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HomeMy WebLinkAbout10-08-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF _ (~i,-,,,.be,(~ (~~ COUNTY, PENNSYLVANIA Estate of a~nhtun j-ar ~~, File Number ~ ~ ~ v0 y ~l/V / also known as ,Deceased Social Security Number ~ '] '~,~'~ Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (CO[YIPLETE A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(/ are the ~~ F Lct.f'U( named in the last Wiil of the Decedent dated rnQ~~~~(P and codicil(s) dated (State relevmu circumstances, e.g., renunciation, death of executor, etc.J 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 Ad (lfapplicable, enter: c.t.a.: d. b. n.c.l.a.; pendente lire; durante absenttn; durante minori[ate) 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.) 1 Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional streets if necessary. Decedent was domiciled at death in ~~ i r ~Qrnd County, Pennsylvania wit/ her last principal residence at l3 o nt, SDY1Ylc (~.r ar1 t".ttt'~l~_P~ l7 i L~ ~ (Lretstreet addreas, town/cu , town~irp, coungr, sta e, up code) Decedent, then ~ years of age, died on ~Lb 2z+~~ at ~ '- ~ Prvl 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 Counry Value of real estate in Pennsylvania ~ 51~{~. t2. situated as follows: ~ S bSl . t l n!I M `- ( t3Cink '~ ~T O o ~ Ci 1Ntiin~ Qr Q~r~ sr-~n ~ [~ltdnl' Wherefore, Petitioner(s) 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: Sin Form R6V-02 rev. !0.13.06 Cr(,~ R13CORDED OFFICE OF RF.GIS'I'ER OF DG'ILLS 2008 OCT 08 CLERK OF ORPI-L1NS' COURT CUtiIBERL.~_~D CO., P.1~. Oath of Personal Representative CONINIONWEALTH OF PENNSYLVANIA SS COUNTY OF C i,t,rlti 12c. (~ k_nd The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are due 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 before me the ~~ day of . ~,o0g For e Register )1 `~ Signature ojPersonal Sigzature ojPersonal Representative Signature ofPersonnl Representative File Number: ~ ~ " ©~ ' / ,(`"'/ Estate of gn~ nfitXl ~'D r /LLi„ ,Deceased Social Security Number: (~~ - bs _ ~ ~g Date of Death: (:{ 1•~ 7 T2 t~ (3~-~_ AND NOW, I ~ _ ~ (~C~1~~, -Gk's=L)-, ifn~cons~i"de,,ra~t"io._n/_o,,f the foregoing Petition, satisfactory proof having been presented before me, I /D~ ,E~C~R(EED that Letters___ (t~Xl C(,rYt1C~Il~l1.L, are hereby granted to ~1~ ~~1,{,1 tLl~~~ ~~ - in the above estate and that the instrument(s) dated ) described in the Petition be admitted to probate and filed of recor as the last Will (and Codicil(s)) of Decedent. FEES ~ ~ /`j ~_ Letters $ ~~. Register ofWills]~Qr Short Certificate(s) ........ $ ~ ~' "' Renunciation(s) .......... $ ... $~_" t~~7~ Z~'~i~. J. $ ~~ = vV ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ z Form RGV-o? rev. 10.13.06 Attorney Signature: Attorney Name: Supreme Court I.D. No Address: Telephone: RECORDED OFFICE OF REGISTER OF `FILLS 2008 OCT 08 CLERIC OF ~ ORPFL~:\S' COURT ,~`' CU\IBERLAND CO., P.1 ~N~ 705905MS REV. 6106 "~ -la ~~ ~~~ a.-, 1. ~ } This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66> P.L. 304, approved by the General Assembly, June 29, 1953• Military Status ,a N1D5-143 REV 11;2006 TYPE r PRINT IN PERMgNENT BLACK INK WARNING: It is illegal to duplicate this copy by photostat or photograph. r . ~-n~-~ ~ o~ Calvin B. Johnson, M.D., M.P.H. Frank Yeropoli Secretary of Health State Registrar 133365 No. MAR ~ ~; 2~g Date COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reversal 1. Name of Decadent (First, middle. Iasi srMlx) 2. Sex 3. Social Security Number 4. Dale of Deatn (Mmlh, day, year) ' Male 174 - 05 - 1788 Feb. 22, 2008 5. Age (Lzs[ Birtntlay) Under 1 Under 1 tla 6. Date of Binh (Month, day, year) ]. BIMIYace (City antl state o ountryl 8a. Place of Death (Check onN one) n " 90 "°"ma °' "°apim' omar: ~ "°'° °"" Feb. 2, 1918 Carlisle, PA Vrs. ^Inpalient ^ER/Outpatient ^DOA ~NUrsilg HOme ^Residence ^Other-Specify. $b. County of Death bc. Cuy, Boro. Twp. of Death Btl. Facility Name (II not Insglulion, glue street and number) 9. Was Decedent of Hispanic Origin? [g No ^ Vas 10. Race: American Indian bock While etc Cumberland South Middleton Manor Care , , , . Health Services nfyea,apedlyr,°ba", ($pac;y, Mexican Puen° Ri"an. aN.) White 11. Decedent's Usual Dccu Iron Kntl of work done tlue most of waki life. Do rat slab refired 12. Was Decetlenl ever in the 13. Decedent's Education (Speciyy only highest gretle compleetl) 14. Marital Sletus: Marr'letl, Never Marnetl 15. Surviving Syouse (It wife give maitlen name) Kind DI WoM Klnd of business I Indust ry U.S. Armed Forces? . , Widowed, Divorced (Spedly) Elementary / Secontlary (0-12) C°Ilege (1-4 or Si) Laborer ruckin Co. ~lYea ^N° 8 Widowed 16. Decedents Mailing Address (SlreeL city i town, slate, zip code) Decedent's Did Decetlenl 136 N. Spring Garden Street Actual Residence 1]a Stale PA Live in a , Ic ^ vas Decedent Lived In Carlisle, PA 17013 ,]ncpanty . , Twp_ Township? Cumberland ,fd.®NO,DeoedentLivatlwnnm Carlisle ' Mael limda "f cdy r Boro 18. FatM1er s Name (first, mirklle, lass, sufiq) 19. Mother's Name IFirsl, midde, maitlen sumamel Har Forne Ma Zinn 20a. Infortnanl's Name (Type / Pnnt) 20b. Informant's Mailing Atltlress tarsal, ciy! town, able, zip code) Marie A. Sanderson 136 North Spring Garden Street, Carlisle, PA 17013 21 avMelhod of Dlbppsd"n ^ Cremation ^ Donation 21b. Date of D'epositlon (Month, tlay, yaer) 21 c. Place of Dlsposigan (Name of cemetery, crematory or other place) 21 tl. Location (City /town state zip code) )[$ 13une ^ RamovalfromSlale I WnCremetlonorDOretbnAulhodaatl ^ - Feb. 26, 2008 Westminster Memori l G d , , C li Olner - Sp city by Medksl Exsmlrer / Cororor7 ^ Yas ^ No ~ a ar ens ar sle, PA 17013 22a. SlgnaWre of Funerel Se ce Licensee arson acting as such) 22E. License Number 22c. Name era Atltlress o1 Facillry Hof fman-Roth Funeral Home & Crematory, Inc. - -~ 138425 219 North Hanover Streets Carlisle, PA 17013 Complete Items 23ac only when certlly ng h s i 2 Te 1i bast of my Mrawletlge tleaM osurratl at the time, dale antl place soled. (Signature antl offs) 23b i e Number 23c to Signed (MOnln tlay year) Len6 p y c ao a not avatlable al t me of tl¢aN to caniry cause o1 death. ~} - .~ 11` E/u/ C /f`J ~ V L a ` t ~~ S J'~, ~ . , , ~~~ ~ 3 ~ ~ ~ ~ ~ N cams z4 r marl be eom elea b W v patron who pronounces tlea1M1 i - zs. Time of Deam ~ rongdnoe ( /. yaer) r,~ zs. Datev d Deaa Montn, da~ ~ ( ~ ~~ 0 z6. O case Rai r ae to Mea'°al Exa,T,o. coroner rot a Reagan o:na tna,~mat°n or onatiom . ~ ~J Nf ,~,~_~,~, ~ ~~JU .. g ~ Ves CAUSE OF DEATH (See lnstruptlone end axempbe) Item 2]. Part I: Enter the chain d event - tliseases, injuries, or corllpliGlions -Thal tllrectly roused the tlealh DO NOT enter terminal M r Approximate interval. h NU Pan II: Enter other 5 ndkant condlions coot D t I d th, M 28. Did Tobacco Use Contribde to Dealn+ . s suc as ca C ertesi Onset to beam respire ory arrest, or venlrkular libdllation wilhrwl slwwing the et'rology. List only one cause on each line. but not resul g in the untledying rouse given In Part I. ^Ves ^ ProbaGly _ IMMEDIATE CAUSE (F'nal disease or / ~ ^ No ^ Unknow " ~ contliticn resulting In tlealh) ~ ~ (Y )n~ ~ _~ t"~Ci ~F -~ I /L. ~ a I ..SKK--- ,,,~~` 29. If Femala. Oue b (or as quanta off'. ^ Nal pzegnanl within past year Seq .ugly 4d contlitrom if any, b leadrg lp the cause IStetl on line a. ^ Pregnant et time of death Enter Na UNDEXLYINC CAUSE Due to (or as a consequarae off: ^ Nol pregnant, but pregnant wihin /2 tlays (disease or Injury Thal indaletl Ina o vents resuking In tlaatnf LAST. of tlealh Due lp for as a consequence oty ^ Not pregnant, ON pregran143 tlays to 1 year d. r before death ^ Unknown If pregnant within the pass year 30a. Was an Autopsy 30b. Were Autopsy Fntlings 31. Manner d Death 32a. Dale of In u Month, tla I ry ( y. year) 32b. Describe Haw Injury Occurred Padortratl? A il i d ° C 32c. Place al Injury: Home Farm Street Factory r ve a or b e ompletion ~/ LS warura! ^ Homidtla f , , , , Office Builtllrg, etc. (Specify) o Cause of Death? ^! ^ Yes ~N° ^Ves ^ No ^ Accident ^ Pentling Invesligalion 32tl. Time of Injury 32e. Injury el Work? 321. It Transpodation Injury (Speciy) 32g. Location of Injury (Street, dly I town. slate) ^ Suicitle ^ Coultl Nol be Dalerminetl ^ Yes ^ No ^ Driv r! Operator ^ Passe gar ^Pedesldan B M ^OIM1er Speufy 7 33a. Certifier (check ony onel • Certdyhq physician (Physician cedityllg cause of tlaatn when another physaian has pronouncetl death and completed Item 23) To the ball f k l d 33b. Signature ant TII ~'~ a ~;' `) ~ C ~ o my now e ge, deffih occunetl tlue 1o the reuse(s) antl manner as ablerJ_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Pronouncing antl cenltying pnysiclen (Ph sic an b r n th i tl lh tl if _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - y i o p o ounc ng ea an cert ying to cause of tlealh) To the beat of my knowledge, tlealh occurred at the time, tlale, antl place, end tlue to the caux(s) and manner ea ebled ^ 33c. Lkensa Num 33tl. Dale Signetl (MOntn, tlay, year) _ _ • Metllcal ESeminar/Coroner _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~%~~ (~ '~ f ( ~ --' ~ 7 / ~ J ~Gl /~ On the beala of examinetlon antl I or Invasllgatlon, In my opinion, death occurred et the time, dale, and plate, and due to the ceuee(s) end manner as ebfed ^ , _ 34. Name and Atltlress of Person WM1C Completetl Cause of Death Illen ' 2]f Type /Print 35. Regis) r' inalure anr.~lat'n - }'''•0a ''~ I a Filed (MOmh, tlay, ear) Darryl Guistwite ~ I l I d I 1 I U I ~ 56 Ashton Streets Carlisle, PA 17015 Dlspositlon Permit NO. l~ I 1 J~1V RIiCORDED OFFICE OF REGISTER OF ~~'ILLS 2008 OCT 08 CLERK OF ORPH_~NS' COURT CL'~II3EKI.:~ND CO., P~~ r'~ LAST WILL AND TESTAMENT of Brinton F. Forney I, BRINTON F. FORNEY, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I give and bequeath all of my estate of every nature and wherever situate to my daughter, MARIE A. SANDERSON, and if she is not living at the time of my death, I give and bequeath all of my estate to the FIRST UNITED METHODIST CHURCH OF CARLISLE, PENNSYLVANIA. 3. I nominate and appoint MARIE A. SANDERSON to be the Executrix of this my Last Will and Testament; she is to serve as such without bond. Should she die before my death, renounce or refuse to serve for any reason, nr die leaving any of r:~~,, estate unadministered, I nominate and appoint the FIRST UNITED METHODIST CHURCH OF CARLISLE, PENNSYLVANIA, as substitute Executor, also to serve as such without bond, with the same powers as are given herein to my Executrix. 4. I hereby suggest that my personal representative retain the services of Irwin & McKnight as attorneys in the settlement of my estate. RECORDED OFFICE OF REGISTER OF VG'ILLS 2008 OCT 08 CLERIC OF ORPH.~NS' COURT CL`IiBERL_~~D CO., P_~ IN WITNESS WHEREOF, I have hereunto set my hand and seal this ogn day of May, 2006. ~ ~ (SEAL) BRINTON F. FORNEY Signed, sealed, published and declared by BRINTON F. FORNEY, the above-named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. .~ ,.. ~ 2 ACKNOWLEDGMENT AND AFFIDAVIT WE, BRINTON F. FORNEY, MARTHA L. NOEL and SHARON L. SCHWALM, the Testator and witnesses respectively, whose names are signed to the 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, that he had signed willingly, that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of their knowledge the Testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. - ~~~ BRINTON F. FORNEY MARTHA L. NOEL SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA . 5S: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by BRINTON F. FORNEY, the Testator herein, and subscribed and sworn to before me by 11~TARTHA L. NOEL and SHARON L. SCHWALM, witnesses, this /8 day of May, 2006. No~arv Public COMM~NW~ALTH OF PENNSYwArvIH ` Notarial Seal Roger B. Irwin, Notary Public Carlisle Boro, Cumberland County My Commission Expires Oct. 3, Zoos Member. Pennsylvania Association Ot Notaries 3