HomeMy WebLinkAbout12-29-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of LESTER D. LINSENBACH, JR.
also known as
Deceased
COUNTY, PENNSYLVANIA
File Number ~ ~ - i J~~ ~ ~ ~ U
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Social Security Number ., c~
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Petitioner(s), who is/aze 18 years of age or older, apply(ies) for: - ? -_, tv _
(COMPLETE 'A' or 'B' BELOW:) ` ~ ~
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A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ",~y ~3trted in the -:.~
last Will of the Decedent dated and codicil(s) dated ~' ~~~ rs
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(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 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.; pendente life; 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: (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.)
Name Relationship Residence I
Todd Linsenbach Son 10454 E. Corrine Drive, Scottsdale, AZ 85259
Dana Shover Daughter 85 Apache Trail, York Haven, PA 17370
(COMPLETEINALL CASES:) Attach additional sheets ijnecessary.
Decedent was domiciled at death in Ctunberland County, Pennsylvania with his /her last principal residence at
4 Brookview Drive Newville PA 17241 (Upper Frankford Township)
(List street address, towrt~ciry, township, county, state, zip code)
Decedent, then 61 years of age, died on December 21, 2008 at Carlisle Regional Medical Center, South Middleton
Township Cumberland County PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 50,000.00
(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:
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:
Dana Shover, 85 Apache Trail, York Haven, PA 17370
Form RW-02 rev. 10.13.06 Page 1 of 2
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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 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.
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Sworn to or affirmed and subscribed
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before -re ti-~e Z9 day of
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~ For the Register
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Signature of Personal Representative
Signature of Personal Representative
Signature of Personal Representative
File Number: ~~ - d D ~ ~ 21 g
Estate of LESTER D. LINSENBACH, JR. ,Deceased
Social Security Number: 165-38-2431 Date of Death: December 21, 2008
AND NOW, ~ pm ~>,c,~ a~ _, c~Dd ~i' . in consideration of the foregoing Petition, satisfactory proof
having been presente before me, IT IS DECREED that Letters ~m~ni b~ : ,.~ ~iL~
are hereby granted to ~~~
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 W' 1(and Codicil(s)) of Decedent.
FEES ri
~ Register of Wil ^ 1~
Letters ............... $ ~ • CX7 1 •,-+~l/j 1;1 /,J~ ii//""))
Short Certificate(s) ........ $ 2~3 • yO Attorney Signature: l~
Renunciation(s) .......... $ S _ C1C~ Robert P. Kline, Es uire
J~ ... $ 1 D • r~~ Attorney Name: 9
L ~ ~r .. $ J ~ c~~ Supreme Court I.D. No.: 58798
(~ tau m~-F ry
" ' $ P.O. Box 461
$ Address:
.. $ New Cumberland, PA 17070
... $
... $
• • • $ Telephone: (717) 770-2540
... $
TOTAL .............. $ ~ 30 . dG >~0
J
Form RW-02 rev. 10.13.06 Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~eh Irn~ this certificate, ~6.Op tots (.~ to cerury unu ulc uuv3lnaLlvtt ltCtC ~tv~tt t,
correctly 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 Olf-ice for permanent filing.
P 15000869 _ ~ DEC 3Z0B
Certification Number ~ _oca Re~istr:n- Date [sued
iEV II/2006
PRINT IN
ANENT
;KINK 1131-417
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions and examples on reverse) STATE FILE NUMBER
1. Name of Decedent (First, middle, last, suAix)
h Jr
ba
D Li 2. Sex
Male 3. Social Security Number 4. Date of Deam (Month, tla ear)
DecemberL~
2008
nsen
c
Lester 165 - 38 "'2431 ,
5. Age (Last Bidhdey) Untler 1 year Untler 1 tlay 6. Date of Binh (MOnm, day, year) 7. Binhplece (City and state or for eign country) 6a. Place of Death (Check oMy one)
I Mmrns Day, vans kn"uus
October, 9 1947
garrisbur PA
g Hospital:
^
^ Other.
^
^
^
61 yrs • Inpatrenl ER I Outpatient
DOA Nursing Home
Resitlence
Other Spedty
Bb. CounTy of Deam Sc. City, Bo w of Death Bd. Facdiry Neme (II not instituClon, gNe street antl number) 9. Was Decedent of Hispanic Origin? ®No ^ Yes 10. Race American mdlan. Black, Whde, etc.
Cumberland
South Middleton
Carlisle Regional Medical Center (II yes, specify Cuban,
Mexican,PUenoRican,etc.) (Specify)
White
11. Decdent's Usual Occu fion Kind of work d one tlunn most of wo life. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Specify only highest grade comp leted) 14. Marital Status: Monied, Never Marrietl, 15. Surviving Spo use (II wife. give maiden name)
KiM d Work Kind of Business! Industry U.S. Armed Forces? Elementary I Secondary (0-12) College (1.4 or 5+) Witlowe4 Divorced (Specify)
Electrician Residential ^Yea ®N" 12 Divorced
1 B. Decetlent's Mailing Atldress (Street, city /town, state. zip code) Decedent's Did Decedent
Actual Reaitlerrce na. sole Pennsylvania Uve m a no. ®ves. Deceeem Dved m IInner Frankford Twp
4 Brookview Drive TOY'"ship? 17d
l3ecedem wad wimm
^ No
Neville, PA 17241 .
.
170 c"~nry Cumberland Acual umitsm clty!Born
18. Famer's Name (First, middle, last, suXix) 19. Mother's Name (First, mkldle, maiden surname)
Lester D. Linsenbach, Sr. Mar aret Ellenber er
20e. Inlortnant's Name (Type I Print) 206. InfortnanCs Maifing Address (SlreeL city I sown, state, zip code)
Mr. Todd Linsenbach 10454 E. Corrine Drive, Scottsdale, AZ 85251
21 e. Method of Disposition i ^ Cremation ^ Donatpn 21 b. Date of Dlspositlon (Month, day, year) 21c. Place of Dispoenion (Name of cemetery, crematory or finer place) 21 d. Location (City /town, slate, tip code)
® Burial ^ Removal from State j Wes CremeBon or Donation AWhorized
^ Other-Spea7y~ byMWlcelExeminerlCOronerT ^vea^No DE!C. 26 , 2DU8
Woodlawn Memorial Gardens
Harrisburg, PA 17109
22a. Signanxe of Funeral see r pe ' g as such) 22b. license Number 22c. Name antl Atldress of Faa7iry Zimmerman-Auer Funeral Home , Inc .
- ~ FD-013413-L
Complete ttems 23ac ony when certilyirg 23a, To the best of my kraxietlge, deem occured al the time, date and place slated. (Signature and arts) ~ 23b. Lkrense Number 23c. Date Signed (Month, tlay, year)
phyaiden a nW available al Time of deem to
ceniy cause of deem.
Hems 24-26 muss DB compmtetl by person 24. Tme of Deeth 25. Date Pronarxretl Dead (Month, tlay, year) 26. Was Cese Referted to Medical Examiner I Coroner for a Reason Other than Crematbn or Donalbn?
who prarlounces death. 6:16 A. M. December 21, 2008 Yes ^No
CAUSE OF DEATH (See Inatruetlons and examples) t Approximate imerval: Pan II. Enter other significant condlions conlnMnlnq to tleelh, 28. Did Tobacco Use Contribute to Dealh~
Item 27. Pan I: Enter the chain of events - tliseasas, injuries, a canplkatbns - Thal direaty causatl me tleam. W NOT solar terminal evenh such as tartlet anesL r Onset to Death bN not resulting in the undetlying cause given in Pan I. ^ Yes ^ Prooaoly
reapiretory onset, or ventrkular fibnlletlon wmal showing the etiology. Usl only one cause on each line. ~
I
^ No ^ Unkrawn
IMMEDIATE CAUSE IFinal disease or Chronic Obstructive Pulmonary Disease r 2s. 11 Famala
condition resulting in death) -f a t ^
Due to (or as a consequence of): r
' Nol pregnant within past year
^ Pregnant al time of tle91h
Segrrentlallyy list cordttions, if any, b.
leatlirg to 1M cause listed on line a. r
Enter fha UNDERLYING CAUSE Due to (or as a consequence op:
^ Not pregnant, out pregnant wdhln 42 days
(disease or iryury that initiated the o r
ltin
n death) LAST
t
s of tleelh
.
even
s re
u
g I
Due to (or as a consequence of):
^ Not pregnant, out pregnant 43 tlays fo 1 year
tl. Oetore (kath
^ Unkrwwn it pregnant within Ina past year
30a. Was an ANOpsy 30b. Were Autopsy FlMings 31. Manner of Deeth 32e. Dale of Injury (Month, day, year) 326'. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory,
Pedomred? Available Prbr to Cornpletbn
~ NaNral ^ Homicide Oplce Building, etc. (Speciy)
of Cause of DaatM
^ Yes ~ No ^ Ves ^ No ^ Accident ^ ParMirg Investgatbn 32tl. Tme of Injury 32e. Injury at Work? 321. II TrenspMatbn Injury (Specify) 32g. Location of Injury (Street, city I town, state)
^ Suicide ^ Could Nat be Determine0 ^ Yes ^ No ^ Driver I Operator ^ Passenger ^ Petlaslrian
M Other- Spedly
33a. Certifier (check oMy one) 33h. Signature C o r o n e r
• CMHying physician (Physician cenifying cause of death when arather physician has pronounced death aM competed Item 23) -
To the bast of mY Wrowledge, death occurred due to the ceusNsl end manner as etHed_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• Pronouncing and uredgying phyek:len (Physician lath Dronouncing death and cerfitying to cause of deem) 33c. Lice N r 33d. Dale Sigrred (Month, tla , earj
To IM lseN of my knowlWge, death occurred sl the tmr, dale, aM paa, and due to the cause(s) and mennx as slated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ December ~ ~ , 2 008
• Madkel Exeminer I Coroner
in my opnlon
death occurred et the time
dale
and place
and due to 1M uuee(s) arM manrer es atated
On Vre beelc of exeminadon antl 1 or Investlgatlon
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,
,
,
,
,
_ 3y Name end Atldress of Person Wlw Compleletl Cause of Death (Item 27) Type I Print
' Michael L. Norris, Coroner
s Sgnature antl District Number
35.Registrar 36. Dots Filed (MOnm, day, year) 6375 Basehore Road, Suite 111
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Disposition Permit No. 0309224
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RENUNCIATION ~ '
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REGISTER OF WILLS _
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CUMBERLAND COUNTY, PENNSYLVANIA ~ ~ ` ~
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Estate of LESTER D. LINSENBACH, JR. Deceased
can
I, TODD LINSENBACH
(Print Name)
in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
my sister, Dana Shover
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
s
(Signature)
10454 E. Corrine Drive
(Street Address)
Scottsdale, AZ 85259
(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 renunciation for the
purposes stated within on this ~~~'? day
of ~ ~ C ~~~ ~ c°"/~ oZ v o ~
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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.)
COMMONWEALTH Of PENNSYLVANIA
Form RW-06 rev. 10.13.06
NOTARIAL SEAL
SHARON R. FEISTER, Notary Public
New Cumberland Boro., Cumberland Co.
My Commission Expires April 15, 2011