HomeMy WebLinkAbout12-31-08P~~I~'Y~~ FO~Z ~I~tOB ~T~ ~~~ CR~'~~' ®~ LE ~~~R~
~- T ~ r ' T ~ ~ COL~iTY", PE`s ~~Yi,~':=.,~I:~
RFvIS _ LR Or `-vIL~~ OF rim ~ T' ~ cI
f ,w~ ,~, , ~ Piie Number ~, ~%~ `~~'
Estate ~.
a!sc kno•Nn as ~S"'
Deeeased Serial Securih/ '/~'=~~~_~ _
Petitioner(s), who is/are 18 years of age or older, apply(ies} for:
(CO,L(PLEZE 'A' or 'B` BELD6V:)
(~ A. Probate and Grant of Letters Testamentary and aver that Petitiot:er(s) is ~ aFe the Ildf!~'.t(' ~ ~ j I f~- na~:~ed in t;ie
last w;i! of the Decedent dated ~.._~~ l~( 3(~ ~[iQ _~and codicil(s) dated
(S:at2 relevnnt cirewnslances, e.g., reruutciatiorz, death ~f 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 insUument(s) offered
for probate, was not the victim of a killing and •.vas never adjudicated an incapacitated person:
^ B. Grant oCLztters of Administration
(ij appiicabfe, ert:ec c.t.a.; d.b-n.c.ta.; pender~te lire; durantz aosa~u:a; .wnnle :,urror~itn;e;
r~ ,
Petitioner(s) after a grope; search has /have ascertained that Decedent left no Wi!I and was survi~ied by the fo!lowin~-spouse (if any?d heirs: (.;~'..,
Adntini~tralion, c. t. a_ or db n.c[.a, enter dale of Will in Section A above and complete list of heirs.) ~ ;~ `="
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Name Rzlatiership R=s'i-~^"~~'' C`i
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(CONIPLETELYALL Cr1SES:) Attach additivnat sheets if necessary.
(List sb~ee! address, ~owngg/city, +Ebwnship, coiuiq~, state, zip rose/
Decedent, then U~ years of age, died on~~~~ at
situated as follows:
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incipai residence at _ __,_
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/ poi ~
'J/herefoie, Petitioner(s) respecttiilly request(s) the probate oFthe last Will and Codicil(s) presented wi[h this Petition and the grant of Letters in the appropriate fam to
the undersigned:
Si~naaira Typed or printed name and residence I
~~~ h'o y er- i,t,} . C,~ y is
Foru~ Rf~P-Q? rev. !0.13.06 P~l~e 1 Of 2
Decedent at death owned property with estimated values as foltows:
(lf domiciled in PA) All personal property 5~~~. ~ ~~ :OG
(If not domiciled in PA) ty in Pennsylvania ~
(If not domiciled in PA} Personal property in County ~
Value of neat estate in Pennsylvania ~
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
(~ ~1 SS
COUNTY OF l .i.Pf)'),~c'i"'Cl!? K.
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.
1 !'J
~ _:._.
Sworn to or affirmed and subscribed ' "~
Signatu of Personal Representative ~'
Q
before; me the ~ ~ l day of - `•7
~r ~~~ ~'
1 ~C"e{~~ ~~ Signature of PersonalRepresentatrve _..
~~
r For the Register Signature of Persona! Representative ~
N
File Number: ~ ~ ~~ ~ , ~~
~1 ~,l {~, (1~ ,Deceased
Estate of ~ O Y'C'~ L! U) S L ~,~1 `~" Y ~' ~' `~-'~ ~ `-~
Social Security Number: 1 ~J~ ' ~~ ' . ~ 3~ ~ Date of Death: ~~~ C, s ~ ~ ~ ~ ~'~ <~
AND NOW, _~1 L~kC ~^c\~rr_C" ___, ~~Z_, in conside ation of the f regoing Petition, satisfactory proof
having; been presented before me, IT 1S DECREED that Letters
are hereby granted to /"
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate
of record as the last Will
Codicil(s)) o1~Decedent.
FEES
Letters .... ~~~. r.Q~v . $ of , o 0
Short Certificates} .. ~ ... $ o?'-4°C.
Renunciation(s) .......... $
~J<<I ... $ 15 <>-
... $
... $
... $
... $
... $
... $
TOTAL .............. $L~I'`~ ~ --&.66
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Register of Wills
Forn Rw oa rev. 10./3.06 Page 2 of 2
IQC~A~m ~E~ISTRr~F~'S ~'~~A`T`~t~l~ ~ .~,`~'
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"s u3 k" ~"-~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS
a P, c!Fk.f.l lN~o ^
FEk11F'.ENi
a~~cki;ix CERTIFICATE OF DEATH r~ r~~ ~~jj'•~~
ISee instnlctinns anA cramnlnc nr. rowo.~aa ~..r~ ~~. ~......,._~. ~,( 1 (lC/,l ~ ~1W)
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I Narne d Decetlant (Feu. middle, last, suXu) 2 Sex 3 Serial Seaairy Number a. Date of Deem (MUnm, day. rear)
Dorothy L. Guise Female 195 - 16 - 3361 December 21, 2008
5 Aga (Las, E¢mday) UMx 1 e Under I tlay 6 Dele of Bvm (Monet, tla , year( 7. BiMpWCe (Cis aM ssese a filar n wank ( Ba Place of Deam Check only one)
Mmes Wrs Muun Mnuws NaspiW' peter.
86
Yra February 9, 1922 Shippensburg,
^Inpalienl ERloa 4ent DoA
^ Wa ^ ~Nurung ~Om~ ^kendance ^Omx-Spmly
Bb County of DaaN &. City, Sae, Twp d DeaN Bd. Fau4ty Name (If nos inslilulion, give sweet antl numbs) 9 Was D .edanld Hispanic Origin? 'may No ^ Yes 10. Race American Indan. Blame, White, ek
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Cumberland Gamp Hill Manor Care Health and Rehabilitation (~y
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11. Decedent's Usua1(kapatitn (Hind d wvk done Burin moss d waking IAe Do not slate retved.( 12. Was Decedent ever in me 13. Decedent's Education (Specify only highest gads completed( tor. Marital $M1111'. Martial, Nevx Maned. 15. Survmy Spouse (Il vole. 4ve maiden name)
Kuldd Wok Kwdd Eusinessllndustry US. Pzmed Faces? ElemenurylSOCOntlary (0.12) C¢Ikge (1d or 5.) Widowed, Divorced (SpecihJ
Homemaker Own Home ^Y=: N¢ Widowed
16 O¢cetlera's Mai4ng AdAess (Sweet, sty 11mm, sate, z,D code) Decedent's Did Decedent
Market Street Actual Ra:idmW 1?a $Mla PA live ins 11c ^ Yes, Decodaot l)vedm iwp
Mechanlcsbur
PA 17055
9 rdwn,nip?
,7b c°anly Cumberland ,yd ~ "°'D°`¢d""'L+'edw'°°^ Mechanicsbur
, g D„ ,ea°
Actual limits e/ Y
IB Fad.a's Name (First, middle, last. sumxl 19. Momer's Norma (Fast, mitldle, matlen surname)
Isaac Russell Henrietta Varner
ZCa Inlormants Name (Typal Pnnll 20b. Inlpmanl's Ma4rg Address (Strew, my/town, Blase. zip coda)
Roger Guise 925 C1 Road York Haven PA 1 7570
21 a. Method al aslmsiuon []Cremation ^DdnabJn
( 21b Date ¢l Dlslwvuon (Monet, say. text 21c. Place of Disposition(Nome of cemetery. a¢masaya omx place) 21d Location(Gty NOVa,. star,, nPCWe)
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b~nal ^ Ramaval hum Stara ; Waa Cramallon or D¢na0en Authorized
^ ~?. m¢xl ; byM xalEaamm.rrcdrdn.n ^ye, ^No
December 24, z0o8
Sunnyside Cemetery
York Springs
PA
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such( 22b License Numbw 22c Name aM Adhaudfarilny
" - ~ FD-012662-L Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055
to It s 2 only when oanifying 23a Nor best 01 m ovAedga. dean occwad al me lime. dale and place staled (Signature and OIIe) 23b. Lironse Numbx 23c Date Sgnetl (Month. day. year)
pnr=~ra i va,labla al4me d seam lu
¢nuy ea:e ¢I tleam.
- s 2a2b muss Ce mmpleled by person
aTO 2d Tune cl Deam 25. Data Pronounced Dead (Nandi. day, year) 2fi Was Case Relerted to Medical urer 1 Coron~W aReason Wrer man Cremauog a Donabpn~
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p°ndenJeadaam 1 9 S M. ~ _ _ ^ Yaa [~
CAUSE OF DEATH (Sea lnslruetlons antl aaamplast Appoumate Vmalvaf Pan ll. Enter Deter sidnihcanl conditions cony bvyno odeam 2B Did iobacw U:e Conmbute to Deam?
em 27. PART f. c" ,a me than ci events- d+seases, mlwies, n complication.-Ines tluauly caused Na tleam. W NOT emar terminal events such as cardiac erred, Onset 1¢ Death Wt nw resuNng tit m¢ untlxlying cause given in Ph l ~ Yes ^ Probably
respuatay artesl, u venViculx hbrillalion lwlhoul showing me atiobgy list only ore cause on each line
No ^ Unknown
IMMEDIASE CAUSE
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Due m (a s e consequen a o1J ~
a r,yNol pegnanl vn1Mn pas year
S¢Guenha4 MSt wndieons Ban, b
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to cease 45ted do 4neey l`~vll(~ l)~~ t/lUl}
leadin 1/ ,{
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Ems Uie UNDERLYING CAUSE Due a (w as a consequent r ^ Ndl pegnanl, cut pageant wiWn a2 days
(d3e~se °r injwy Nal mieal¢d me ~ - OO ~ 7 L
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in tleam
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Dun l01el as • <omaque+aa uf) ~ Nw puyna+l, but paynanl a3 Jars lu I yax
d deem
d ^ Unknom A p¢gna a,mm m¢ pas yax
30a Was an Autopsy 30b INxe Autopsy Findings 31. Manner of Daam 32a Date of Injury (Monsh, day. yax) 32b Oesaibe How Injury Q:curted. 32c. Place d In„ay Home, farm, Saew. Faaury,
Performed? vailable Prior to Compl~hon
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^ Yes ~c ^ Yes ^ No ^ F:oaunt ^ P¢mm~q Invesogalion 32d. Time of Inryry 32e. Inlury al Wmk? 321. If Transpatalion injury (Spauty) 32q. localien of Injury (Spae1, sty I sawn, state)
^ Swc~Je ~Gouid Not ba Delenrined ^ Yas ^ No ^Drivxl Operalw ^Passenger ^Padezv~an
M. ^olnx - sp<ary-.
33a CeNtier (d+eck ordy one) 33b Signalwe and T+lk o(Cenilix
Cenityin8 phys+c+an (Pnysiaen cerutyinq case °I deem wr.=n ancin•r pnrsiaan has ponouncetl loam and completed Item 23) -
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ioNabeAOlmyknowledga,dnth occmrod due to Ne causa(sJ and manner 9a elated _____
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• Pronouncing antl cenilying phyeinan(Phystoan both ponounung tleam and cerulymgto cause of deaths ~~YT
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_ _ _ _ _ _ _ _ _ _ _ _ _ ~ _ _ _ _ _ 1.d
Matltcal Ezaminerl Coroner ~\
IZ /ZI-~IZ I~Z~
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On Na basis of uaminatian andlor inveehgabon, in my oplniun, dean occurred al Ne dine, tlale, and plat., and due to the cause(s) and manner as slaz¢d.__y dQ
3a. Hama antl AdQess of Person Who Compktatl Cause of Death (Item 271 iypa lPnnt
3:. lee
- ^uV Si au and Dtsn'tn
< ~' I~, I ~ ~~ I ~ 1 ~, I 36 Dale Fikd(MOnm. day, Year(
2C2,n~u'r.lN,'vs ~~/ISlan~ t7µ(~~z.{12,/,~~
13ou N~Nrl~ei. ~ SzE IZ Lrkw ire, ?r1 (-~u43
Disposition Pr;lrnlt ND~.~.~~~1 y~f)
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LAST WILL AND TESTAMENT
-'~-
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OF - , ~ ~„
-..
DOROTHY R. GUISE 1 .~-
N
I, DOROTHY R. GUISE, of the Borough of Mechanicsburg, County of Cumberland
and State of Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this my Last Will and Testament, hereby revoking and making
voiid any and all former Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my
decease as the same can be conveniently done, including the payment out of the principal of
my general estate, of all inheritance, estate and succession taxes which may be assessed in
consequence of my death.
2.
I direct that all the rest, residue and remainder of my estate be converted into cash and
for this purpose I authorize, empower and direct my Executor hereinafter named, to sell any
and all real estate which I may own at the time of my decease, as well as my personal
property, at either public or private sale or sales.
After my estate has thus been converted into cash and upon the payment of all my just
debts and obligations, the costs of administration of my estate and upon the payment of all
inheritance and succession taxes, I direct that the same be divided into four (4) equal shares
-1-
anal that the same be paid out and distributed as follows:
(a) I give and bequeath one (1) such equal share to my daughter, PATRICIA A.
PERRY.
(b) I give and bequeath one (1) such equal share to my son, ROGER W.
GUISE.
(c) I give and bequeath one (I) such equal share to my daughter, DOROTHY L~.
GUISE.
(d) I give and bequeath one (1) such equal share to my grandchildren who are
living at the time of my death, share and share alike.
LASTLY, I nominate, constitute and appoint my son, ROGER W. GUISE,
Executor of this my Last Will and Testament and direct that he be excused from posting
bond or other security for the faithful performance of his duties, in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this =~_,~ day of
July, A. D. 2003.
~,A, _ ~ ~ > '~ ~ (SEAL)
Dorothy R `wise
-2-
COMMONWEALTH OF PENNSYLVANIA )
SS
COUNTY OF CUMBERLAND )
I, DOROTHY R. GUISE, the testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the same instrument as my Last Will and Testament; that I signed
it willingly, and that I signed it as my free and voluntary act and deed, for the purposes
therein expressed.
Sworn and subscribed to before
me. this i' ~ day of July, 2003
,~ n
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f c i t~ ~l ~ e ~'C if ~ ~'1
Notary Public
,~~ - ~ ~~ ~.~~ ~ (SEAL)
Dorothy Guise
C~MONWEALTN OF PENNSLVANIA
Hs+d M. ~~isl Seal
~'D eao.'c.~, ~nd~
~ ~ Ares ,June 27.~i
M""°'r "°",a
COMMONWEALTH OF PENNSYLVANIA )
SS
COUNTY OF CUMBERLAND )
We, the undersigned, J. ROBERT 5TAUFFER and JOHN M. EAKIN, the
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw the testatrix,
DOROTHY R. GUISE, sign and execute the instrument as her Last Wi11 and Testament;
that: the said testatrix executed it as her free and voluntary act for the purposes therein
expressed; that each of us, in the hearing and sight of the testatrix, signed the Will as
witnesses; and that, to the best of our knowledge, the testatrix was, at the time, eighteen (18)
or more years of age, of sound mind, a nder o constraint, duress or undue influence.
/`~ 7~ / ~~-- ~L ~
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Sworn and subscribed to before
methis 5'c ~'' day of July, 2003.
Notary Public
C~~WEALTH OF pE~gLVANIA
Heidi M. ~~ Seal - 3 -
~~ 8~oio~Gxif*,leyPui~ic
F~i-es ,June 27, Z0
Assoaapon prNo~