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HomeMy WebLinkAbout02-04-09 (2)PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF _ ~ ~.>\t.~~- COUNTY, PENNSYLVANIA ~ ~ _ Estate of ~~.rw~~l ~ ~ 9-p-1t~1~,~2^~ File Number ~ ~ V ~ \ ~~ Ct -~ .~ also known as i ~ n ,Deceased Social Security Number ''[ ~ "` ~j ~ ~j '~ ~ ) 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 named in the last Will of the Decedent dated 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 execution of the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: L~!I B. Grant of Letters of Administration (Ijapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durance ntitroritnte) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and hears: (!f Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) t Decedent was domiciled at death in County, Pennsylvania with his /her last principal residence at (L1Sf street address, town/city, township, county, state, zip code) i ~ Decedent, then ~_ years of age, died on ~ at d ~ `( tv ~. (?U 13 Decedent at death owned property with estimated values as follows: C~~"''- ''' , (If domiciled in PA) All personal property ~ --'~1 ;~`";^ ` - (If not domiciled in PA) Personal property in Pennsylvania r~rl C7 - QJ ~ : _ (If not domiciled in PA) Personal property in County ~ t•Tt ~ [ _' •"_!:? Value of real estate in Pennsylvania ~~ ~ , Q(f ' . ,; ..v situated as fol Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grani~'Letters in the~ropria2e"fbhA the undersigned: ~ or printed name and residence. c Form RW-02 ,~et,. !0.13.06 Page 1 of 2 (COMPLETE INALL CASES:) Attach additional s/:eets if necessary. Qath of Personal Representative COMIv10NWEALTH OF PENNSYLVANIA SS COUNTY OF The Petitioner(s) above-named swear(s) or affirnl(s) that the statements in the foregoing Petition are hue and coned 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 ignature of Persona epresentative be ore me the I ~~ day of ~-~ Signnture of Personal Represeretntive For the Register Signature of Personal Representative File Number: ~ ~ ~ ~ ~ `~,~ Estate of •l,r"YU C ~-~ ~~~`~`-~ ,Deceased rj Z. ~ r ~ ~ ~ .Date of Death: LA-{ Social Security Nurlber: ~ AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been preseraed before me, IT IS 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 and filed of record as the last Will (an d Codicil(s)) of Decedent. FEES ~{, i $ ~ ~ t~l ~ ~\~ Regi er Wills 1 n • . Letters ...... ~ `•'• r: ~ _ ~~{ (Vr Short Certificate(s) ........ $ Attorney Signature: ` Renunciation(s) ....~...... $ Attorney Name: ~ °"ti` ~~ ~GU ~~ ... $ ~ Z~~ $ Supreme Court I.D. No.: _ .. 7V ... $ Address: ' ... $ ~ ~ ... $ ... $ ... $ • ~ • $ Telephone: ~ 1 ~ ~\~ --`~ ... $ TOTAL .............. $ ~ rJ Pa oa 7 of ~ Form .R' "-~i_' . erg r ti. i 3.vG IOi.805 RHV (UI/071 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 145~~698 Certification Number 't Z H706.143 REV 11y26P6 TYPEl PRINT IN PERMANENT BLACK INK (Lest This is to certify that the information here given i correctly copied from an original Certificate of Deaf. duly filed with me as Local Registrar. The angina certificate will be forwarded to the State Vita Records Office for permanent filing. A• ~eu.c~~~-~~e,,~Ay 1 sj zoos Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) n ~~ m ~rn-- C~ v~ ~~ ~~ +v 0 A .o 'Tt t fi 2 r t last, suffix) STATE FILE NUMBER C.T ` ( I 2. Sex 3. Social Security Number 4. Date of Death (MOnm, day, yea. HARRY C. GANDY Male 419 - 52- 8791 May 11, 2008 Under 1 year Under 1 day 6. Date of BiM (Month, tlay, year) 7. Bi Monmx PAYS Hours M'uMn nhpece (CRy antl skte «loreign ceunlry) 69. Plata d Death (Check only one) z ~ ~~ - ~; c ~= r-~' ~ ` -~ -i-~ I~, r~,~-> ~..1,~-~ C~ \ ~). 6 7 Hospital: Othen Yrs. Jan. 27, 1941 Atmore AL Bb. County d Deam &. City, Boro, Twp. d Death ®Inpedenl ^ ER / Outpanent ^ DOA ^ Nursing Home ^ Residence ^Other - $reaty: C~ i ed. FacilAy Nacre (If not inslMUtkn, give street and number) 9. Was Decedent of Hispanic Odginl No Yes Cumberland South Middleton Tw Carlisle Regional Medical Center IR Yes, speaty token, ® ^ iD.Race:American lntlian, Black, White, ek. Mexican, Puerto Rican, etc.) (~~ 11. Decedent's Usual Occu Mon Kind of work done tlu' mast d wdki life. po rim stele refired 12. Wes Decetlent ever in the 13. Decedent's Education Black KiM of Wark Kintl of Business / Industry U.S. Armed Forces? (SPecity only highest grade completed) 11. Manta Status: Merced, Never Monied, 15. Surirving Spouse (lf wile, give maisan name) Mill ator Elementary / Sewndary (0.12) College (1-4 or 5•) Wxhwed, Divorced (Specil}7 F ^vey ~fNp Unknown Married i6. Decedent's Mailing Address Igeet city /town, slate, aP coda) Decedents Sara J. Cuff 55 Cavalry Road Aciwl Residerxe na. gale Pennsylvania oid Decedam TwvnsniP. 17°. [~ Yes' Dewaem Dved m North Middleton T Carlisle, Pa 17013 176. count' Cuaberlacxl ' 1Td. ^ No, pecedemLivedwdnin cap 18. Father's Name (First, misdk, bsl, sufix) Actual LinRs d CRy / Bom 19. Mdh«'s Name (Post, midAe, maiden surname) ~Y Gandy Nannie Bell Jordan 20a. Infartnant's Name (Type / Pnnl) 20b. Inbrtnanl's MeiRig Aetlress (Street, clly /town, stare, zip mde) Sara J. Gand 55 Caval Road Carlisle Pa 17013 21 e. Memod of Disposdbn l l~Oramatbn ^ Donation 21 h. Date d ^ Burial ^ Removal ban State Dispositbn (M«ah, daY, Yroq 21 c. Place d Dkproilian IName d cemetery. cremelory or om« pkw) 21tl. Location Wu Crematon «Done6on Autlgdad ICM /town, slate, zip axle) ^ omer-sreaTr: hrMrWlrolExamirw/corwlxy ~y~^y~ MaY 19, 2008 Hollinger Funeral Home & Crematory Inc. Mt. Holly Springs, Pa 17065 22e. signature «al Servke ~ ( acdrlg es such) 226. Uwnse Number 22c. Name ens Adders of Fadfdy ~" PD--012909-L Ronatt Funeral Home 255 York Road, Carlisle, Pa 17013 Campktn s 23et omy when arrGyinp 23a. Tome best d my kgwlsdga, dum axuned at me erne, dale aM pkro slates. (SiguNre end Idle) Pnydda brim evadable et erne d death ro 23h. Lwenu Number 23c. Date Si goad anm, say, er) wmty caaseddeam. © oa 9 Z6 3- ~- ~ ~ 2 ~~g' gems 2426 must be c«nPkkd by person 2/. Tmre of peam 26. Dale Pr«Ipxrad pass m, ~a ~ 'roar) 26. Was Case Referree ro Me®cal Examiner /Coroner for a Reason Other men Cremation « Donedon? who prdro«xes dram. J. ~. r1 O ,L-3,.~/ ^ ras CAUSE OF DEATH (see irretruetlons and examples) , Appradmme interval: Penn: Fmsr doer dmi6rrm_ mmtm"~ try;~~„ ro deem 26. Did Toba¢o Use ConbPoula b peam? Mem 27. Pad I: rest the dlap d event-diseases, irquries, «ronpewMms -met dnxtty caused the deem. DO NOT enter 1«mmal events such u wNiac awst, I>irekry arrest «vemdubr bbnkadm w~pty,sgvaing me e6okg/. Ua aHy aria cause on kit'. ~ Oree1 b peam but not resdXng in me uneedyirg cause given in Pen I. ^ Yes ~ ~~no~Ty IMMEDIATE CAUSE Pool dsea e « ' i - r•~, '~^ UnMwwn cadlem resalang i, from) -~ a. /C~iL.wy YAr 1 ~„~- r LY^o Duero (a u a wYaequenro oQ. I r 29. X Female: badn~ ~N tl~ie woes ksbtl~an I'sMie a. b' r ^ Nd pregnenl wilnin past year Enter Ble UNDERLYING CAUSE Due to (or as a mnsequenw d): ' ^ Pregnant at Tine of deem ' (diseme «iy«y met idaakd me ; events resurorp m droml LAST. c. r ^ Nd pregnem, do pregnant wimin qz saYy Duero (or as a consequence o9: r d deem (~ d. i ^ Nd lYlagnanl, dA pregnant /3 days ro 1 year V 1 before tleaMl 30a Wu an Auropyy 30b. Were Autopsy Fmdngs 31. MB«wr ^ Unknown d pregnant witlin me pas( year Pad«med7 AveMabk Prior ro Compmion 37a. Date o`Iryury (Month, say. Year) 326. Descdbe How Injury Occune0 al Caiae d Deem? Namrel ^ Fiarrlkde 32c. Pbw of Injury: Home, Farm, greet, Fad«Y Ofice BWlding, etc. (Speay) ~C ^ Vas ^ yw yo ^ Accid«p ^ PerxNrg Investigation 32e. Tme of In1urY 32e. Irqury at W«k? 32f. If rremponaeon Injury (Speak! Location of Injury (greet dry / tarn, amts) ~ ^ SuiMtk ^ Caultl Not he petermined ^ Yes ^ Na ^ Om« /Operator ^ Passeng« ^P M' Omer-Sp«s/y: 33a. Ceretbr (ctleclc aNy anal Bx. Bignamre aria rme or r • TCerlilyl~plryskien (Physldan cenllyig rouse d deem when anWler pnysician boy pr«iourced Oum antl ampmtrd Rem 23) v y Enowbdge, awm occ«rsd due Le the awe(s) and manner u slnerL _ _ _ _ _ - - ^ ~ ~ • PromunclrpantlcenRyingphyeklan(Pnydaanbomprenoixidngdeemanaaendyilgmroayadmem)------------------------- ~ To the hest of my llnawledge, deem accursed M tlse Ume, date, and phw, arM dw to the rouse(s) and manwr u smterL _ -- _ _ _ -- _ _ n NwMer 33tl. Dale Signed (MOnm, day, year) MedkYEeeminer,COroslar ------- (~~© 9 z63-- M (~ • Dn the hub d eaemhutbn end / « mvaedgation, m my apinbn, death occurred M the tlme, dale, and place, and dw to tM rouse(s) and manner ay smted_ ^ I ~ ~ ?tea d 31. Name and Aderess al P 36. Signature ery~pi&n Np ,bar ^ ~ ~ ~ ~ d (Mom 27) Type / Pnnl ~ ~ H ~~Gi_LwVaLL~ I~~~I~I care Rlea (MOnm, my, ree~ S (.. l aMlf ~d/C~- v Disposition Permit No. O I~7 /.~ ~ ~ o ~ ~ro`1 RENUNCIATION /~ REGISTER OF WILLS ` ~~~~~'G ~ti'y COUNTY, PENNSYLVANIA Estate of '-z I, ~f/.'2/STOP E ,~ ti' /2 ~~~ Y (Print Name) , In Ihlj~ S ~~iv of the above Decedent, he administer the Estate of the Decedent and respectfully request that Letters be issued two 7 (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~~~`-'~~ day -~ ,~2-.~._ epul~y for Register of Wills ~ .° -~, II~cr3a3ed ~ ~ ~ r ~ ,_, +. cr ~ latr y ' ~~ tY-~ og~slaip as s -2-., ...,.Y .~ renoumee the=.~ to .. ..,, c.. , . _j ~ .z e~~ (Signature) (StreetAddress) G v~we ~~q~~,s~ ~ P,9 i ~v i3 (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 Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date ofexpiration ofNotary's Commission.) Form RW-06 rev. 10.13.06