HomeMy WebLinkAbout12-05-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of DOROTHY L. ROLLER
CUMBERLAND
COUNTY, PE~~INSYLVANIA
File Number ~ ~ ~ ~ t~~
also known as
Deceased 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 Executor
last Will of the Decedent dated May 18, 1976 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 born or adopted after exe~:ution of the instrument(s) offered
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(COMPLETE /NALL CASES:) Attach additional sheets if necessary.
Decedent .vas domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
42 Oneida Road. Lower Allen Townshia. Cumberland County, PA 1701 1
(List street address, town/city, township, county, state, zip code)
Decedent, then 85 years of age, died on January 5, 2008 at her residence - 42 Oneida Road
Decedent at death owned property with estimated values as follows:
(lf domiciled in PA) All personal property $ 16,500.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 0.00
situated as follows:
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'
JOHN K. ROLLER, JR.
or printed name and residence
~ ~ 42 ONEIDA RD., CAMP HILL, PA 17011
named in the
Form RGV-01 rev. 10.13.06 P1g0 I Of 2
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ra
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^ B. Grant of Letters of Administration ``~~ t~
(/f applicable, enter: c. t. a.; d.b.n.c.t.a.; pendente lire; durance absentia; durante,ipine~tQre~ C") t' -
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spoti~e;(fy~ and 1Qdlts: (/f t
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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 ~~ day of
I~C~a~-~ ~~-''~ , C)
For th egister
of Personal Representative
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Signature ojPersonal Representative
Signature of Personal Representative
File Number: ''~, ~ (J d / ~~~~ _
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Estate of DOROTHY L. ROLLER _, Deceased
Social Security fN~u(/mtberr~188-12-4156 Date of Death: JANUARY .5, 2008
AND NOW, ) ~) ~`Jl! ~1 II,~~_, ~_, in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters TESTAMENTARY
are hereby granted to JOHN K. ROLLER, JR.
in the above estate
and that the instrument(s) dated MAY 18, 1976
described in the Petition be admitted to probate and filed of
FEES
Letters ............... $ ~,~.
Short Certificate(s) ........ $
Renunciation(s) .......... $
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L ... $ -~
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~~~ . ~-
Attorney Signature:
Address: JOHNSON, DUFFLE, STEWART & WEIDNER
301 MARKET S., P. O. BOX 109
LEMOYNE P.A 17043-0109
Telephone: (717)761-4540
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Form RW-02 rev. 10.13.06 Page 2 of 2
Supreme Court I.D. No.: 9601
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LOCAL REGISTRAR'S CERTIFICATION CIF DE~4.T'y
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P ~ 8~~~.889
Certification Number
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RtV 112006
/PRINT IN
MANENT
tCN INK
This is to certify that t``=ie information here given is
correctlt/ copied from ar ori~.inal Ga~tificate of Death
duly tiled with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for herrnanent filing. ~AN ~ ~ 2~~s
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Local Registrar rv `• ' Date Issued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
1, Name of Decedent (First, midtlle, lest suffix) 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year)
Dor - - Jan.5 2008
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5. Age (Last Binhday) Under t year Under 1 tlay 6. Dale of Birm (Month, day, year) L 0irm (Chy ant stale a foregn country) 6e. Plata of Deelh (Check onty one)
Monna Days Ham wnmm Hospital: Other.
8 5 June 4 , 1 ~ 1, 2 L
Yrs. a m o y n 2 , P A ^ Inpallenl ^ ER ! Odpetlenl []DOA ^ Nursing Home Resitlence ^Other Specity
_
Bb. County of Death tk. City, Boro, Twp. of Death Btl. Facility Name (If rwl inalilulion, gNe sVeet and number) 9. Wes Decedent of Hispalic Odgin? No ^ Yes 10. Rap:American Indian, Black, While, etc.
(If yes, spactiy Cohan, (S lyr
hi`te
Cumberland Lola2r ~.lle:~ 42 Oneida Rd. Mexicen,PuanoRlpo,etc.j
11. Decedents Usual Occ tqn Kind d work dop dun moll d work' tile. Do not state retired 12. Wes Decedent ever in the 13. Decedent's Education (Spadty onN highest gretle completed) 14. Mental Slams: Monied, Neuer Marded, 15. Surviving Spouse QI wife, gNe maiden name)
Divorced (Specify)
Widowed
Kind of Work KiM of Business I IMUSIry U.S. Armed Forces? ,
Elementary! Secondary (0.12) Cdlege (1-4 or 5+)
Roller
onn it
s=_or2tar Arm' D2 of ^raa ~"° .
12 marria3
16. DxadenYs Mailing Atldress (Street, city /town, slate, ziP cods) Decedent's
t 7
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S Dltl Decedent
lvania Live in a „°
Decade,,, uved in L o ;9 ~ r A 11 ~ n Twp
~ yea
Penns
4 2 O n e i d a R d. Actual
esi
ence
a.
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6
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y
Townanip?
C u m b e r l a n d 17d. ^ Nc, Decedent Uved Mlhin
P A 17 011
Cam H i 11 , 17
.
ounty Actual umda a city! Bore
I6. Famer's Name (Fuel. nrddle, last, suffix) 19. Momer's Nama (First, middle, maiden surname)
Archie C. Sober Eunice Hobson
20a. Inlomanl's Name (type 1 Print)
John K. Ro11ar,Jr. 20h. InformenYa Meilkg Address (Street, qty /town, stare, zip coda)
42 On•aida Rd., Came Hi11,PA 17011
2/a. Memod of DsposAton ^ Cremation ^ Doption - 21 b. Date of Deposition (Mmm, day, year) 21c. Place d Diaposifion (Name of cemetery, crematory or other p4ae) 21d. Location (City I town, slate, zip coda) P A
Burro ^ Renaval born Stale roes cremtlian as oeneBen Aulnodzed
• Jan . 10 , 2 0 0 8 S l a t e H i 11 C e m e t e r y S H, i r e r: - -. <_ t.. y~,
^ er ~ Spedy: by Yedkel Examlrter I Coroner! ^ Yes ^ No
2 ~ mare d Fune Service Licensee la persm aclmg as such) 22b. License Numher 22c. Name and Address of Facility -
FD-013163-L Mussel?nan FHSCS,324 Hum:nal Ave.,L~moyne,PA17043
a Items 23a< onN when ceNNing 23e. To the best of my knowledge, deem occurred al Iha lime, date antl Dace slated. (SigneNre and title) 23b. License Numbr~r 23c. Dale Signed (Momh, day, year)
physiden a rat avatiable at lime of deem to
certiN cause d dean.
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Mena 2446 must be completed by person 24. Lme of Deam 25. Date Pronounced Dead (Month, day, year) 2fi. Wes Case Referted to Metlkxl Examiner I Coropr for a Reason Other Than Crematan or Donation?
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wM prorrolxlces death. :CC ~ i M. , A aV 5 z LAC) ~=? ^ Yas (~l
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CAUSE OF DEATH (See instructions and examples) r Approximate interval: Pan II: Faster dher sig6i9rad cand9ions conrnhulingto deem, 26. Utl Tobeceo Use Contribute to Death?
Item 27. Pan I: Enter Ore them of events -diseases, Injures, a compRCalbns - met direclN caused tlae dim. DO NOT enter terminal events such as p(dIBC anent, Onset to Deam but not resulfing in the undenying pose given in Pan I, Yes
^ Prohahry
^
respiratory arrest, or ventricular fibdllatien wimoul showing me e0ology. List onN one cause on each line. ^
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LJ'^u ^ Unknown
IYMEONTE CAUSE (Final disease or ,G/:/, ~ /~ ~ ~(/, _
cenGtion resutiirg in deem) _~ a. // yZ-'~!/C ~~~j"~!/ ~' C ~ ! ~s4• ~ // r
~Z(' •/'~/~ i / t (% !r /Oiluc
29. If Female:
Due to (or as a equenp oQ: of pregnant within pall year
^ Pregnant at lime of death
$eryanliaNy list conditions, H airy, 6. ~
leadrrq to me pose Nsted on Yne a. Due to (or as a was
sepuance of): r ^ Nol Pregpnl, but pregnant wthin 42 tlays
Faster Rw UNDERLYING CAUSE
(d'aease or injury that uktiated me ° r
r
r
of death
evens resdfing m deem) LAST.
Due to (or as a consequence ofJ:
l ^ Not pregnant but pregnen143 days to t year
d. before deem
^ Unknown if pregnant within Iha past year
30a. Was an ANOpsy 30b. Were ANOpsy Findings 31. Manner el Death 32a. Date el Injury (Month, day, year) 32b. Descn6e How Injury Ocpned 32c. Place of Injury: Home, Farm, Street Factory,
Pedonned? Availade Pita to Canpldion
of Cause of Dea1M
lural ^ Fbmaade .~ _- ~_ Office Building, etc (Specity)
^ Yes ~NO
^ Yes ~ No ^ Accident ^ Pending Investigation 32d. Tme of Iryury 32e. Inlury al Work? 32f. If Trensponation Injury (SpeciN) ~ 32g. Loption of Injury (Street, city I sown, sutel
^ Suidtle ^ Cald Nd be Delermnetl ~_
^ yes ^ No
^ Driver I Operelar ^ Passenger ^Pedestnan
M ^Other ~ SpedN:
33a Cerdfier (dock only one) 33b. Signature and Ttie of Cenifier
~
• Cerblying physidm (Physidan certifying pose of death when anomer physuian has proraunced dean and completetl Item 23)
To the best of my knowledge, death ocprretl dos to the pose(s) and manner as atMed_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ v
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• Pronouncing and txelgying physlclen (Ptrysician Mom pmnaundng death antl pnitymg la cause of deem)
To tM Des(W my Nrawkoge, dean Otpnetl at the 6rrre, date, antl place, and tlp to me pose(s) antl manrwr ee ateted_
• Lkdkal Examiner I Coroner
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. Lice umber
-
G,~-Y /~..,~ 7 Z ~C Z - ~' 3t(q,D to Signed (Month, y, year) ~,
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On the Meals of examination era 1 or Investigation, in my opinion, deem occurted el the t{me, dale, end place, end due to the causa{s) antl manner as slated_ ^ red Cause I Death (Item 27) Type 1 Pnnl
me and dtlre f Person Who Canple
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Regetrer's Sgptu District Num /Js"~ I ~I / I 7 I ~I ~ I onm, day, year)
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DISDOSItIOn Permit No.
Pennsylvania, Guardian of any property which passes either under
this will or otherwise to a minor and with respect to which I am
authorized to appoint a guardian and have not otherwise specificall
done so provided that this appointment of a guardian shall not
supersede the right of any fiduciary in its discretion to dis-
tribute a share where possible to a minor or to ~~nother for the
minor's benefit. Such guardian shall have the p~~wer to use princi-
pal as well as income from time to time for the minor's support and
education (including trade school and college education, both
graduate and undergraduate) without regard to hiss or her parent's
ability to provide for such support and education, or to make pay-
ment for these purposes without further responsik~ility to the minor
or to the minor's parent or to any person taking care of the minor.
6. I direct that all taxes that may be assE~ssed in consequenc
of my death, of whatever nature and by whatever ~iurisdiction impose ,
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
7. I appoint my husband, JOHN K. ROLLER, JF:., Executor of
this, my last will. Should my husband, JOHN K. F:OLLER, JR., fail
to qualify or cease to act as Executor, I appoint. my daughters,
EUNICE P~. RO5S and PATRICIA Y. ROLLER, Executrices of this, my last
will.
8. I direct that my Executor, Executrices or Guardian shall
not be required to give bond for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this ~~~'~ day of `j7~ ~ c'L~- 1976.
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Dor ~ by L. Roller
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OF ;„
DOROTHY L . ROLLER ~.~~
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I, DOROTHY L. ROLLER, of Lower Allen Township, Cumberland
County, Pennsylvania, declare this to be my last will and revoke and
will previously made by me.
1. I direct that all my just debts and funE:ral expenses,
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including my gravemarker and all expenses of my :Last illness,
shall be paid from my residuary estate as soon a:~ practicable
after my decease as a part of the expense of the administration
of my estate.
2. I devise and bequeath all of my estate of every nature
and wherever situate to my husband, JOHN K. ROLL~~R, JR., providing
he shall survive me by thirty (30) days.
3. Should my husband, JOHN K. ROLLER, JR., predecease me or
die on or before the thirtieth (30th) day follow_i.ng my death, I
devise and bequeath all of my estate of every nai:ure and wherever
:~~1~ituate in equal shares to such of my children, I~UNICE M. RO55 and
PATRICIA Y. ROLLER, as survive me by thirty (30) days.
4. Should either of my daughters, EUNICE M.. ROSS or PATRICIA
Y. ROLLER, predecease me or die on or before the thirtieth {30th)
day following my death, I devise and bequeath thc~ share of such
child to her issue, per stirpes, living on the thirty-first (31st)
day following my death; and should either of my :paid daughters,
EUNICE M. ROSS or PATRICIA Y. ROLLER, leave no such issue living
on the thirty-first (31st) day following my death, I devise and
bequeath the share of such child to my other chi:Ld or her issue,
per stirpes, living on the thirty-first (31st) d~~y following my
death.
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5. I appoint DAUPHIN DEPOSIT TRUST COMPANY., of Lemoyne,
Signed, sealed, published and declared by the above-named
Testatrix as and for her Last Will and Testament in the presence
of us, who, at her request, in her presence and in the presence
of each other, have hereunto subscribed our names as witnesses.
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OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
CUMBERLAND
COUNTY, PENNSYLVANIA
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Estate of DOROTHY L. ROLLER
FRANCES MOORS
and
Deceased
(each) being duly qualified according to law, depose(s) and say(s) that she / he !they was /were well-
acquainted with ~ ~Ri'oT'r-y L . Rot~~R and am/are familiar
with the handwriting and signature of the decedent, and that the signature of ~7RoTNy G. , ~o t ~ ~,Q
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~v~eo r h;r G . ~b z`~,e
is in his/her own proper handwriting.
(S~gnature)
122 S. 7TH STREET --~
(Sn•eet Address)
LEMOYNE, PA 17043
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
,-
before me this ~) ~ ~ day
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Deputy for Register of W 11
(Signature)
(Street Address)
(City, State, Zip)
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Farm RW-04 rev. 10.13.06
OATH OF SUBSCRIBING WITNESS(ES) "~
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REGISTER OF WILLS L:• f
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CUMBERLAND
COUNTY, PENNSYLVANIA "`~ `~"
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Estate of DOROTHY L. ROLLER
JERRY R. DUFFIE
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Deceased
(each) a subscribing witness to
(Print Name/s)
the 0 Will ~ Codicil(s) presented herewith, (each) being duly qualified according; to law, depose(s) and
say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same
and that she / he /they signed the same and that she / he /they signed as a witness at the request of
the Testator /Testatrix in her /his
(Signature)
(Street Address)
presence and in the presence of each of r.
_ ~~
(S' nature)
_ 301 MARKET ST., P. O. BOX 109
(Street Address)
(City, Stare, Zips
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
of
day
Deputy for Register of Wills
LEMOYNE, PA 17043-0109
(City, State, Zip)
Executed out of Register's Office ,~
Sworn to or affirmed and subscribed ~ ~
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bef re me this ~ ~ day ~ ~° ,'
of u~1 ~ _, ;2~,
Notary Public ~ ~~
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
NOTE To be taken by Officer authorized [o administer oaths. Please have present the original or copy of instrument(s) at time of notarization,
Form RW-03 rev. 10.13.06