HomeMy WebLinkAbout09-22-08_ __
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of ELIZABETH A. GIFFIN
also known as
Deceased
File Number ~ t G U o ~'l~
Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~ named in the
last Will of the Decedent dated 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 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 Administration
(If applicable, enter.• c.t.a.; d. b.n.c.t.a.; pendente life; durance absenria,~ durante 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: (If
Administration, c.t.a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
_ Name Relationship Residence
DONALD C. GIFFIN, JR. SON 1934 KENT DR., CAMP HILL, PA 17011
DONALD C. GIFFIN ~ HUSBAND ~ DECEASED: AUGUST 20, 2008
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was, damiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal residence at --~
11 BGXWOOD DR LOWER ALLEN TWP CUMBERLAND COUNTY PENNSYLVANIA 17011 ca
(List street address, town/city, township, county, state, zip code) ~ ~ ~
to
Decedent, then 83~ years of age, died on MARCH 22, 2008 at HOLY SPIRIT HOSPITAL ' '-~ ,-~ B
~- __
-- -
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Decedent at death owned property with estimated values as follows: -' ~ --, e ->
(If domiciled in PA) All personal property $ ..,~ _i~ ~ 10 000.0
(If not domiciled in PA) Personal property in Pennsylvania $ ~ =J . ~ _ -
(Ifnot domiciled in PA) Personal property in County 5f~ ~g : ' ?
Value of real estate in Pennsylvania $ N
situated as
Form RW-02 rev. 10.13.06
Page 1 of 2 ~~~~
~/
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the gant of Letters in the appropriate form to
the undersigned:
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 lrnow]edge and belief of Petitioner(s) and that, as personal representative(s) of~e Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed ar~d subscribed
bef re m2 the ~~ ,/~d'ay f
~'v
i
For the Register
File Number:
Signatlrs~eofPersonalRepref to Je'V~ /r
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Signature of Personal Representative :7 r+ f'~'1 ,
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Signature of Personal Representative ~ --. _
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Estate of ELIZABETH A. GIFFIN
Deceased
Social SecuriQty Nulmber: 1I8_8-20-9104 Date of Death:MARCH 22, 2008
AND NOW, ~QT-6 ~~1~J. a'~ , _o r ~, in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters OF ADMINISTRATION
are hereby granted to DONALD C. GIFFIN, JR.
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 Wi~l (and Codicil(s)) of Decedent.
FEES u ~ -~JUUI.I 11 <
Letters .... lG/. ~~ .... $ -1S egister of Wil s
Short Certificate(s) .. 5 ... $ 02 ~ Attorney Signature:
Renunciation(s) ........
.. $
/al,, f C- Q ... $ `~ Attorney Name: LIS MARIE COYNE
~1 ~J / ... $ .S Supreme Court LD. No.: 53788
$ 3901 MARKET STREET
$ Address:
. , , $ CAMP HILL, PA 17011-4227
... $
... $
~~~ $ Telephone: 717-737-0464
... $
TOTAL .............. $ 0.00
Form RW-OZ rev. 10.13.06 Page 2 of 2
105,gp5 RF,V f01/g71
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
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.
P 14124038
Certification Number
~~m.. i ` M z 5 ooa
Local Registrar Date Issued
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REV 11/2008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS -~ N -
~^"E IN CERTIFICATE OF DEATH N
CK INK
(See instructions and examples on reverse) ~,,T< <„ ~,,,, ~„ ^ , o ~~ ~~
1. Name a Decedent (Flrst, mklile, last, wNa) 2. Sex 3. Social Security Number v l v `+
d. Date of Death (MOnlh, day, year)
Elizabeth A. Giffin Female 188 -20 - 9104 March 22, 2008
5. Age (Last Bidhday) lhitler 1 year Ualer 1 as 6. Date of Bidh (MOnm, day, err) 7. Birthplace (Gity and Nate a loreign camtry) Ba. Place of Death (Check only one)
83 xromns Days cram ktwxxee ~,dag ~:
01-23-1925 Petersburg
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PA
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I,npadat ^ER/ompatienl ^DOA ^N
~ ursing HOme ^Residerwe ^Omer-SpeaN:
eb. County of Deam Bc. Cky, 8oro, Twp. a Death Btl. Facility Name (K rot inst4ution, grve sheet and armber) 9. Was Decedent of Hispanic Odgin? No ^Ves 10. Rap.Amerk;an Indian, BKick, White, etc.
Cumberland East PennsbOro Twp (If yes, specify Cuban,
Holy Spirit Hospital Mexican,PuenoRipn,etcJ (gp~,[»
White
11. DecetlenYS Usual ecn KiM a work dare tlu - most of life. Dona Mete tali 12. Was Decedent aver in me 13. Decedent's Education (Spr!crfy oril y highest Breda completed) 14. Marital Satus: Mamed, Never Mameq 15. Survivirg Spouse III wife, give maltlen name)
KiM a Work Kuo a Busipsc / IMuslry
Ac Dept. Of Agricult U.S. Amred F~ s? Elementary / SecoMery (0-12) College (13 or 5+) Widoweq Divorpd (Specify)
re ^vaa No 2 Married
onald C. Giffin Sr.
16. DecedenlnnsM...ailing Address (Street, ciN /town, state. zip wde)
11 [7V xwDOd Ln . Dapadanra Dro D~^t Lower Allen
Aciuel Resitlenp t7a. Slate PA live in a 17c. ~ Yes
Decedent Loved in
Camp Hill, PA 17011 .
TownsMp? Twp.
~„ad w;mm
17b. County Cumberland 17d.^~~9c ~¢Sr
o c~N / aaro
18. Famer's Name (Flrs4 rtcdae, lest au8ix) 19. Homer's Name (Fast mddle, rttaiden sumama)
Carl Cummins Rebecca Irvin
20a. In!«manYs Neme (type / Pdntl 20b. InlamanCS Mailing Address (Street dry / rown, state, zip code)
Donald C. Giffin Jr. 1934 Kent Dr., Camp Hill, PA 17011
21a. Medved a Diappition 1 ~Cremetbn ^ paregon 21b. Date a DiaDOSilnn (Mpm, day, year) 21c. Place a DiaPpikon (Name a cemetery, crematory a other place) 21d. Location (CNy / tam, Nara, zip coda)
^ 19wial ^ RemovalhanState ~ waecrematloaaDmNbnAuthorhed
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2008
March 25 Hollinger Funeral Home &
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o9ler.spacdy:
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22a.
Funeral
as 22b. License Number 22c. Name and Address of FaciNly Myers-Horner Funeral Home
- 014819 L 1903 Market St. Hill PA 17011
Complete Items 23a<aily when pditying
Weatnmeadeamlo
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~ 23a. To t a my Imowledge, m occured at ~ ,date and place staled. (Signature and ode)
~ 23b. License Number 23c. Date SNyfedl(MOnm, day, y
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sems 2428 mull M cesnPleted M person 24, Time o Death 25. Date P raced DeaQ (Manor, der ,year) 28. Was Cesa Relened la Medical Examiner /Coroner
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~ for a Reason ghat man Cremation or Donalbn?
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CAUSE OF DEATH (See Instructlons a examples) r Approximate interval: Pad II: Enter omrer Noni8pnl cerxfikala n.nrih fires to loth,
Item 27. Pan I: Enter the amain of events -diseases, injuries, a artlpacaKOnc - mat areaN caused me dam. W NOT enter terminal everts such as cardiac araN, r Onset ro Deam but nor rasaan m the undo
9 ~ rtying cause given in Pam I. 28. Did Tobago Ua Cantdbute to Death?
^ Yes ^ Prppabty
respiratory artesL a venlricaar fibdpatron wimoa showing the etiology. Lill pmN aw cause on each line.
~
pAMEDIATE CAUSE 'Final disease or ^ No ^ Unknown
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caaKOOn rauhing in deem) ~'
C:hIL1
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A 29. If Female:
.y
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Due to (« as a aerate oq: ^ Nol pregnant wNun pest year
/ ~
Segepnt~agy hst caldtbns, if airy, b, r•'~„~y,~,,.,y,y,':'_ Ga+N-~(;/~ i JD,,I~~FWU i
leadrg to the cause Nsted on Yne a. ^ Pregnant al time of dam
pa ro (a as a aerate o
Eger me UNDERLYpIG CAUSE ~~ ~~ ~
^ Na pregnant, but prelpant wdhrn 42 days
(dreeaee«kywymat;at~tadme ~. G..v;,r,~.yu ~?-~e,w D,~'er.~.t.G r
events resulting m dash) LAST. r aaam
Due to (« as a co rw:e oQ
r ^ Na pregnant, ba pregnan143 Sys to f year
d r belae loam
^ Unknown if pregnant wmhin the past year
3De. Was anAWOpay 30b. Were Autopsy Findings 31. Menpr a Death 32a. Dale a Inury l~h. ~Y Year) 32D. Descdbe How Injury Occurred 32c. Place a Injury: Home, Farm, SIraL Factory
Pedametl?
AvaBable Prpr to Complatgn
rV
l' /Natural ^ Homicide ,
OX'ce Building, etc (Spacily)
of Cause of Deam?
^ Ves ®No ^ Yes ^ No ^ Acddent ^ Pendng InveNigelion 32d. Tana a Injury 32e. kryury at Work? 321. g 7ranspor189on mWY (SpaaN) 32g. Locaton of Injury IStreet dry /town, state)
^ Sridtle ^ CaM Na p DNendned ^ Yes ^ No ^ Driver /Operates ^ Passenger ^Pedeslrian
H Omer ~ SpeaYy:
x+a. cedi8er !check onN one)
• CeHKying physlelan (Physiden caNNing cause of deem when anaher physician has prorwuncetl deem antl mmptetetl Item 23) 33b. signature aM raeaCeNfier
~ Will)am P. Apollo, MD, FACC
To the best a my kmwledge, dam opurrcd due to the cease(s) and manner a sMed_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ C.--
- G / ~ Mott Heart & Vascular Group
• PronounNng arW prtdying physklan (Physiden both pronamuting poor eM pnilying to taus a dam}
To th
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33tl. Dale Signed (Haan, day, yar)
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o the puWs) and manner ea Nated_ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _
• M
dkal Exemlpr /Corone ,
P1D CLy
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On the heals of examination arM I or Inveetigatbn, In my opinion, deem occurred at me Uma, date, and ptap, arM due to the cauags) end manner as stated- ^ ,0
- 3/ J 1
Uts
y1 Norma aiW Adtlreas a Penon Who Completetl Cause of Deem (Item 27) Typo /Print
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35. Registrer's ~ re and Disl' r~
~ J o2~ 1 ~ ~~ / ~~ ~ 36. Date Fled (Month, tlay, year) Wpllam P. Apollo, MD, FAI;C
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