HomeMy WebLinkAbout09-15-08PETITION FOR PROBATE AND GRANT OF LETT
REGISTER OF WILLS OF ERS
~- COUNTY, PENNSYLVANIA
Estate of ~~ y, fi y/ ~~ y~,., -
also known as „r ~ ~~ ~~~'~ ~' o ~ /~~
File Number (, f•',
Deceased Social Security Number ~
- a20 - /~'- //.3.L
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COtYIPLETE 'A' or 'B' BELOW.)
~G A. Probate and Grant of Letters Testamentary and aver that Petition
last Wil! of the Decedent dated _~~// ~~ ~n ,, er(s) is /pre the ~ y PAL f y, y
and codicil(s) dated named in the
(State relevant circumstances, e.g., renunciation, $eatlr of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child tyorn or adopted after execution of the
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
instrument(s) offered
tv
^ B. Grant of Letters of Administration ,.~.Q o
oa
t%? _7_: i_.-~
_~
to _
Petitioner(s) after a proper search has /have ascertained that Decedent left no Willr and wras survived by the following s v ~~) ~ ~
Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete I~st of hetrs.) ~ r r~
- t.
P_ . ~(f~ny) and heirs.e {If r
Name CC..~J ~
;i v `rt ~ -
N
(COMPLETE IN ALL CASES:) Attach additional s/:eets if necessary.
Decedent was domiciled at death in
`~1 County, Pennsylvania with hi /her last principal residence at~__
(Lrs[ s7reet address, [own/city, township, coon ,/ _
t), state, zr code)
Decedent, then ~`3 years of age, died on ~ /Q
at ~p m.
Decedent at death owned property with estimated values as follows:
(If domiciled in PA)
(If not domiciled in PA) All Personal property
Personal property in P~nnsyivania $
(If not domiciled in PA) $
Value of real estate in Pennsylvania Personal property in County
situated as follows: $_~~O ~~
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codirilrcl .,~o..e^._~ _ •..
the undersigned:
ronn KyY-0? rev. 10.13.06
Page 1 of 2
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~ I ~ ~ ,.()
SS
The Petitioner(s) above-named swear(s) or affirm(s) that the statements
the knowledge and belief of Petitioner(s) and that, as ersonal re resentativ s
~n the foregoing Petition are true and correct to the best of
administer the estate according to law, P P
~O of the Decedent, Petitioner(s) will well and truly
Sworn to or affirmed and subscribed
before tr•e the ~ ~`~'y ~ w ~~ ~~
-------~_, day Of Signature Personal Re^-
r .~rnrattve ~
l,.. _ ~ ~V
Oath of Personal Representative
Oath of Personal Representative
COMIvIONWEALTH OF PENNSYLVANIA
r~ ~ ~ y~~ ~,.~ p~~ SS
COUNTY OF l_~~ ' ~ !J ~1 ' ~ _
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in t'he 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 affirmed and subscribed
~ l''' /
Signnture ~f Personal Represejrtative " "
~ ~y
day of
before ire the ~ ~ f7
co °o
~ -;
„
~ ~ ~
~
Signnture ojPersonnl RepreseVrtative -i "p ~ ('r~
_ f-r r T~r
For e Register Signature ojPersonnl Represeyrtative
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File Number:
Estate of Ma~t~ I~ pI'f 1U-C ~l~..T-~ ,Deceased
Social Security Number: ~ +b ~' ~ ~ 3.2 Date of Death: ~ f / ~l'7
AND NOW, ~5~ ~al ~ ~`'~~, ~t La , in consideration of the foregoing Petition, satisfactory proof
having been presented be ore me, IT IS DECyR~EED that Letters ~ S 1~'1PI'T~1~[J
are hereby granted to _ _ ~~ I ~ Q ~ I Y L C ~FI,I"1 JJ _-, - -_-
cJ ~ in the above estate
and that the instrument(s) dated I 2~~2
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES '
l~f ~ Register of Wills (~( r' /~~
Letters ............... $ (^~ U
Short Certificate(s) ........ $_ Attorney Signatuj-e:
Renunciation(s) ......
w ~,~,.~
... $
... $ ~.
... $~~~
... $-
... $
... $
... $
... $
... $
... $
TOTAL .............. $
Atton~ey Name:
Supreme Court LD. No.:
Address:
Telephone:
Form RW-0' rev. !0.13.06 Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 14543841
Certification Number
IEV 112006
PRINT IN
ANENT
:K INK
. f. Name a Decedent (FiM, mitlde, last, sufix)
PaAq.4.(,R f/Oe.GCe AtCC7fl. -(Jt
5. Age (Last BidhtleY) IMdar I Year lhgar 1 mY
klonew °aYr ,mss kanlee
' 83 Yrs.
66. County of Death &. Ciry, Boro, Twp, of Deem
Culnbex.Cand Alechanicebc
11. Decetlents Usual ~ Kntl of work dos du ~ roost d Ile. 0
KIM of Busyesa i
T¢~[nlirla,[ Sexv.i.ee Fx ~ bt/~
16. Decedent's Maikrp Address (Sreetciry /tam. stele, tip code)
1305 App.Ce Dk.cve
Alecban.icabwtg, PA 17055
1B. Femer's Name (First midtlb, IasL soda)
Jamee ~. AICGtt b[n
20a. In(armanrs Name (Type / Pnnl)
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 filing.
SEP ~ X00
~G i
Date Issued
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1-Q ~ t"r7 S.s 3 C" }
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
2. Sex a. Social Secunry Number
„- p,~ 4. Dale of Death (Mordh, tlay, year)
3. Dots o1 BIrM Month, tle , ~A•CE' 220- 18 -~ 1132 Se . 10, 2008
( Y Y~r) 7. Smtdaa (CNy aM state a canlry) Be. a of Deeth Check one)
Ap2.tl 4, 1925 da9~~, AfD omer
!b. Fadlry Name (II rql insmulbn, ^ilnpalieM ^ ER ! Oulpelienl ^ OOA ^ Nursing Hoene ~] Residence
give shad aM number) ', 9. Was Decedent of His ^Olhar . Speciy:
Parxc Ongln? Na ^ Yes 10. Race. American IMyn, Sack, While, etc.
1303 A Dxtve n1 yea. apealy cwan,
Mexkan, Pwro Rican, elc.l (SPecdH
~. s181e reli 12. Wes Decedent ever In the f 3. Decedents Educelion (~~,~
ashy U.S. Amled Forces? (SPeary °nry hest 9rede eomdeled) 14. Mantel Salty: Marred, Never Married, 15. Survive
Elementary /Secondary (I}12) College (1 w 5.) Widowed, DNOroed (Specify) n9 Spouse (II wile, give maiden name)
(Yea ^No 1 ~. u^" •n J
Deadertts Pe-yLeuLyania DldDeuydertl swkva~al.ru R <na R. South
Aaal Residence 17a. Sate
Live in a 17c. ^Yea, Drxydenl Uved m
176. Canty Cwneex~ Township? rrYyll L
17d. Ir~l No, DecMent Lived within "„ „ t _ -_ ~.~UUh TwP
Actual Limis a weca.,aaA~M q
19. Homer's Name (FysL midAe, maiden eumema) City! Bore
Akfltt.e E. Hoe.LPo
M![,b . Ke .f.lla. MC.~ ,~ 20b. Inforrtent's Haling Addreee (SUael, city / lave, atero, zip coda)
21a. MemM pr Dispatleon p~c,emaepn
Banal ^ Removal Iron State ^ Dorietpn 1305 A D~t.tve, 1lechan,~cebwt PA 17055
21b. Dale a Disposition (Monm
day
Year) 21
P
~.~, ~ Was Cremstlprt a Donetbn AuptpnzM
^ Ottier
i M' MMkal Fsammer f Coronary ®Yea ^ No
22
SQ
t ,
,
c.
lace a Dispalllon (Name cemetery, crematory or omer Mce)
P
+
21d. Laalbn (Ciry /sown, state, zip cede)
a. F
Licensee (prperson aangaa such) 2ffi. license N
._ , .
,
wlber ~
.
15 2008 yE
emati.on
S'' et
e
o PA
22c
Name and Add
11aJtJt[dbfLt PA
~
FD-013376-L
c«nplete
z3
.
l
'
_O
~~J n~
ress d Fadkry Aueex ~ell)Ok.(ge Houle slid Gt
2AW.
4 17109
'
tCOn Sexvt
.
k
eeb Irce„
~ r~ 23a. TP me PY , eeem
100 Jo eetown Road, Na~uttbbwt
physicigri a na avNabk at a deem to
A occar~d "" tmte a aM date stated. (sipneture eM tile) 9, PA 1710
/
cxaN ceuw a deem. - / `-""~-~4N C1
N
2
1. ~-s / 23b. Licen a Number _ Dale ~ etl (MOmh, day. Year)
~ ~a--.../.w"l
"
5
ame
~
426 mwt be annlemtl W parson 24. Time Of Dean
~~ 73~ _ ~ /~ ~ ~ ] L
win prmantys loam. Deed (MOmh my
~•' ~
,a
M.
/
,
. ri
,
, / ~ ~,~.~ ~ 26. Wes Case Referred m Medical Examiner /Coroner
Reason Other Than Nervation or D
i
~
onal
on7
CAUSE OF DEATH (See inetructloni s ezamplea) ^Yes
Item 27. Pan I: Ereer me cnan of events - diseases, i
njurks, or mnipkcatbrxs - IAet tlirec0y allaed me deem. DD NOT enter terminal events such as artRec a
r APlxoxinete mlerval; Pan II; Enter Omer '
tesDyemrY+rres6 a venuicWar itbNleAOn withart showin
Oi
tid
~
g
e e
ogy List only oce cause on each hie.
1MMEWITE CAUSE lFklal disease or
/
andaion rmul6ng in Beam) mes6
~ Oneel m Deam
26. Ditl Tobacco Use Calndne to Deem?
r bIK not resultlng in me untlenyng cause given N Pen I. ^Yea ^ Probaby
r
~
v~n ~
-' a. ~' 4
D i ^ No Unknown
r
~.
ue to (rx as a conaeprence oq
let contidona, I airy. ~~`
I~p~ awe Ystetl °° kna a
b. ~'~~' 1 ~ "' ~' ~
, -
~
~ ~
' ~
.
r ~ ~ ' ~ c'~i+.+-. c .. h'ti . x 29. 0 Female.
~ /
.
r
+
Eaer Aie UNDERLYNIG CAUSE Due to (a es a consequence
f ~.
U
~ ^ Nol pregnant within pest year
b/lrs., ~
~rs rerun dmBelem) u t~ a G Li sr ~ .~
~ •~ C "~~ ~
uue to (w as a conse
uen
~ a ^ Pregnant al lime of death
r ^ Na pregnant ba
Pregnant withi
^
4
q
ce og
d. ~ t;
~~~
n
2 days
of deem
r
~ P 30b. Were Autopsy Fmdaigs 31. Memer a Deam ~ ^ Not pregnant, but pregnant 13 days M 1 year
belare tleam
Available Prior to Congklan rte! 32a. Dale a In)ury (MaM, tlay Yeatl 32b. Describe How Inpxy Occurred ^ Unknovm if pregnant within are pass year
a Caua a Deem? rl ~velurel ^ NpnypiM
,.., /
^ Yes L7M Yes
^ ~ ^ Accitlenl ^ Peridrci91nveel bar 32d. Time a I '
~ rMurY 32c. Place of m ury: Home, Farm, Sreat. Face
~, Olio BW~ng. etc (SpaNNI
~~
32
^ Sacbe
^ CaH Na M Dnermywd
l
C e. Injury al Work? 321. II Tnneponeeon I ' /Spau/yl
^ Yes Dever /
^ No ^ Operator ~] Paeeanger ^Pedeatn
M
329. Laatlan d Inury (Sreet city /town, slate)
a.
edlkr (sack Dory one) .
en
r0lhar. Spea'ly:
' Cerftlyhp dtyakkn (' tlealh ad°rtM due to Mee aver physician has pronpurney deem aM complalad Item 23)
To the best of m
uMel and manner se sleted
' P 336. SlgneNn pM Tple a CemOx
~
_ _ _ _ _ _ _ _
rortounchtg aM °~rYm9 DNYaI°len (Pn ' ~
T° tM best of Yswtian bom prawurcing death aM cenirying to awe a deem) _ _' _ _ _ _ _
mY mtrxakdge
deaM oec
d , f ~~
~/s~0
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 6~
,
ums
at the tMra, date. aM place, aM due to the ease(s) aM manner ee Wted_
' Medkel Exammer I Coroner _ _ _ _ _ _ _ _ _ _ ~~ Literrse NUnber
^
_ _
On the bean a axamylatlon eM / or invesdgetlon, M my odraon, deem occurred at tlw tyre data eM ploy, eM dw W the ceuee(e
~O `'J ~ .~ 7 ~
M 33d. Date Signetl (Month, day, Year)
//
J t
~
~9 e r ) a
manner as steted_ ^
34. Nerve antl Address of Person Woo
Corrgkletl Cause of Deem (Item ~ 1 ~ [z a{
~
~ J ~• ~
27
T
~~-
t
- 1 •Y I _ ~ ~ t~ ~ ~ ~ I )
ype / Pnnl
-
36. al~led IMam. day, Year ~. /, /A2 =r /, c.. f /40
Disposition Pen
il N
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o.
ai -c~- 099 N
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LAST WILL AND TESTAMENT ~~~
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MARTIN H. 1VICGUFFIN N
I, MARTIN H. MCGUFFIN, of Mechanicsburg, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding, do hereby make, publish and
declare this as and for my Last Will and Testament, hereby revoking and making void any and all
wills by me at any time heretofore made.
1. I direct that all my debts and funeral expenses be paid as soon as practical after my
death by my Executrix hereinafter named.
I direct that all taxes that may be assessed as a consequence of my death shall be paid
from my residuary estate as part of the expenses of the administration of my estate.
2. All the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, I give, devise and bequeath to my wife, REGINA R.
MCGUFFIN, provided she shall survive me by a period of sixty (60) days.
3. In the event my said wife, REGINA R. MCGUFFIN, should predecease me or fail to
survive me by the aforesaid period of sixty (60) days then in such event, I give, devise and
bequeath my Estate to my daughter, COLEEN M. CLINESCHMIDT.
4. In the event my said daughter, COLEEN'M. CLINESCHMIDT, shall predecease me, I
give all the rest, residue and remainder of my Estate, real, personal and mixed and wheresoever
the same may be situate to ST. JOSEPH'S CATHOT,IC CHURCH of Mechanicsburg,
Pennsylvania.
5. I hereby nominate, constitute and appoint my wife, REGINA R. MCGUFFIN, as
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
Executrix under this my Last Will and Testament. In the event she should predecease me or fail
to qualify, I nominate, constitute and appoint my daughter, COLEEN M. CLINESCHMIDT, as
Executrix under this my Last Will and Testament. I further direct that no Executrix appointed
hereunder shall be required to post bond to secure tl~e faithful performance of her duties in the
I
~ ~
Commonwealth of Pennsylvania or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and
Testament written on two (2) pages this 11th day of March, 2002.
( AL)
Markin H. McGuffin~
Signed, sealed, published and declared by MARTIN H. MCGUFFIN, the Testator above
named, as and for his Last Will and Testament, in' our presence, who, in his presence, at his
request, and in the presence of each other, have hdreunto subscribed our names as attesting
witnesses.
(SEAL)
,~,
f ~,
~~ j r
~ ~ ~ (SEAL)
~~_
LAW OFFICES
SNELBAKER,
BRENNEMAN -2-
& SPARE
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY OF CUMBERLAND ~
We, MARTIN H. MCGUFFIN, PHILIP H. SPARE, ESQUIRE and JANE J. GOONEY,
the Testator 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
Testator signed and executed the instrument as his Last Will and Testament and that he had
signed willingly, and that he executed it as his free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the
Will as witness and that to the best of his or her knowledge the Testator was at that time eighteen
years of age or older, of sound mind and under no constraint or undue influence.
~r
/~
Testator
fitness
,~ ~
W' ness
Subscribed, sworn to and acknowledged before me by MARTIN H. MCGUFFIN, Testator, and
subscribed and sworn to before me by PHILIP H. SPARE, ESQUIRE and JANE J. GOONEY,
witnesses, this 11th day of March, 2002.
v `-1
Notary Pub '
LAW OFFICES
SNELBAKER,
BRENNEMAN
& SPARE
~t~ sear
~~ ~~ CuRS~etfand Coenq,
Expires Nov 24, 2003
DBT, f~U1~-!li& fi3A 01 N f~93
CERTIFICATION OF NO'T'ICE
REGISTER. OF
~u~nb~Y/r~n~ COLN1
-ER Pa. O.C. Rule ~.~(a)
(ILLS
. PEN:~'SYLVANIA
Name of Decedent:__ 777,4 -'~ ~ ~ ~/, m ~~ /~J
Date of Death:_ 9~/b~Q p ile Number: 02048" - 06 9'd 9
Date Letters Granted: 9~/.S~OI~
To the Register:
I certify that Notice of Estate Administration required by Pa. O.C. Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficia ies of the above-captioned estate on
~s ~_~
Name: Address:
L~~°~U/~ ~ ~ Y~ ~'G1r~Fi1[ /~ Yi 1%~ ~1 PC'I/ yl SOS bt[ `Y p/.~
i7Grs-
(Ifmore space is needed, attach separate sheet.)
Notice has now been given to all persons entitled thereto
Pa. O.C. Rule 5.6(a) except:
Date/,, /Q~
117
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N
ture o Person Filing this Fon
Capacity: Q Personal Representative ~ Counsel
/~. 71')~
.Nam Pe son Filing this Form
~ i ~Y~ v~
Address
Telephone
,~
Form RGY•08 rev. 10.13.06 Iii
~I