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Home My WebLink About09-17-08 (2)PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of THOMAS R. SOUTNER also known as COUNTY, PENNSYLVANIA File Number _ ~ I - V~ ~ ~~ ~~ 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.) hJ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the n `~ red in the last Will of the Decedent dated and codicil(s) dated ry __ ~ro rn .~ r-- ~-- m - (State relevant circumstances, e.g., renunciation, death of executor, etc.) `' CJ7 ~ "^~ - ~n~~ ~ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the ~rii~iient(s~fered . - for probate, was not the victim of a killing and was never adjudicated an incapacitated person: - ~7 r D ~ B. Grant of Letters of Administration ~,,~ (q app[tcabte, enter: c.t.a.; d.b.n.c.t.a.,~ pendente liter durante absentia; 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: (/f Administration, c. t. a. or d. b. n. c.t.a., enterdate of Will in Section A above and complete list of heirs.) ndy Louise Sibl 521 Bridge Street, New Cumberland,PA1 102 Parkview Rd., New Cumberlanri Pay 7070 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 1912 Carlisle Road Cam Hill Lower Allen Townshi PA 17011 (List street address, town/city, township, county, state, zip code) Decedent, then 61 years of age, died on July 28, 2008 at Holy Spirit Hospital, Camp Hill, PA 17011 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 10,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: TOTAL $ 10,000.00 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: Sienature T Qom,. I Susan ~ Pearlman 1912 Carlisle Road, Camp Hill, PA 17011 717-737-9868 Form RW-02 rev. 10.!3.06 Page I of 2 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 lrnowledge 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 ]aw. Sworn to or affirmed and subscribed before me the ~~ day of ~`LG.1L ~ ~ ~L Fart Register /P~1L~ Signature ojPersonal Rep ~ Q~~ Signature ojPersonal Representative Signature ojPersonal Representative r~ ~ ~,. r` i _. ~ ~ ._ ~ ~7~T ~ File Number:__ ,~ ~ ~ ~ ~ 9 i3 ~ ~ D ~. Estate of THOMAS R. SOUTNER ,Deceased r O w Social SecuFity Number: - _ Date of Death: Jul 28. 2008 AND NOW; ~ b 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 Will (and Codicil(s)) of D e ent. FEES o / .• Letters ............... $ ~ ~ Re ~ ~Wi!!s ~x~- \ r~ Short Certificate(s) ........ $ ~CG• ~ Attorney Signature: ~ ~ ~"~.-.- Renunciation(s) .......... $ ~ Attorney Name: Shelly J. Kunkel Esquire ... $ ~" ' ' $ Supreme Court LD. No.: 64485 ... $ ... $ Address: 109 Locust Street ' ' ' $ Harrisburg, PA 17101 ... $ ... $ $ Telephone: 717-236-9301 ... $ TOTAL .............. $_ O~ -$$0" Form RW-01 rev. 10.13.06 Page 2 of 2 I(IS.urrn RF~'tnl.n,, ~~-i~~C~'~/~8 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat olr photograph. Fee for this certificate- $6.00 P 1454~25b Certification Number I :v nnoofi RINT IN NENT :INK This is to certify that the information here given is con•ecdy copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. LG~ ~ ~ AUG 0 1 1008 Local Registrar Date Issued C7 ~~ c; ~ ~ __ J 1 ~~ rn `~' ~ ~~~ -v i 7~ ~ C7 c ~ r .. . '~ yQ-r~ [7 ~ iT> C= ~ .~ . ~ A - O W COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) t. Name M Decedem (First. mitltlle, IasL sudixl STATE FILE NUMBER 2. Sex 3. Social Security Number 4. Dale of Death (Month, tlay, year) 5. Age (Last BirlMay) Under t year Under 1 day 6. Oats of Btrth (Month, day, year) 7. Birthplace (CAy and state or torsi n count 2 - 3 6 6 5 61 J U 1 2 8 2 0 0 MmNS Days Hers Minulea 9 ry) 6a. Place of Death (Check Doty one) 61 Jan. 16, 1947 Harrisbur~,PA "ospnal Other: Yrs. Bb. County of Deatn 8c. City, Bom, Twp. of Death ^ Inpatient I~R / Oulpaliem ^ JOA ^ Nursing Home ^ Residence ^Other ~ Specity: 8d. Fadlity Name (II not instdmion, gNe street and number) 9. Was Decedent of His anic Ori in? P g No ^ Yes 10. Race: American Indian, Black, VJhae, etc. Cumberland East Pennsboro Holy Spirit Hospital u'YeS,apeGfyaDan, ($pep! Mexican, Puerto Rican, etc.) W rl l C e 11. Decedent's Usual Occ Ibn (Kind of work tlone dwin most of world Me. Do not stale retired 12. Was Decedent ever in the 13. Decedent's Education (Specity only highest grede completed) 14. Marital Scotus: Married Never Married, 15. Surviving Spouse (If cads, give maiden name) Kind of Work Kind of Business! Industry U.S Armed Forces? Widowed, Oivcrcetl Elementary! Secondary (0-12) College (1-4 or 5+) (Specify) Yes ^No 16. Decedent's Marling Address (creel, dry /town, state, zip code) Decedents 1 2 never m a r r i e d 1912 Car 1 1 S 1 e R d. Actual Residence t 7a. sate Penns Did DepeaeM Y 1 V a n 1 d Live Ina t ~ C o m H 1 11 , P A 1 7 0 1 1 rib. county 7p. ve,r Decedent LNed in ~. n Township? r n m h a r l a n d t 7d. ^ No Decedem Lived warm or o ,- D,, Twp. 1 S. Father's Name (FIreL mitltlle, IasL suNx) Aduel Umils of ' Clry / Boro John A. S o u t n e r 19 MMher s Name (First, midtlle, maiden surname) 20a. Informant's Name (Typo /Print) Irene Adams Susan Pearlman 20b. Informant's Maikng Address (sreeL city! town, state, zip coda) 21 a. Method of Disposition 1912 Carlisle Rd.,Camp Hi 11, PA 17011 remotion ^ Donation ^ Burial ^ Removal from State Wes Cremation ar Donation Authorized ^ 21 h. Date of D¢poskion (Month, day, year) 21c. Place of Ois Position (Name of cemetery, crematory or other place) 21 d. Locati on (Clly /town, slate, zip code) r'~dY !6yMedlcalExeminer/Cororrer? yes^Np N M F Aug.4, 2008 Evans Crematory Leola PA 1740 re une Licensee (or person acting as suchl 22b. License Number 22c. Name and Address of Facility , ~t ~'~~'~'~ le hems 23 h FD-013163-L Musselman FH&CS,Inc.,324 Hummel Ave.,Lemoyna PA17043 ac Dory w en carkying physkian a rid availeMe al li M d 23a. To the Desl of my knowledge, death occurted al the time, dale and place sWtetl. (Sgnature and INIe) , ma eath l0 cenAy cause d death. 23b. License Number 23c. Date Signed (Month, day, year) Items 2q~26 must 6e cpmpleletl by person 24. Time of Death 25. Dale Prorrouncetl Deatl (Month, tlay, year) who pronounces death. n ~ ~ M 7t ~ u ~ p ~y ~1 /~ ' 26. Was Case Refened to Medical Examiner /Coroner for a Reason Other Than Cremallon or Donation? ^ V CAUSE OF DEATH O r~1 (. l% es ~No (See instructions antl exa plea) Item 27. Pen L E Ie the tllain of even ~ diseases, injuries, or canplications - Thal areaty caused the tleath. W NOT enter lertninal even resdstory enact or ventric l tibnll ~ Afaproximale interval. ts such as cartliac arrest Pan II: Enter other simiflcanl cond'I'on o M ~ f - I d'-th, 28 Did obacce Use Conlnbule t D u ar atkn without slowing the etidogy. List only one cause on each line. , ~ Onset to Death but not resulting the undertying cause given in Pan I. o eaN? Yes ^ Proha6ly IMMEDIATE CAUSE IFinal dsease or dn A condition resukirg in death) C'P`~lQG µ,~~~s./y -~ a. , y / G r r ~ N / ^Na ^Unknown D to s a consequence of) r ~ ~ ~},Q ~~ + / .C(~Cr-CS 29. If Female: . SequeMialry list conditions, if any b. Z J ti ~2 t+ ~ ~~~ - // ~ leafing to dte cause I¢ted on line a. f('!A Enter the UNDERLYING CAUSE Due to (o a cons uenc f I ~! e , _ // O /~A~!* ~' y ~ /~(~ //~ ^ Not Dregnant wilnin past year ^ Pregnant al lime of d th eq e o t. (Grease or injury Nat inkiated the c ~~ •~ ~ ~y /v(, d ~ . events r ~l m ; // ea ^ Nol r na l e h . ~~ zy,,~~~, ew o rg in death) LAST. _ [ /~J l~ Duet (o a rn seq ante off. , i / (/~ n . P u! g Y 9 Pre nanl within d2 da s of death d. r ^ Not pregnant. but pregnant q3 days to 1 year 30a. Wes an Auopsy Performed? 30b. Were Autopsy FirMings Available Pdor to Complelkn 31. Maurer of DeaN ~ 32e. Date of Injury (Month, day, year) 326. Describe How Injury Occurretl before death ^ Unknown if pregnant within the pass year of Cause of Death? o/ 41 Natural ^ Homkide 32c. Place of Injury: Home, Fann, Street, Factory, Office Building, etc (SpeciyyJ ^ Yes ~NO ^ Yes ^ No ^ Acddent ^ Pending Investigation ^ S 32tl. lime of Injury 32e. Injury a1 WoM? 32f. If Transportation Injury (Sped! Y/ 32g. Lacalbn of Injury (Street, city ! town slate) mckle ^ Could Nol be Determined ^ Yes ^ No ^ Dover I Operelor Passen ^ gar ^pedeslnan , 33a. Certifier (Check Dory one) M ^Other - Specity~ • Certllying physklan (Physktan cenirying cause of death when another h h 33b. Signature ntl T of Certifier / a p ysioan s pronouncetl tlealh and completed Item 23) To the best of my knowledge, deem occurred due to the cause(s) and manner es stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ , • Pronourldng and certltying physidan (Physician both pronouncing deem and cenirying to cause of death) To the best of my knowledge, death occurred al the lime, dale, and place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ 33c. Lw se Number • Medical Examiner/Coroner ~'T ~v` On the basis of examination and / or investigation, in my opinion, death occurred al the lime, date, and place, and due to the cause(s) and manner as slaled_ ^ l//UV/ 34. N m a address 35. Registrar's Signawre a tnd Number ~ ~ ~ J ~ ~ ~ ~~ ~ I ~ I 36 Oata Fil (MO 6, day, year( ~ Disposition Permit No. ~ ~ ~ ~ .) .~ 33d. hD C rp~el9d~ u,5~e olpeath Il7pai 27,J typ/e //Pr`int / /~C.nt~ (Q~~C~L(GIJ~ l Cam, Yeerl RENUNCIATION n c- o REGISTER OF WILLS ~ ~ ~' ~_ ITI CUMBERLAND COUNTY, PENNSYLVANIA '~r~ ~ m ~ I ,.a~~ "c" ~ ~ V ~ c7 -rt ~C ~ , ~ ,~,. Estate of THOMAS R. SOUTNER 0 ~"~ Deceased I, Steven Joseph Soutner (Print Name) , in my capacity/relationship as sibling of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Susan Pearlman ~ ~~; (Dare) ~ (Signature) 102 Parkview Road Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Farm RW-06 rev. 10.13.06 ()tree! Address) New Cumberland, PA 17070 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunc> ion for the pure ses state within on this ~~ day Notary Public My Commission Expires: ~'r- ~ ~_ 2 d ~ 2 (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA NotaAal Seal -- William D. Wierman, Notary Public New Cumberland Boro, Cumberland County My Commission Expires Sept. 15, 2012 Member, PAnnsylvania Association of Notaries RENUNCIATION CUMBERLAND REGISTER OF WILLS COUNTY, PENNSYLVANIA Estate of THOMAS R. SOUTNER ~o ~_~7 ~ r~~rrr, .,.~~~ :~ f~~ s:~~~c ;: -~ c:~ ,~~ ~-.-t I, Wendy Louise Soutner (Print Name) na ~ ~' r-~ - - -v -~ '_ ~ ~_ -_ .tr- :. Q w Deceased in my capacity/relationship as sibling of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Susan Pearlman - .Z - c~ ~ (Date) Y ~ (Signature) 521 Bridge Street (Street Address) New Cumberland, PA 17070 (City, State, ZipJ Execrated in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. !0.13.06 -D~~ ~~3~ Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this ~ ~'~'~- day of c ;_ Z~~ ., otary Public My Commission Expires: ~ '-3 ~ ~ cJ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) OMMONWEALTti OF PENNSYLVANIA Notarial Sea- Patricia A. Gordon, Notary Public Fairview Twp.. York Courtty tVly Commission Expires July 31,2(109 Member, Pennsylvania Astaociation of Notaries