HomeMy WebLinkAbout02-12-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
-- _ __
- - _ __
Estate of DOROTHY M. ZULLINGER File Number 2 ,,2~ ~ - ~ ~ ~j~j
also known as
,Deceased Social Security Number 191-18-4269
ROY S. ZULLINGER JR
Petitioner(s), who islare 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
f~7
State 2levant circumstances, e.g., renunciation, death otexecutor, etc ,- (~ ~
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of ttiiztrumenti~offered; _
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ - ~> t~ ~'
-~--_ _
~:,
i
II ~ l l`
1'y~ ~ ~
QX B. Grant of Letters of Administration --% ~ ; ,?
apprca e, enter c.t.a.; ..n.c.t.a.; pe ente rte; urante a sen ra; urante mmontate _ _
Petitioner(s~ after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spou§ (if any) andctairs: (Jf
Administration, c.t.a. or d.b.n.c. t.a., enter date of Wil! in Section A above and complete list ofheirs.) -~..i
Name Relationship Residence
ZULLINGER, ROY S JR Son 444 WHITMER ROAD
Shippensburg, PA 17257
(COMPLETE /N ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his 1 her last principal residence at
444 Whitmer Road, Shippensburg, Southampton Township, Pennsylvania 17257'
(List street address, town/city, township, county, state, zip code)
Decedent, then $3 years of age, died on 12/24/2008 at Shippensburg Health Care Center, Shippensburg, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $
(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: NONE
20,000.00
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:
Signature Typed or printed name and residence
if
Shippensburg, PA 17257
Form RW-02 Rev. 10-13-2006
Copyright (c) 2006 forth software only The Lackner Group, Inc.
Page 1 of 2 -
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 this ~~ day of
r
~ n
>' ~ , , ~~ ~ C ~~~
Fort Register
V
ROY S. ZULLINGER JR
Signature of Personal Representative P~
c~
C7
~'
~
Signature of Personal Representative ~~'
c _ ~l
----
't~J J1, G. •
^
.~~ ~}
'~~~ '
~q
.w - it
File Number: ~1-AB~~.~-~~ "' ~~.~ ~ ~~ p
Estate of DOROTHY M. ZULLINGER ,Deceased
Social Security Number: 191-18-4269 Date of Death: 12/24/2008
AND NOW, , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters of Administration
are hereby granted to ROY S. ZULLINGER JR
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 (and Codicil(s)) of Decedent.
FEES
Letters ............................................ $ ~ ~V • ~T~
Short Certificate(s) ........................ $ ~~ ~(.~
Renunciation(s) ............................. $
~~ ~~ $ 1(~ ~YU
~.a ~;YYI,I~.~"1 ~ $ ~ ,~~
$
$
$
$
$
$
TOTAL .................................... $
Atti
Supreme Court I.D. No.: 10264
Zullinger-Davis, PC
Address: P.O. BOX 40
Shippensburg, PA 17257-0040
Telephone: 717-532-5713
Form RW-02 Rev. 10-13-2006 Copyright (c) 2006 forth software only The Lackner Group, Inc. Page 2 of 2
Attorney Name: Hampton C. DaVIS
~1~~~~. ~~~°~`~~ ~~~~s~~=~,i~"I~~N CAF ~~~~'n-
~~r~~~l~~x.: .'t dx3 lil£C~il{ f?~) C~LIa?'ICi-l1it~' F!,tc. ":4"'a?"~ S: `y' l: S":C~tQ~i1~i# t3 t' (?PlOtCFCa'3,KJ~a,
P 14~>6?20
III .,..
,
~d ~ -:
,
,:
_
~~ .
c- ~•
,
~
4'i, Lsx-
rw
f c,~
f`~.
,r
~~A} , r z
C
..,.. In _.'i(i! I:t{, ., ,,It ~1'.i ~(Il~ir. Ile') ~3 I'll I~
.f 1~ ~..tII ,`~' ;. ~,l{ il.:li ~ I iii 1l )i l)~,I(h
;~~ I,~:.; nil) I t f'r, .{.rr ;in,ll
'f '{r.'L fi AI III 11 ,. ,ic'il (~ IIC l;;lt~ ~V 1!;1(
~~a~
. -.. _- r.. I I
.~.1 t'[`,;i I' ,?.Sli' .,5111,!
N
C',a
~-~ ~
n -r'j
f ~
~ ,. . ,1
. ,~.
- ry
~ 1
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS i
- '°{',
c. _. 7
CERTIFICATE OF DEATH -~ =~j ~p ~"'~~
(See instructions and examples on reverse) STATE FILE NUMBER •--~
H106-143 REV 112006
TYPE /PRINT IN
PERMANENT
BLACK INK
~l
))
'
t. Name of Decedent (First, middle, last, sullix) 2. Sex 3. Social Security Number ale of Death (Month, da
.". ~
~~
DOROTHY M. ZULLINGER Female 191 _ 18 - 4269 Dec. 24, LCimi
5. Age (Last Binhday) Under 1 year Under 1 day 6. Dale o1 Binh (MOrllh, tlay, year) 7. Binhplace (City end stale or loreign country) Ba. Place of Dealn (Check only one)
kbmM1S Days Hwrs Mnules Orrstown Hosphal'. Other.
g g rns. Au 1 1 192 5 Franklin Co4m PA ^ Inpatient ^ ER I Outpatient ^ DOA ®Nursing Home ^ Residence ^Other ~ Specify.
Bb. County of Deatn &. Cny, Boro, Twp. of Death 8d. Facility Name (II rat Institulron, gve slreel and number) 9. Was Decedent of Hispanic Origin? ®No ^ Yes 10. Race: American Indian, Black, While, etc.
(II yes, specity Cuban, (Specil)zj
Cumberland Shi ensbur Tw Shi ensbur Health Care-Center Mexiwn,POe"pl°6an,el°.) White
17. Decedents Usual Dccu Iron Nerd of work done d un nror of workin iXe. Do not state retired 12. Was Decedent ever in Ina 13. Decedent's Education (Specify only highest grade wmp ktetl) 14. Marital Status: Married, Never Married, 16. Surviving Spo use (II wile, give maiden name)
Krnd of Work Kintl of Business /Industry U.S. Arrnetl Forces? Elementary 1 Secondary (0-12) College (1-0 or 5+) WidoweQ Divorred (Specil)1
Presser J. SchoenESnan Cb. ^vea ®NO Widowed
16. Decedent's Mailing Atltlress (SYreel, coy I Cann, slate, zip code) Decedents Did Decedent
ed lp Southampton Twp
Pennsylvania Live ina 17
Y
D
de
t L
444 Whitmer Rd. ,
r..
es,
ece
n
rv
Adual Resitlerice 17a. Slate
rnwnanip?
1n1
^N
D
a
mLN
a
uhm
Shi ensburg, PA 17257 .
p,
epe
e
e
w
ndcpanly Cumberland
Actual Limits of Cily I Boro
16 Father's Name (Rrst, middle, lass, suffix) 19. Mother's Name (First, middle, maiden surname)
McCla Martin Verde Hutts
20a. Inlonnant's Name (Type /Print) 20b. Inlormanl's Mailing Address (Street, cM 1 town, state, t ip code)
Ro S. Zullin er Jr. 444 Whitmer Rd. Ship ensbur PA 17257
21 a MethoRDl Disposition ^ Cremation ^ Donation 21 b. Date of Disposition (Month, tlay, year) 21c Place of Disposition (Name of cemetery, crematory or other place) 21d. Loretion (City I town, slate, zip code)
® Burial ^ Removal from Slate !Was Cremation or Donation Autnonzed
^ gher~Speciry: byMetlicalExaminer/Coroner? ^Yea^NO
Dec. 30 2008
ll MEarorial Gardens
l~d~erland Va
West Peru>sboro PA 17013
22a. Si naNr Funeral Service L ee acting such) 22b. License Number _
22c. Name arb Address of FaciNY 1 12 W. Kll'xj St •
- ~. ~ FD O1 1776-L e er-ffiicker Funeral Home Inc. , P.O. Box 336, Shi PA 17257
Complete kerns 23a~ Dory when cerolyirg 23a. To the be 1 my krwwledge, death occurred at the lime, dale and place staled. {Sgnalure and title) 23b. License IJumber 23c. Dale Slgnetl {Month, tlay, Year)
ph rcian is np1 available at lime of death to
~
/1
3
0
cerlAy cause of death. l
7
~J~ ~ P ~-(/
Hems 2426 must be q°mpletetl by person 24. Tana of Death 26. Date Pronovrroed Dead (MO ,day, year) 26. Was Case Relented to Medical Examinee /Coroner 1w a Reason Other Ihan Crematon or Donation?
who pronounces death. / (~~/ M. ~ ^ Yes ~le
CAUSE OF DEATH (See instructions end examples) r Approximate Interval. Pan II: Enter other gi,'nl~nl cond lions conlribulinq to deaPr 28. Ditl Tobacco Use ConlribNe to Death?
Item 27. Pen r. Enter the cha n o1 events - diseases. injuries, or romplications - Ihat directly caused Ua tleath. DO NOT amen terminal events such as cardiac arrest. Onset to Dealn but mt result ng In the underlying rouse given in Par I. ^ Yes ^ Probably
respiratory arrest, or venlrkular Ilbrillalion withal showing the eliobgy. list oMy one cause on each fine.
r ^ No ^ Unknown
IMMEDIATE CAUSE IFinal disease or ~ f
C
2B. II Female:
condtlan resulnnq in death) ~ I
a t
ithi
t
^ N
I
Due to {or as a consequence ol). pregnan
n pas
year
°
w
^ Pregnant at lime of death
Sequentlelly list con66°ns, 1f any, b. ~
leedil~g to the cause 1161etl on bne a. Due to a copse I
(or as quence o )~.
^ N°I pegnanL but pregnant within 42 day[
Enter the UNDERLYING CAUSE
(disease or injury Inat initialed the ~ -
l
d
d
lh
LAST
of tleath
s resu
ven
mg rn
ea
l
Due to (or as a consequence of). ^ Nol pregnant, but pregnam 43 days Ip 1 year
d. belore death
^ Unknown it prognanl wdhin the past year
90a Was an Autopsy 30b. Were Autopsy Fillings 31. Manrrei of Death 32a. Date of Injury (Month, tlay, yogi) 320. Describe Haw Injury Owurred 32c. Place of Injury. Home. Farm, Street, Factory,
Penorrned? Available Prior Ip Gomixletion Olllrn BuNdirg, etc (Specity)
of Gause of Death? alural ^ Homicide
^ Yes X40 ^ Yes ~o ^ Accident ^ Pending Investigation 320 Time of Injury 32e Injury at Work? 321. II Transponalim Injury (specilyJ 32g. location of Injury (slreel coy I town, stale)
''((--'' ^ Suicitlc ^ Could Not be Delertninetl ^ Yes ^ No ^ Dmer I Operator ^ Passenger ^Pedestrian
M ^Othei ~ Specily
33a. Conilar (check only one) 33b. Sigrfelure all Title of C ~'
G
Centtyinq physician (Physician certifying cause of death when another physician has pronounced tleath and completed Item 23) 2~-
To the best of my knowledge, death occurretl due Io the causes) end manner es slaled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
acian (Phyucian both pronoumm~g death ell cenilying to cnusc of death)
s
phy
^ 33c. Ucenso NurrAei 33d. Date 5igne Month, day, year)
~
e, Ili occurretl at the time, date, antl place, antl due 1o the cause(s) and manner es staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
70 lhcab Exaomirnerk Coroener
. Mad ~ (\ ^ ~ / _ ~ _
V (' l~/ 1 ~ ~
/ `
On the bests o/ examination antl t or Investigellon, in my opinion, deal at the Ilme, dale, end place, end due to the cause(s) andmanner as stated_ ^ 34 Nam rrtl Address of Per n Wla Completed Cause of Dcalh ptem 27j Type I Pri I
~
~ ~
7~`~.-
~ . z
~
~
~
lr
35
R
'
5)
l
tl D
h FIJ 3. Dalc FIIEtl j~1°nlli tla
nar)
,~
.
x
~ ~~. ~
fi 6 ~~
~-,r
y3
~~ e
.
egis
ai
s
gna
urc an
is
~ r y, y
Diapoairon Perron N°. ~ (9 93 7 3 { r ~