HomeMy WebLinkAbout12-10-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF ~~'ILLS OF _ COt1NTY, PE~`~~SYLVANI~~~
f~
Estate of r ~~ ~N~ ~~~pGl/~i~ ~-r2 File Number o~~ ~ ~ ~ a~~
also known as _
_ ,Deceased Social Security Number ~~~ •`~~ ._ ~01 yyy~
Pe~itioner(s), who is/are 18 years of age or older, apply(ies) for.
(C(~;LIPLET'E 'A' ar 'B' BELOW:)
ql~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are tJJhe /~~, ~ d~ 1ZG ~ ~ i/~ ~% r ~~'~~lnata7ed in the
last Wall of the Decedent dated ~-/ - Cf ~ and codicil(s) dated ,!/!/9-
(State reievnnt circu,nstances, e.g., renunciatio,r, death ojezeeutor, etc.)
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 Administration
(!`npplica6le, enter. c.t.a ,~ d.b.n.c.t.n., pendente lice; durmrte absentia; durance neinoritnteJ
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: (Ij
Administration, c. t. a. ord.b.,r.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~
Name Relationship Res~;~e °~ -
`r7 ~
' ','_~
P
-.
- .:..,
- -' " ~
i w;;
i r-~ ~.. _
(COMPLETE hV ALL CASES:) Attach additional streets rf necessary. _~ ~ r ~
_,s ~ ~ =
Decedent was domiciled at death in ~?y y-1 •p .,
Q 2 ~ /~J_ County, Pennsylvania with his /her last princ>~l residence at'_____
(List street address, town/ctty, township, count),, sta~de/
Decedent, then ~_ years of age, died on /~j~ v. ~ O at
~vv$
Decedent at death owned property with estimated values as fcllows: ~j
(If domiciled in PA) All personal property $ / 6 % ~ UGC
(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:
Nrheretbre, Petitioner(s) respectfully request(s) the probate of the last ~~'ill and Codicil(s) presented with this Petition and the giant of Letters in the appropriate form to
the undersigned:
[ Signature Tvped or urinted name and residence
;'~/)/Z[
/ v2
Fo,,,, Rw-o~ rer. 10.13.06 Pale i of 2
Oath of Persol~al Representative
CO'~I`~fON~VEALTH OP PENNSYLVANIA
COUNTY OF ~-.?.a(`n~ V~C7.~~ SS
.
'The Pentioner(s) above-named swears} or afnrn~(s} that the statements in the foregoing Petit ion are live and con~ect to the best of
the know}edge 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.
-.
/,, ~ ~.
`" ~
L'~~"" f L`
~~
~
`"Z'
S~.~cn: to or affirn-~ed and subscribed Tl
- ~
(~ SFSn Wore of Personal Representative r'
~
`'~'
~
day of
be~Eore :ne the -
~
~-
-
_~~r cJ
`
~ ~ r~C~c.r 2 ~
~` ~~~, Signature oJPersenai Representative - `? e-~
~?
~ _... _ro
--
For the Register
Signature ojPusonal Representntive - -
~U
~ i
~
Y ~ , v r
- rt
V '
File Number: U
'~ ~ ~ ~ ~ °~3 I
Estate of 1 ~P ~~ f1~ ~ ~ ~~ ~~~~~ ,Deceased
Social Securit;r Number: ~ tD~ ~ ~ ~ a~ ~ Date of Death: ~ I ~.3b ~ ~
AND NOtiV, Y`C~~~ ~ ~ , inconsideration of the fo
~~~ regoing Petition, satisfactory proof
having been presented before nee, IT IS D CREED t _
hat Letters ~P~~Z} i^{'1P_tl rL~
are hereby granted to ~ ~ Ve
in the above estate
and that the instrument(s) dated _~ ,1~.~,
described in the Petition be admitted to probate and filed
FEES
Leti:ers .....~,~~~ .... $ ~5
Short Certificates} ....~.... $_~~
Renunciation(s) ... ~...... $ „j
... $
.. $
.. $
... $
.$
_ ... $~`
TOTAL .............. S ~`~'
f record as the last Will and Codicil(s)) f Deced, t;t.
l r
Register oJWitls ,
Attorney Signature:
Attoney Name:
Supreme Court LD. No.:
Address:
Telephone:
Fvrm RW-0' rev. ID.13.0( P3~e 2 Of 2
IUS.Hti~ RFb' r0110'l
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this cert)f~°,cute. `~(~.QO ~~~~O~p~_~ This is t~~ k~crtil_~ I eft ti)L Inli~i-m)t<~n i~r)t° ~~iticr. i°~
rfr',r
+' E.~ ---,ry,~;~ currcctl~ cl,~ied f)• r~) .)n t~lfr~inal t ~~r~~ti.at~ ~~f I?eath
~~`o~~i ~ ~.Js, dull fiileit ~~irh nip .fs Lo~)i Ke~~,u~al. If~~ ~;nfs)a=.
l
I ~~'. z~ celhtlcatz~ will h~ fore (tied '~~ the titaie ~ lie]
~. ~( ,?)- al Recurd~ +: )1-fire !O hL~rn;.in~nt tilllr_.
~*~ *~~
~_ p ~ J
P ~. 4 810 4 ~ 7 ~ ~'q9T-- ~~a~`, ~~ .~_oEC~cl_2-208 -
- - ~.. MENt p~ f -
Certification '~!(unber ~==~°-',r„~`"''~ Local Re~~istrar f-x I),)t: I~suL•kl
C7
~ lQ _.
~ i~
.
~~
.
~ 1. .
_
r-
_.. _ _ :s ~
~ - ,.
I~ _ .,
~.
_~
__ - - ., _.
.__,
~ _~1
~ s_ ~
D _
CT
1EV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
ANIENTN CERTIFICATE OF DEATH
;K lNK (See instructions and examples on reverse)
STATE FILE NUMBER ~ ~ ~
~ '~) ) ~ ,~
1. Name of Decedent (First, middle, last, sulAx) 2. Sex 3. Social SecunN Number 4. Data I Death (Month, day, yearl
Helena D.. Hawbaker Female 168 - 36 ~ 3294 ~-
5. Age (Last Biehday) Under 1 year Under 1 tlay 6. Date of Birth (Month, day, year) 7. Birthplace (Cdy and state or for eign country) Ba. Place of Death (Check only one)
MonIM Oeys Mours Minutes Hospital: Other:
March 22
1915 PA
Gettysburg ^I
t ^DOA
ti
t ^ER/O
t
ti N
i
H
^R
id
^Oth
i
S
93 Yrs. , , npa
en
u
pa
en urs
ng
ome
es
ence
er
N
pec
Sb. County of Death Bc. City, Boro, Twp. of Death Bd. Facility Name (II not institution, give street and number) 9. Was Decedent of Hispanic Ongm7 ®No ^ Yes 10. Pace: American Indian. Black, White, etc.
- (If yes, specify Cuhan, (Specilyf
Cumberland Newville Y ' Mexican, Puerto Rican, etc.) White
1 t. Decedent's Usual tan i Kind of work d one Bunn nwst of worki life. Do not state retired 12. Was Decedent ever in the 13. ant's Education (Sped ly highest gratle compl eted) 14. Marital Status: Martied, Never Manietl. 15. Surviving Spo use (If wife, give maitlen name)
Kind of Work Kind of Business I Industry U.S. Armed Forces? Elementary /Secondary (0-12) College (1-4 or 5+) Widowed, Divorced (Specify)
Custodian Grace II.M. Church ^Yea ®Np 10 Widowed
16. Decedent's Mailing Address (S1reeL city /town, slate, zip code) Decedent's Da Decedent
Pennsylvania Live in a t]c
^ vas
Decedem Lived in T
17
A
t
l R
d
St
t
210 Big Spring Road .
,
wp.
c
ua
es
ence
a.
a
e
Township? 17tl. 1g] No, Decedent Livetl within
Newville PA 17241 nh. county Ctrmherl and Actual Limits of Neville aN r Sorn
78. father's Name (First, middle, last, suhlx~ 19. Mother's Nama (First, middle, maiden surname)
Amos LuckEenbau h Sallie Bisho
20a. Informant's Name (Type /Print) 20h. Inlonnant's Mailing Address (Street, city I town, state, zip code)
Mrs. Mildred Aughenbaugh 400 Highway 1283, Loris, SC 29569
21 a. Method o1 DisposAlon ~ Cremation ^ Donation
~ 21 b, Dale of Disposnion (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 27 d. Location (City I town, state, zip code)
^ Burial ^ Removal from State
i WasCremetionorponationAuthodzed
' ^ Other ~ Specify: '~, by Medcal Examiner I Coroner? Yes ^ No Dec. 3 2008
, Cremation Societ of PA
y Harrisbur PA 17109
,
' 22a.Sgnatur neral aatLicensee rsonac~ such) 22b.UcanseNumber 22c.NameandAddreaanfFadlity Aner Cremation Services of Pennsylvania, Inc.
. ~ FD-010694-L 4100 Jonestown Road Harrisbur PA 1710
Complete hems 23a-c only when ceNtying _
23a Toth I my know edge, death occuned at the lime, tlate and place staled. (Signature and thle) 23b. License Number 23c. Date Signetl (Month, day, year)
physidan rs rrot available at lime of death to n ~ / a /I ;J i
C ~---
[ , ~
, C
cenlty cause of tle~h.
.,J
~C 1
~ .
Items 24-26 must be completed ty person 24. Timpof'DeaVLx f M +[ (
QQ UU
~/''III
7 25^Date Pronounced Dead (Month, day, year) 2fi. Was Case Rafened to Medical Examiner I Coroner for a Reason Other than C•emation or D nation?
^ N
Y
' who Oronounces death. 7 M
'
j t - t ~ o
es
^
CAUSE OF DEATH (See instructions and examples) t Approximate interval: Pan II: Enter other sienfcanl conditions contributing to death, 28. Did Tobago Use Contribute to Death?
Item 27. Pan h Enter the g it ojgvgnlt -diseases, injures, or complications -that directly caused the death. DO NOT enter terminal events such as cardiac artesL Onset to Death but not resulting in the untlerlying cause given In Pan L ^ Yes ^ ProbahN
respiratory arrest, or ventricular lihnllation without showing the etiology. List Doty one cause on each line.
^ No ^ Unknown
IMMEDIATE CAUSE 'Final disease or '
condhion resuhmg in death) a_ ~`~ . • ~;: _ J' t ~ 1 v U ~. t
-~ C u ~1!]P
29. II Female
^ N
Due to (or as consequence of)` i ot pregnant within past year
Sequenlialty list conditbns, h any, b. ^ Pregnant at time of death
leadirp to the reuse listed on lim! a. r
Due to (or as a consequence op: ^ Nol pregnant, but pragnam within 42 days
t
Emer he UNDERLYING CAUSE
el death
(tlisease or Injury that inhiated the c t
events resuhing in death) LAST i
f
D ^ Nat pregnant, but pregnant 43 days to 7 year
ue to (or as a consequence o
).
before death
d.
^ Unknown II pregnant within the past year
30a. Was an Autopsy 30b. Nlere Autopsy Findings 31. Mann of DeaN 32a. Dale of Inlury (Month, tlay, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory,
Performed? Available Prior to Completion Ohae Builtling, etc. (SpecityJ
cl Cause of Death? atural ^ Homicide
^ Accident ^ Pending Investigation 32tl. Time of Injury 32e. Injury at Work? 321. If Transponatlon Injury (Specify) 32g. Location of Injury (Street, city /town, state)
^ Yes to ^ Yes ^ No
^ Suicide ^ Could Not be Detertnine0
^ Yes ^ No
^ Dover I Operator ^ Passenger ^Petlestnan
M ^Other ~ Specity~
33a. CeniNer (check Doty one)
l
t
d Item 23)
tl d
th
d 33b. Signature an dl -
-
>^ ~
)
C%
comp
ea
an
e
e
• Cenifying physician (Physician ceniying cause of death when another physician has pronourtce
death occurred due to the cause(s) and manner as steted_ _ _ _ _ _ _ ^
To the best of my kn<rwledge , ( _s.--
j
.,
.
,
• Pronouncing and certifying physician (Physician bosh pronoundng tlealh and cenitying to cause of death)
^
and due to the cause(s) and manner as staled
la
t th
ti
tl
l
d
d 33c. License 33d. Dale Signed (Month as a0
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
me,
a
e, an
p
ce,
a
e
To the hest of my knowledge, death occurre
i
/C
l E
a0 (O ~f I ~ t'~- f Z f / ~ r~
~ \ '
oroner
ner
• Medica
xam
On the basis of examination and / or investigation, in my opinion, tlealh occurred at the time, date, and place, and due to the cause(s) and manner as staled_ ^ 34. Name and Address of Person Who Completed Cause of Death (Item 27) Type /Print l
~
/ I ~~ `) ' I
Registrar's ii~ric ry r ~ ate Filed (Month, day. Year)
I
I ~~~ -
,,.----,..__ o__., .,- nano t n~ r^~ r r ~ -4-; _ . ~ !;> I \? ,
a ~ 0 8 i a3~I
h.w
~,~ ~"~
~__
-c ~~ -5 . _.. ,...._.
-1] p
-~ ,:
~~ ~ r
LAST W/LL AND TESTAMENT ,; o
_J'~ ~ '.
y ~
I, HELENA V. HAWBAKER, of 820 Lisburn Road, Apartment 301, Camp, Hill,
Cumberland County, Pennsylvania 17011, do hereby make, publish and declare this to
be my last fast will and testament, hereby revoking all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefor, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at
m;y death, for such period of time after my death as seems expedient to said
representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate to my daughter, Mildred A. Aughenbaugh, or if she is deceased, then
to her children, share and share alike..
4. I nominate and appoint Mildred A. Aughenbaugh and James
Aughenbaugh to be the co-personal representatives of my estate, to serve without
bond.
6. I suggest that my personal representative retain the services of Harold S.
Irwin, III, Carlisle, Pennsylvania in the settlement of my estate.
<,~
IN WITNESS WHEREOF, I have hereunto set my hand and seal this / day
of May, 1998.
'~~~~_ ~ ~ (SEAL)
HELENA V. HAWBAKER
Signed, sealed, published and declared by the above-named person as and for
a last will and testament, in our presence, who at said person's request, in said
person's presence and in the presence of each other have hereunto set our names as
subscribing witnesses.
~.
'~ _ /
,Li ,~
~_ _.
l~
ACKNOWLEDGMENT AND AFFIDAVIT
WE, HELENA V. HAWBAKER, GAY L. IRWIN and HEATHER A. BARBOUR,
the testatrix and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that
the testatrix signed and executed the instrument as her last will and that she had
signed willingly, and that she executed it as her free and voluntary act for the purpose
herein expressed, and that each of the witnesses, in the presence and hearing of the
testatrix, signed the will as a witness and that to the best of their knowledge the
testatrix was, at that time, eigh#een years of age or older, of sound mind and under no
constraint or undue influence.
°~ ~! ~~ ^-
HELENA V. HAWBAKER
~ i
~' _._..~.~G~`Z
~.- ~GAY L. I IN
1 ~ ,,~
HEATHER A. BARBOUR
COMMONWEALTH OF PENNSYLVANIA
:ss:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by HELENA V.
HAWBAKER, the testatrix herein, and subscribed and sworn to before me by GAY L.
IRWIN and HEATHER A. BARBOUR, witnesses, this C S `day of May, 1998.
Piotaria4 Seal
Harold xS. Irwin 1i1, Notary Public
Carlisle oro, Cumberland County
My Commission Expires Sept. 14, 19°8
Member. Pennsylvania Asscc~ation of Notaries
Notary Public
12-88-'88 17;57 FPOM-IB~1IN LA41 OFFICE 7172439288
~~~u~c~,~T~aN
Ire Re Estate of HELNA V. HAWBAKER, deceased.
To the Register of Wills of Cumberland County, Pennsylvania_
T-389 PO02/t~t~2 F-876
c~, \ L 8 I a3~
~.-~~ ~t 1.1 .t ., r~ ~ .~ , !
The undersigned, JAMES AUGi7HENBAUH, hereby renounces his right to administer this estate
and respectfully asks that Letters Testamentary be issued to MILDRED A. AUGHENBAUGH.
WITNESS my hand this ~ day of December, 2QO8.
~J ~~.~s ~ ~ 4 ,~ _ ~~
~l
JAMES AUGHENBAUGH
400 Highway 1283
Loris, SC 29569
SWORN TO AND SUBSCRIBED
BEFORE ME THIS ~~ ~ ~
DAY OF DECEMBER 200~~ /~
'1 / /
NOTARY-PUBLIC
~~i ~ z~~~
~7
-
~ ~
ry
- . ~--
~
~ _
-
" d --
~:
'
~..~ --o
-- ~ ~ -
tV
>
-~ , .