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HomeMy WebLinkAbout08-21-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of RANDY L. WARDECKER File Number ~ ~ • ~a ~ r ~~ ~,~' also known as ,Deceased Social Security Number Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) r~> A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is !are the ~-.~ r~ w named irl the last Will of the Decedent dated and codicil(s) dated ;= --~~ ;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 born or adopted after execution-tif fi~}te instrut tut(s) offered, J _..-{ .. for probate, was not the victim of a killing and was never adjudicated an incapacitated person: - -a B. Grant of Letters of Administration (If applicable, enter: c. t. a.; d.b.n.c.t.a.; pendente liter durante absentia; durante minoritate) Petitioner(s) after a proper search has 1 have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (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.) Name Relationshi Residence JORDAN L. WARDECKER SON 2268 PINE ROAD, NEWVILLE, PA 17241 ~ ~ _-- (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his 1 her last principal residence at 22.68 PINE ROAD, NEWVILLE, PENN TOWNSHIP, CUMBERLAND COUNTY PENNSYLVANIA 17241 (Ltst street address, town/city, township, county, state, zip code) Decedent, then ~8 years of age, died on JULY 16, 2008 at CARLISLE REGIONAL MEDICAL CENTER, CUMBERLAND COUNTY PENNSYLVANIA Decedent at death owned property with estimated values as follows: (ifdomiciled in PA) All personal property $_ 1,500.00 (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: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Lettetr> in the appropriate form to the undersigned: G%~ I JORDAN L. WARDECKER, 2268 PINE ROAD, NEWVILLE, PA 17241 ~~ ~ - h/a/., / ~Go . Form RW-02 rev. 10.13.06 Page 1 of 2 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 representatives} 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 ~. c," / Z For the Register ~, ~ `~!~ of Personal Representative Signature ofAersonal Representative Signature of Personal Representative File Number: ~ ~ ' ~ ~' ~ ~ ~' ~ Estate of RANDY L. WARDECKER Deceased Social Security Number: Date of Death: JULY 16, 2008 AND NOW,~I_ ~[~ ~ ~~ /,( .I.LC,~T~_ - fix.; - , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters OF ADMINISTRATION are hereby granted to JORDAN L. WARDECKER 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 ~ _rJ~~ ~{ ~ .~~ ~~` tl(~~ .. ~(.~~~.-~ ~ Y Letters ............. .. $ 20.00 Short Certificate(s) .... .... $ 4.00 Renunciation(s) ...... .... $ JCP $ 10.00 AUTOMATION FEE $ 5.00 ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .......... .... $ 39.00 " Regist~efro~fWi~lls ~:?.F',= V~~ C~rt~ Attorney Signature: i~ ~/ `-''t ~ . Attorney Name: ROGER. IR IN, ESQUIRE Supreme Court I.D. No.: 6282 Address: 60 WEST POMFRET STREET CARLISLE, PA 17013 Telephone: (717) 249-2353 Form RW-02 rev. 10.13.06 Page 2 Of 2 OCAL REGISTRAR'S CERTIFICATION OF DEATH 1NARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this rc"rtific~te. ~6.O1) P 1441529 Certificatitm ;umber This i5 to certify that the iufiormation here given i correctiti~ copied frL~m an <~riginal Certificate of lleatl duly filed ~Aritt7 me as Lora{ Registrar. The ori~~ina certificate ~,aill he forwarded tc~ the State Vita R:~L~<1rd~ C)1~fice f~~r perma(lent filing. ~ 10~ al Ri•gisha;,-:C) y~ I~aie_lssuixl ~~ :¢~- - 4,' -,, r., ~, _..- 7-:r. ~~ ._ , .. H105 144 REV 11f10U6 TYPE/PRINT IN PERMANENT BLACK INK et~~_anR t5 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ---- CORONER'S CERTIFICATE OF DEATH ``1 `y~' f, (See tnstruCtfons end examples on reverse) STATE FILE NUMBER ~~_~ ~~~ = r(1 ~j~ 1. Name rb Dacetlenl (FireL mtldle, lest, auaiz} 2. Sex 3. Social Security Number 4. Date o! Death (Month, tley, year) Randy L Wardecker Male 210 - 40 -4709 July 16, 2008 5. Age (leaf &rthday) Untler 1 ar Under 1 dey 6. Date d Binh (Momh, tley, year) 7. Birttglace (Ciy ell stale or lorelgn count) Ba. Place of Deam (Clxak orrl one) 48 "°°`~`~ °"` """` ""~`~ 5e 9, 1959 Carlisle Hoepitab soar: p . Yra. IaiY3 Cot3n PA ^ Inpatient ER 7 OMpeDeni ^ DOA ^ Nursing Hamr ^ RasMence []Omer Specify: 8h. County of Death 8c. City, Twp. Deem Bd. Fecidy Noma (It not k57iluaon, gNe street and number) P. Was Decadent of HispeMC Origin? ~ No ^Ves 19. Race: Ameyican Indian, &aW, White, etc. Cumberland South Middleton Carlisle Regional Medical Center (k yes, spedly Cohan, M i l?i P (SPeciM ex rsn, can,etc) uena 1~Lite 11. DanBtleM's Ueuel Occ tpn KkM1 of vrorh doce d u' most of life. Do nM date rekred 12. Was Decedent ever in (M 13. Decedent's Education (Specfy only hipheM gretle carg lmed) 14. Martial solos: Monied, Never Married, 15. SurvNing Spo use (N wile, give maiden rmma) K tl M Work Kind d Business i IMUStry U.S. Amled Forces? Elementary / Secatdary (0.12) Cokege (7d or 5+) Widowed, Divorced (Specfy) Laborer Giant Distsib. Otter ^vas ®No 12 rs. i6. il8cedeM's Meiling Address (Street, city! town, stets, zip code) DecetleM's Did Decedent Apual Residence na. smle Pennsylvania Lke ire 1?c.®ves, Decedent Lined in_ Penn Twp. 2268 Pine Rd. Townshry? t7d ^NO Decedem Lived wknin Newville PA 17241 , . 176. County Cumberland Aawnimasm ciyreom 18. Father's Name lFiraL miaae, Iasi, audix) 19. Mother's Name IFIrs1, mkNNe, makkn sumamel Millard L. Wardecker Pauline I. Hollows 20a. IMOmlent's Name (Type (Print) 206, IMOrmant's Mailing Address (SUeel, lily / born, sMte, zip cotle) Lisa J. Markle e R e '1 4 21a. MNtprl d Dispositon ®Cremalion ^ Donation 21 b. Date of Disposition (Month, day, year) 21c. Place m DSposkron (Name d cemetery, aemalay a other place) 21 d. Locelion (City I town, slate, zm code) ^ Bwiat ^ Removal tram Slate i Wes CremNkn a Dorralbn Aumorl:etl ^ anti,-spealry by lAMwllixammerrCarorrora ^vea^Na Jul 21 2008 Smithsbur Cremator Smithsbur , MD 22a. tore al ice/L~~ee for~rsan aging as such) 22b. Licecee Number 22c. Name ant Address of Fedlily 112 W. v~ ••,• $t • ."' '7 - ?" J" '~~ ~" FD 012984-L er-E2'idcer Flmeral Herne Inc. P.o. Bo~c 3 36 PA 17257 Camplele gems 23ec only when corNying 23a. Tome best of my knov4etlge, tleam occurred al me tmie, dale and place slated. (SigneWre andmle} 23b. Ucanae Number 23c. Date Sgned (Morro, dey, year) physnen U not evailede e<Gme of tlwth to certify cause of deem. Items 2426 mull be cangnetl by person 24. Tme M Deetn 25. Date Pmrn~alced Deed (Month, day, yr) 26. W s Case Relerretl to Medical Examiner /Coroner for a Reason OIMr than Cremation or Donation? woo pronounces tleeth. 7:45 A. M. July 16, 2008 vas ^No CAUSE OF DEATH (Sae Inatruct(ona entl examples) r Approximate imervat. Pan II'. Enter Omer bkaatiranl mrAdions mntn6utina to death, 28. Did Tobacco Use Caari6ule W Death? Item 27. Pan I: Eller the their of evens -diseases, injures, or conlpkratrons - that dkatly wusetl the deem. DO NOT enter termir~et evens such as cardiac ertesl, Onset to Death 6u1 not resutling in me undedyirg reuse given n Pan I. ^ Yes ~] Pro6e6y respiratory artesi, m vannpller flDnllelbn wkhoW snowirg the etiology. LM any ore cause on each line. No ~ Unknown IMMEDMTE CAUQE (Final dsease or rnrMition rewlorpm ctrl ->y a. Atherosclerotic Cardiq~ascular Disease CardiomeQaly 29. It Female: ^ Due to (or as a consequence op: r Not pre warm pas, 9~ ~` ^ Pregrenl at ikre of deem Sequenlialty ksl mntlitore, X arty, b. leading to me reuse Dated on kne a. Oce to o as a con 1 Emer IM UNDERLYING CAUSE I r sequence of : ^ tb1 pregraM, Mn gegrianl wlhin 42 days (disease or injury that initialed me t r m deaml LASL events result M death g Due fo (or as a consequer~ca oQ: egrla 43 days ro 1 year [] Not prepnanl, Dui pr nl tl. r before death ^ Unknown g Dregnan widen tlce past year 30a. Was en AMOpsy 30b. Were AMOpsy FlMsgs 31. Alannerd Deelh 32a. Data of Injury (HOMO, day, year) 32b. Descnba How Injury Occurred 3'.?c. Place of Injury: None, Farm, Slmet, Feaay, PeMmwd? Availa6@ Pda to Completion 1o i Aural ^ Homidde Otlica BuikYmg, el4 (Sped~N) auaa as Daam? a c J~• Ves ^ No fff'''"'```"` ~, l UJ Ves ^ No ^ Acddent ^ Pending Imrestigalion 32d. Tme of Injury 32e. Iryury at Wak? 321. It Trensponalron Iriju7 (Speciy! [~ P QP tl O d ^ 32g. Lowlim of InjuN (Street, city / awm, state) fff T` ^ Suipde ^ CoWd Not he Determined ^ Yes ^ No Dmer! perelm assenger esl e en M Other ~ Speay: 33a. Ceneier (tlwdr any me) Sib. Sgnalure ant Title al • Ceditylrg physictan (Physician canayinp cause cf deelh when enolher physidan tors pmnwplcetl deem and aarlPfaled Item 231 - Co ro n e r To the beetMmy knowledge,tlath carted due to the wuae(si entl mamwr as smed.._________________..__________~.__ ^ • Pronouncing ant cataying phyakkn (Physician bolo prarouncinp death entl cedsyirg to cause M Oaethl h t h tm d c l d bfh d d d ^ 33c. Lkelwe Number 33d. Dale SigrnW (Month, tlay, year) e t u, o, em plots, arM ue e uux(s)an mermen as eute __________________ To the ~~atmmy krrowbdge. lot ocaurta e JUl 17 2008 y > • Msdlul ExamlMry Cororer r On the basis of e>ammM' ) a Invealigadon, m my oplnbn, death occurred at the time, date, entl plsce, end tlue m the csue(s} and manner as sated_ ~ ~. / eMAddr~of Berson NCe Ganmle'wd Cause okDeeth lllem 27J Type / Pnnl 36. Registrars Sgnemrea imdaN T I 121 ~ 121 1 I 36. DaleF (Morro, gag year' 6375 BdSehOre Road S1311e X61 M h i b 7050 . - O u ec an cs urg, PA l • / D;z~anion Permh Na ©o7ewa 9,9