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PETITION FOR PROBATE AND GRANT OF LETS t
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REGISTER OF WILLS OF CUMBERLAND
Estate of ROBERT L. BENDER
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File Number _ ~ -1 -' - "t~
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Social Security Number 174-OS-3629
Deceased
Yenhoner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
0 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the
last Will of the Decedent dated and codicil(s) dated
named in the
(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.; pendentelite; duranteabsentia; duranteminoritate)
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. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
LINDA FORSYTHE - `~ """"" ~
- DAUGHTER 650 BALTIMORE PIKE, GARDNERS, PA 17324
(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
42 NOR ~ H EAST STREET CARLISLE BOROUGH CUMBERLAND COUNTY PENNSYLVANIA 17013
(List street address. town/city, township, county, state, zip code)
Decedent, then 80 years of age, died on APRIL 13, 1996 at NEW TODD HOME, CARLISLE, CUMBERLAND
COUNTY PENNSYLVANIA
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 County $
Value of real estate in Pennsylvania $ 320.00
situated as follows: 1/3 INTEREST IN REAL ESTATE LOCATED AT MULBERRY AVE, CARLISLE, CUMBERLAND COUNTY, PA
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:
Form RW-02 rev. 10.13.06 Page 1 of 2
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 the foregoing Petition are true 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 ` ~~ f~ day of
For Register
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of Personal
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Signature of Personal Representative -"~
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Signature of Personal Representative ;: ~~ ,~ ~
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File Number: ~~" ~~ ~ ~~~
Estate of ROBERT L. BENDER ,Deceased
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Social Security Number: 174-05-3629 Date of Death:APRIL 13 1996
~ 1~ ~ ~ ~1, i_~,> in consideration of the foregoing Petition, satisfactory proof
AND NOW,
having been presented befor e, I S DECREED that Letters OF ADMINISTRATION
are hereby granted to LINDA FORSYTHE
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of
FEES '~_~,
Letters .......... ..... $
20.00
Short Certificate(s) . ....... $
Renunciation(s) ... ....... $
JCP .. , $ 10.00
AUTOMATION FEE .. $ 5.00
... $
... $
... $
... $
... $
... $
... $
TOTAL ...... ........ $ 35.00
as the last Will (and
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
s)) of
Register of 'lls
A. McKNIGHT, III
60 WEST POMFRET STREET
CARLISLE, PA 17013
(717)249-2353
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Page 2 of 2
Form RPV-02 rev. !0.!3.06
105.905 REV. 2-KC, .~ ~ ( "Q.r I~ ) I~
This is to certify that this is a true ropy of the recorc)4 which is on file in the Pennsylvania Division of Vital Recordn accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953•
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $3.00
3870663
No.
H 105.143 Rav. 2/B7
TVPEIPRINT
IN
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Charles Hardester
State Registrar
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL P ECORDS
CERTIFICATE OF DEATH
03465
NAME OF DECEDENT (FrtSI Midcke. l asl!
SE% __. _.__.
SOCIAL SECURITY NUMBER
DATE OF DEATH (Month, Oay, v r)
t. Robert L. Bender :. Male 3. 174 •- 05 - 3629 ASR I ~ ~ 3 I ~ ~ ~.
AGEILesl Birthday) UNDERIVEAR VNDEflIDAV DATE OF BIRTH BIRTHPLACE(Cltyarrd PLACEOFDEATH (Cherkonlyone-see rnslrucnonsonolhet sda)
Months r Deys Hours ) Minutes (MOnlh_Day.V t) Stale or Foreign Country) HOSPITAL. OTHER
Vrs.
80
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28
1915
Car1isle
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COUNTY OF DEATH CITY,BORD,TWP OF DEATH FACILITY NAME PIrwllnslilulion.give sheer »nd numnar) tNAS DECEDENT OF HISPANIC ORIGIN? RACE-American lntllan, Black, While, etc.
No~ Ves^Ilyes, spacily Cuban, (Specily)
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Mexlean, Puerto Rican, etc.
ab. Cumberland ,~. Carlisle ,d. ,I ,o White
DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS/INDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUCATION MARITAL STAFUS-Merrie0 SURVIVING SPOUSE
IGrve Wnd of work done BUrin{{1I 1 U.S. ARMED FORCES7 S i on hl hest rade com let Never MarrNd,WMowetl, (Il wile, give maiden name)
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Electrician Shoe +017
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,] 111 (1dIX5" „ Married ,:.Mar Hoo er
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DECEDENT
S MAILING ADDRESS (Street, Glyrtnwn. Stale, Zip Code) DECEDENT'S '
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RESIDENCE decedent
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Carlisle, Pa 17013 ($ee inslruckons live in e
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FATHER
S NAME (F first, Mrddle. I asl)
Wilber Bender MOTH R'S NAME (Firg, MicMle, Maben Surramel
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INFORMANT'S NAME(T ype/Prlnl) INFOR ANT'S MAILING ADDRESS(Street, I:ily/Town, Slalo. ZlpCWe)
so.. Mar E. Bender :ob. 2 North East St. Carlisle Pa 17013
METHOD OF DISPOSITIO~~~Npp ff_11 rrII
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R DATE OF DISPOSITION
IMOnth. Vay, Year) PLACE OF DISPOSITION-Neme of Cemetery. Crematpry
ar Olhef Place LOCATION-CilyR n, Slate, Zip Code
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emoval from Sla191J
opnation^ other(sDa°~ry ^ April 16
1996 Westminster
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],b. „p. Memorial Gardens „dJJ.Middleton Tw .Cumb.Co.PA
' SIGNATU O FU ALSERVIC EN _ NACTINGASSUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY Hoffman-Roth Funeral Home
' :].. ,]b. 010343 L „~. 219 N. Hanover St. Carlisle PA 17013
Complete Gems 23e-t only when car mg
ptg'~cian H rrol avallame al lime of deem to To the bast of my knowledge, death occurretl at the time, tlate end place staled UCENSE NUMBER
(Si
nature 7~1 1 DATE SIGNED
ceniry cause of deem. g (Homo, Day. Peer)
Ilemsn W~26 must be completed by ~Mfj OF DEA_TJ1~ F G-r DATE PRONOUNCED DEAD (Mwtlh, Day. Yearl WAS CASE REFER
• Ixrso ho pronounces death. j'f' "F [.~ RED TO MEDICAL E%AMINERICORONER?
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27. PART 1: Enter the diseases, injuries or cmnplicel'ans which caused the 09arn. Do not enter the mode oldying,s has cardiac or respirelorv arrest. shock or heart tallure. rApproxknate
Usl only one cause on earn line
PART 11: Olhar signilkaM OOndilions coMnbutmg!o Beam, but
. ~ interval between
) I onset erd deem
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IMMEDIATE CAVSE (Final r
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, t resullirg' the underlyeq cause given In PART I.
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ceuae. Enter UNDERLYING
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AS A CONSEQUENCE t7F)' I
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CAUSE (Disease or injury
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esuking in dealhl LAST O (O
ASACONSEOUENCF OF): I
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MNS AN AUTOPSY
PERFORMED? WERE AUTOPSY FINOINGB
AVAIUBLE PRIOR 1D MANNER OF pEATH DATE OF INJURY TIME OFINJURY INJURY AT WORK? DESCRIBE HOWINJURY OCCURRED.
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COMPLETION OF CAUSE
OF DEATH? b[I
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Homicide
Accident ^ Pending Invesligatbn ^
Ves ^ No ^
Ves ^ No
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Suickle ^ Could not he tlelermined ^ 30a. 30b. M. 70c. 30d.
PLACE OF INJURY
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ome, term, slroM, letlary, oilke LOCATION (SVae1, CnylT wn, Stale)
buiMing. etc. ISlwcilVl
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CERi1F1ER IChenF nary"tr)
'CERTIFYING PHYSICIAN(Vliysic~an verl,lyrrg cause of dearh when anorner physician has pronuuneexf dram and o"npleled ltern 231
To me beat of mY knowledge
death occurred due to the
tl 51 ATURE AN - DF CER -IE /NJJ
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causete) en
manner as stated ..................................................... \
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.. 'PRONOUNCING ANDCERTIFYING PHYSICIAN Ph
re ma beet of m erro 1 vsitian nom prpn",ncmq dean, and cennvn,q to rase of Beam)
Y wledge, death occurred at the tone, 0ate,aM plece,aM due to the ceuea(e)and mamror es.rated .......................... ^ LICENSEN ER DATE SIG DlMnnth ~jyVearl
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• 'MEDICAL EXAMINER/CORONER NAME AND ADDRESS OF PER COMPL TEDC D TH
(Item 27)Type or Print ~~~Nr~ ~ ~ ~.•~
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On iM Daale of saaminNion and/a tnveNigetlon, In my opinion, depth xcurrad st the time, data, arW place, entl tlue to the csuae(a) and
manner as staled ~ ~ ci. ~~
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RED TRAR'S SIGNATURE A UMGER ~
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DAiE FILED Q,funth, Day, year)