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HomeMy WebLinkAbout09-17-08PETITION FOR PROBATE AND GRANT OF LETTERS RE GISTER OF WILLS OF CUMBERLAND Estate of THOMAS R. SOUTNER also known as COUNTY, PENNSYLVANIA File Number ~ I ' O~~ OQ ~g Deceased (Social Security Number 202-36-6561 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) () N A. Probate and Grant of Letters Testaments and aver that Petitioners is / ar ed in the -'. rY and codicils dated ~ the C ~° last Will of the Decedent dated - ~~ O ~ , n , '~'C7 c_ _ t.~ -+_J t-r~t (State relevant circumstances, e.g., renunciation, d th ojexecutor, etc.) Cf) ~ -- _, Except as follows, Decedent did not marry, was not divorced, and did not have a child boat or adopted after execution of t~~-uhient(s~'ered _ - ~_ for probate, was not the victim of a killing and was never adjudicated an incapacitated pedson: - „~ = r _,_ _. O B. Grant of Letters of Administration ' W (Ijapplicable, enter: c.t.a.; d.b.n.c.t.a.; Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and Administration, c.t.a. or d.b.n.c.ta., enter date of Will in Section A above and complete liter durante absentia; durante minoritate) survived by the following spouse (if any) and heirs: (If of heirs.) Decedent was domiciled at death in Cumberland County, Pennsylvata with his /her last principal residence at 1912 Carlisle Road. Cama Hill (Lower Allen Township) PA 17011 (Ltst street address, town/ctty, townshap, county, state, zap code) Decedent, then 61 years of age, died on July 28, 2008 at I~oly Spirit Hospital, Camp Hill, PA 17011 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property ini, Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania situated as fnllnwc• $ 10,000.00 ~+ ~ ^~ w i u,uuu.UU Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented ~ the undersigned: i ith this Petition and the grant of Letters in the appropriate form to Si na re T d r tinted name and residence ~ ~~ Susan Pearlman ~I 1912 Carlisle Road, Camp Hill, ~A 17011 717-737-9868 i I Form RW-Ol rev. /0./3.06 Iii Page I of 2 (COMPLETE INALL CASES:) Attach additional sheets if necessary. Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND The Petitioner(s) above-named swear(s) or affirm(s) that the statements in he foregoing Petition are true and correct to the best of the lmowledge 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 /Pill Signature of Personal Rep rive before me the ~_~ /~d~ay~of ~ _ -Sbc~S!_(L Signature of Personal Represen I five O -, S ~ CA-~ ~ sT. ` ~j rn , . ~, Fort Re ister g Signature ojPersonal Represen five ~7 t-- `~ L. ~m _ _ _, ~., cr5 ~ ,~ ;Y File Number: -o --i ' ° y r=~-~ 2+ G .. Estate of THOMAS R. SOUTNER ,Deceased w Social Security Number: 202-56-6561 Date o~Death: July 28. 2008 AND NOW, - ~ , Q~,~~ , in consideration of the foregoing Petition, satisfactory proof having been presente efore me, I S DECREED that Letters of Administration are hereby granted to Susan G. Pearlman 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 W 11(and Codicil(s)) of D e ent. FEES /~ Letters ............... $ ~ ~T e wins ~- Short Certificate(s) ........ $ • • (/ Attorne Si ature: ' , Y $~ v~ Renunciation(s) .......... $ $ Attorney Name: Shelly J. Kunkel, Esquire ~' • • $ Supreme Court LD. X10.: 64485 ... $ $ Address: j 109 Locust Street • $ ~~'~ Harrisburg, PA 17101 ... $ ... $ • ' • $ Telephone: ! 717-236-9301 ... $ I TOTAL .............. $ '~ij'0" Form RW-02 rev. 10.13.06 ~ Page 2 of 2 {InS QnG RFC%/n./n~~ ) - -- _ - - ~.~~-Dg ~~38' LOCAL REGISTRAR'S CERTIFNCATION OF DEATH WARNING: It is illegal to duplicate this copy ~y photostat or photograph. Fee for this certificate, $6.00 :*• , P 1454225 ~~ -_-~:-__- -_ Certification Number ~~99lMfNT QE~EQ ..uuxuY„rn''at =v 11/zlws COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF RINi IN INK "E"~ CERTIFICATE OF DEATH (See Instructions and examples on re 1. Name d OecederM (First ndtlde, last, sldfix) 2. Sex 5. Age (Last BiMtley) Untler 1 year Under 1 S. Dale of Binh (Month, day, ar) 7. &nhplece (C eM stele a fore toad ) 61 Maws Deye """' nlxaea Yrs Jan.16, 1947 Harrisburg, PA eb. Cwnty d DuM &. city. Born. Twp. d Death ed. FadMy name (N not kretllution, gNe sweet and numbs) Cumberland East Pennsboro Holy Spirit Hospital 11. DecedenYe linxl Khd d work done most d We. Do not slate retiretl 12. Wea Decedent ever in die 13. Decedents Etlutegon (Spedly only ~ Kind d Work Kintl d 13udneu / Indllfilry U.S. Amtaf Face? Elementary / Secontlary (0-12) . ~(' vefi ^hb 12 18. Decedents Meigg Adders (Steel, dry /lam, slate, zq rode) Decedent's 1912 Carlisle Rd. Atn,alRuidence na.s.b Pennsylvania Cam Hi11,PA 17011 nb.counb ret3mhPrland 18. FeMer's Name (Rost midde, 4u1, sufia) 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 RecorL~ice for~rmanent filing. Id`' AUG 0 1 1008 Local Registrar Date Issued 1LTH • VITAL RECORDS e~ STATE FILE NUMBER Sodel Security Number 4. D inn -ox- ~.-..~. _ C7 ~' c:~ t~ -p ~ r-- 1"+l '1; ~ ~ , _ ~ .70-n ~ =- ~~ G ~ - - a r ~ -•, O w of Death (Month, my, year) n R / OdpdieM ^ DOA ^ Nursing Home ^ Resitlenro ^Other - Specity: 9. Wes Decedent d Hispanic Origin? ^ Vu 10. Race: American Indan, Black, Whqe, etc. (If yea, spedty Cuban, ~D~G Mexican, Puerto Rican, etc.) W [ l l~ e rted) 14. Marital Status: Mertle4 Never Menied, 15. SurvNing Spouse (II wge, 9Ne maiden name) r) Widowe4 Divorced (Speci7y) never married Did Decadent TowuN 7 17c.~ Yu, Decwdem Lived in -S n w r A 1 1 P n Tom, D 17tl. ^ No, Decedent Lived within Adual umilfi d ~, r eao John A. S o u t n e r 19. Mdhefa Name (Flrsl, Irene rtleken wmama) dams 20a Iniamenl's Name (Type / Pndl S usan Pearlman 200. InfamwYS Malkrg Add (Street, city /town, stale, zp cotls) 1912 Car isle Rd. ,Camp Hi11,PA 17011 21a Metlgd d Disposition ^ Burial ^ Removal from Stale ranelgn ^ paragon 21b. Date d Dleposlgan (Month, day, yu0 ~ Was Crerrptlorr a Da1Nbn Authorized 21c. Plata d Dispoeigon IN of cemetery, crematory or ogrer P1ace1 21d. Lowlion (Cky /town, slate, ziP mtle) ^ •svetdr: brMrldkrolExaminerycaonar7 Vea^Nt Aug.4, 2008 Evans Cr matory Leola, PA 17540 re d F ~ Litertsu (a person acting u slxdl) 22b. License Nlsnber 22c. Name ant Address of Fedliry FD-013163-L Musselman FH&CS Inc. ,324 Hummel Ave.,Lemoyria,PA17043 nxrts 23ac ooh/ when cerglykg 23a. To the best of my kmwbtlge, duU occuned at its time, dale ant pace slated. (Sigreluro and IPoe) physiden a nd avesede at time d owM l0 23b. License Number 23c. Date Signed (Monts, day, year) tenily twee d duM. Gana 21-26 must M carplelatl q' person 24. Time d Death 25. Date Pronaxlrotl Deed lMonm, day, yur) whoprrowrxwa seam. a 5 A M. J lJ i 8. ~o CAUSE OF DEATH (See instruetions sn0 ex plea) r Approximeb k qem 27. Pan I: Enter me cAein devents - duuu, injuries, a canpgcatleu -That directly eased me deem. DO NOT eder termiul evens stx:h as cardiac arrest rlttpretay arrest a vlxdricdar Nbritlatgn witlrod atlowkg the etiology. Ust Doty one Cauca an each Ilrb. 1 Onset to Os r IMMEDIATE CAUSE IFtrtel diceam or rondlion malting in ) C~p,2 cp[ Q c ~,1,~s ~- -> a i 1 ~' r lhi,s Sepuew'ek lest ton3liou, H arty, b Due to c~areeq~nce dl. r m lhe b ~ o ~ ~~ ~ r ~/ -_ / / a~ ~ U EMer i he NDER n1 IG CA ~hEea Due tc (a a/ / (evaar res Mgq d~eam~j LAST c. ~b ~'~~~2' f ~i( ~/dY' r 1 z .L _ i/~ . Due to (or u a consequerwe oQ: ~ _~ d. r 30e. Nos an Aubpy 306. Were Autopsy FlrMings 31. Mamer d Deem 32a. Date d injay (Month. day. year) 32b. Deacdbe How I u Occurred PedameQ+ Available Prbr to Conpletlon ~c, rY 7 d Cauca d Duch? S1 Nawrd ^ Ftorriicitle ^ Yes ~No ^ Yu ^ No ^ Acddwt ^ PenArg Investgplpn 32tl. Time d Ir~ury 32e. Inryry et Work? 321. n Trerrepale ^ Suk:kle ^ Could Nd M Determined ^ Ves ^ No ^ Driver / Oq 338 Cergkw (checll ady one) M Other - Sped) ' Cardlyirg phytkden (Physician cergfying cause of dam when arlomar physitlan has praalxxed dam and romDleted gem 23) 33b. SI To tlr Met d my knowledge, deem OLCllrred due to the ease(s) and manner as stated- _ _ _ _' _ _' • ^ Rbnpurldng and Ixrtnying phyeklen (Physican tom prorwundng dam and cenlrying to cause of deaml To the teal of my knowledge, dam scarred at the time, dab, and place, and due to tM cwaNe) and manner u etatad_ 33c. Lx _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • MMkal Exsminer /Coroner On the Mais of euminetlon anti / or imungetfon, In my opinion, deNh oocurretl at the time, dab, end piece, end due to the uusa(e) srM manner u sMtad_ ^ ~ 35. Registrar's Signature tie Number - ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ 36 ~ i ~ co~ ~ S Disposition Permit No. y/(1 C J ~ ~ //k " l 26. Wes Ceu Rebmed b MMkel Examiner / Coroner fa a Reason Other than Cremation or ^Ves ~No Pan II: Eder dhar ~ ~ ~ 23. Did dproo Uee Conlnbde to Dum7 bd nd resuning in me undenlnrlg cause given in Pan I. [Yes ^ Probeay ^ Nc ^ Unknown ?~, ~~s - 29. II Female: ~ ~/AI %9 ^ Not pregnant walxn past year ^ Pregynl al lima d tlutg ^ Not pregnant. but pregnant wiglin 42 days of deem ^ Not pragronl, MI pregnant /3 days l0 1 yur balsa duth ^ Unk it nown Prapum wi1Mn me put year 32c. Plea of IMury: Home. Farm. SIree4 Factory, 00iro Buikklg, etc (Specity/ Iry (SPetM/ 32g. Locatbn of Irpury (Street, dry /town, sale) ^Passenper ^Pedeelnan - .,~~ I aw. caste ~ignec INantn, yeerl ' Oo9t~Ml9d~ ~ IDealh (/Wp12v pa /Print RENUNCIATION VANIA N Q -v ,=,' - - - ~~ ~ t' - Deceased ~~ ~c~ ~- p i ~~x coo`-n Estate of THOMAS R. SOUTNF.R I, Steven Joseph Souther (Prrnt Name) sibling of the administer the Estate of the Decedent and respectfully request Susan Pearlman \\ (Dare) ~ Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills REGISTER OF WIL] CUMBERLAND COUNTY, ~ r - ©g - rya m my capacity/relationship as Decedent, hereby renounce the right to Letters be issued to New umberland, PA 17070 <~~ty, sra , zrp) I Execu~`ed out of Register's Office Before the undersigned personally appeared the party a ecuting this renunciation and certified that he or she executed the renunc on for the pure s s state within on this ~'~ day of vh d ~_ Notary public My Coipnmission Expires: q'r-~~ 2 Q ~ 2 (Signature d Seal of Notary or other official qualified to administer ~aths. Show date of expiration of Notary's Commission.) Form RW-06 rev. /0. /3.06 N~d~ ~ ~Iliam D. Wierman, Notary PubNc New Cumberland 13oro, Cumberland County My Commisson Expires Sept. 15, 2012 RENUNCIATION REGISTER OF WIL] CUMBERLAND COUNTY, Estate of THOMAS R. SnI1T'TVF.tz VANIA C ~' ; GU -. '' s ~ f~_~ "' ~ T ~ -. J .~ rs 1 .. .' .. _ f C` ~ fT1 ~' .~ , c~(~-~, ~ o ~~ W , I, W~ Louise Souther (Print Name) siblin>; of the administer the Estate of the Decedent and respectfully request tr Susan Pearlman (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. IO.I3.06 Deceased >!n my capacity/relationship as rove Decedent, hereby renounce the right to Letters be issued to 521 B idge Street (Street Ad ress) New umberland, PA 17070 (City, Stat ,Zip) ~xecut~d out of Register's Office Before a undersigned personally appeared the party a ecuting this renunciation and certified that he r she executed the renunciation for the purpos stated within on this 2 ''"~ day of ~c ~ zt.~~ 'Notary ublic My Co fission Expires: 7 '-3 ~ ~ ~1. (Signature d Seal of Notary or other official qualified to administer o ths. Show date of expiration of Notary's Commission.) OMMONIAIEAI.TH OF PENNSYLVAN Notarial Seal PatnGa A. C3ordon, Notary Public Fairview Twp., York County My Comrnissfort Expires July 31,2009 M tuber, Penrisylvani8 Association of Notaries