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HomeMy WebLinkAbout10-08-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~',ym berl Q~d. COUNTY, PENNSYLVANIA Estate of 1 y 1 (.._ ~ I C. ~ ~ ~r~ 1 f;( Cj e- t~G ~ - CJO ' /D ~! File Number also known as Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) r.a *~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the '~ nar~;l in the-- ~ ~- last Will of the Decedent dated and codicil(s) dated -- p i, : ~', `~ ', :,-~ -_j r-- t , ~- (State retevnnt circumstances, e.g., renunciation, death of executor, etc.) - ~+° CO - ~ , .-_ -, Except as follows, Decedent did not marry, was not divorced, and did not have a child' bom or adopted after execution of the jns , ~ ` (s) of~ed for probate, was not the victim of a killing and was never adjudicated an incapacitated,person: ~ -- r ~ ~ ~°r t~ --t .~- _ "s B. Grant of Letters of Administration ~ Y ~ G (Ifapplicable, enter.• c.t.a.; d.b.n.c.t.a.; pendente lire; durance absentia; durance minoritate) ~~ (COMPLETE IN ALL CASES:) Attach additiotta[ s/reefs if necessary. I,~cedgnt was domiciled at death in Cum bar I ~m~ t,,, his ~ ~ ~ stpr~ cipal residence at (List street nddress, town11/city, township, county, state, zip code) o S Decedent, then d~ ~ years of age, died on ~ 8 ~ ~ at __ ~ L~ S P 1 ~ i T I~-a5 P l'T~r ~-- Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Persona] property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania situated as Fa-m RW-0? rep-. to-13.06 Page 1 of 2 $-~ ~ ~ 8 ~ . $ ~ $ ~ $ ~ 7a ~Q~ Petitioner(s) after a pcoper 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, or d. b. n. c. t. a., enter date of Will in Section A above and completg list of hei f the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTYOF_ Wm b~~'`" IQ1V1 ~. . The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con•ect 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. ~~ Signature of Personal Representative ra Signature of Personal Repr-esentative~ ~ u~ - ~~ '- ~ ---I r' ~ -`.-i Signature o,~Personal Representative -'. ~~ ,' ._>~ ` ~ - - ._. _. ...~~ i --• ~.; _ ~ --7 • ,. ~D - _:_ _ .-) ~.__ - _ '~3 File Number: ~' Y ~ ' ' ` , Estate of N ~ CQ-(~ ~.E M , D ~~+~~ ,Deceased Social Security Number: ~ (~p ' ~ g - g ~ a 9 Date, of Death: ~ j $ ~ d AND NOW, ~~ in consideration of the"foregoing Petition, satisfactory proof having been presented before m , IT IS ECREED that Letters ry11,-~.,.c I cy' V~ are hereby granted to and that the instrument(s) dated described in the Petition be admitted to probate and filed of FEES Letters ............... $ W Short Certificate(s) ........ $ . Renunc'ation(s) .......... $ . $ ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ in the above estate Attorney Name: Supreme Court I.D. No.: Address: Telephone: Fa•ui RW-OZ rev. lU.l3.Ob Page 2 of 2 Sworn to or affir~ d at~d subscribed Attorney Signature: " 705.112REV.1!OS WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR aI ~~b,I©/~ (FEE FOR THIS TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. cERnFicnrE $s.ool COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH ~~.. ~~ ~PLZN OF pF~ ~ ~~ y~~4 ~~ ~`p~~i ~~ ~aG CERT. N~. T 6 1 ~ 3 5 ~'~ yo ~. ~ April 14 , 2.008 z hj~l l9lMEN 0 O~P~ Date of Issue of This Certiecatlon `~~~~R1\'~~~ Name of Decedent Nicole M., DeBiase Fist Middle Last Sex Female Social Securit No• 19 6 6 8 ~ 912 ~ Apr i 1 8, 2 0 0 8 Y bate of Death Date of Birth July 22', 1985 Birthplace Harrisburg, ' PA Place of Death Holy Spirit Hospital Cumberland E. Pennsboro Twp. Penns Ivania Facility Name County City, Borough or Township Race White Server Occupation Armed'Forces? (Yes or No) No Never Marriec~ecedent's $15 Tamar road Mechanicsbur PA 17050' Marital Status ailing Address g Numbar -' Street City or Tov. ~ S[ate Informant Danne W. DeBiase James F. Nickel Funeral Director Name and Address of Nickel Funeral Home, P.O. Box 910..,, Loysville, PA 17047 Funeral Establishment ' Interval Between Part I': Immediate Cause Onset and Death ~a) Adverse Effects of Morphine/H~ron s ,: _.~ _ - M ~ _. r-- it r ~ ~, ~ ~d) Part ll: Other Significant 'Conditions ~ ;~~; ~ ~, .- ~ f-~ ~ . r . i-~ ~; ., - .. Manner of Death -~' ~::~ Describe how injury occurre~: .~ _, ._..7 Natural ^ Homicide ^ Misuse of i'll;ct Drugs Accident ~ Pending Investigation ' ^ Suicide ^ Could not be.Determined ^ Name and Title of Certifier Michael L. Norris Coroner 6375 Basehore Road, Suite ~1 MechanicsburgM~ pA •~'. ~© ner, M.E.) Address This is to certify that the information here given''is correctly copied from an<original certificate of death duly filed with me as Local Registrar. Thee original:certificate will be forwarded to the State Vital .Records Office.. for permanent filing, Q. 50-•4.:55 cal Reg sharof >ltal Records Ostr~ct:tJo April 12, 2008 O1 Barnett St:, New :Bloomfield, PA 17068 Date Recervetl by Local Registrar Street Address City, Borough, Township FAX 7177289920 GIESELER&JOYCEINSURANCEA (7~f ~~`~~`~ r I~002/002 x~- Ru~istor of Wills of Curnberl,u~~ Co' ~ttltty BOND MD SURrTY FOR 1 i/RS©11AL ~tEPRES ~ ~ ENT~'~ c~ -_ Esrtttc of + ' ~' ` ' Nicole Debiase ~ ? --ti No. 945870146 ':_-; ,-~ s Also known as Nicole Debiase - '.~-- ~ . -, - ; ~- ~ ,- _ _ ..._r UCCdaSCCI - L.A3 ,-. Dannie & Deborah _y~ ~ KN~w ALL i3Y Tl~IESC I'KrSEi\~TS, that ~` Erie '-' ~ ~-s principal(s) and Insurance 7s surety (sureties) are held And flrmty bound unto the Coirnnonwealth of T+ennsylv~~i$ i~~ the sum of thirty thousand (5 30, 000 to ba vAiU to the Commonwealth, for wi~;eh payment eve do bind ourselves, j d Illy and severally, our 11ciix, executors, adminisrrntors ~d succc~svrs. the condition oFlhis ohlfggtion being that if Nicole Debiase fiducisrycspaetry) administratrix a'(stata Nicole Debiase afthc estate of ---~r-~__ _.._._ __. . deceASad, or any of than, shall vvel! Ard according to Is~v, then this obligation shn1l be void ~iY 9dminister the estate ad~riinister the estatz and his or their surety or suretie t cult othanv s° it shall remain on ~1i foeCeatives who slta.ll So 5t~nccl and Sealed this ~ 8th day or October he legally bound heruby. ~ x0-~08-_. each intending ro (SaAq S naturr ~ ~R ~~~~" of Pzrsonal ReproseptAtivd ~, 5ignan~rc of Persona] Repressentarive Sio aturr of Persona! IZepresenrative ~lcndityg ,q r Douglas N. Fitzgerald/Attorney in Fact