTE LANDEN, as and for her Last Will and Testament in the
presence of us, who at her request, and in her presence, and in the
presence of each ~oltheA.r have subscribed our~~names as witness hereto.
Name Addre s
z 1
Name ~~~ ~ Addres
"'~` ~
,
COMMONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OF DAUPHIN
We, ANNETTE LANDEN, `-~ < <'~~'~- ~- /'-'< <l~ ~ and
~ ~i ~~ ~J -mac ~.,- , the Testatrix and the witnesses,
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testatrix signed and executed the
instrument as her Last Will and Testament and that she had signed
willingly (or willingly directed another to sign for her) and that
she executed it as her free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the presence
and hearing of the Testatrix signed the Will as a witness and that
to the best of his or her knowledge, the Testatrix was at that time
eighteen (1$) years of age or older, of sound mind and under no
constraint or undue influence, and I, the said Testatrix do hereby
acknowledge that I signed and executed the instrument as my Last
Will and Testament, that I signed it willingly, and that I signed ii
as my free and voluntary act for the purposes therein expressed.
Testatrix
Witness
-_ ~~
Witness
Subscribed, sworn to and
acknowledged before me by
ANNETTE LANDEN,
the Testatrix and subscribed
and sworn to before me by
C; ~ ~ ~=-~..- 1.:~ ~S . ~ i a nd
w tnesses, this ~~~ day of
,~ ~,., ,, ,~ ,,~-,,-` A . D . , 19 9 0 .
Not Public
~~ ~--
_.._
REGISTER OF WILLS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RENUNCIATION
~~
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__, .a~;
IN RE: Estate of Annette L. Landen, deceased. .~
To the Register of Wills of Cumberland County, Pennsylvania: - ~ -
..
<<,
The Undersigned., 1lAL M. LANDEN, hPrPhy rennr~~,rPs the right to administer
the Estate of Annette L. Landen and respectfully asks that Letters Testamentary be issued
to Ted L. Trout-Landen.
5~
Witness my hand this ~_ day of ~ 2008.
Signature
a l ~., .~ ~(~~~
Print Name
Address
9 King Philip Avenue
Bristol, RI 02809
~'>>~'°~ril-`::l .'z..nd .~',:~'.^.ii. tv v~.fCiC iYi~.
this ~_ day of 2008.
~~
Notary Public
{00203~51/I,