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HomeMy WebLinkAbout03-12-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of JAMES H. GOODHART File Number ~, ~~~~~~~c~ also known as ,Deceased Social Security Number 210-40-0637 Petitioner(s), who is/are ] 8 years of age or older, apply(ies) for: t.,,, (COMPLETE 'A' or 'B' BELOW.) C-? ~ ti.a ~-- c i-, ~ '-~, A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~~" ; --~~ amed•in the, ~i...r..~ ~~ last Will of the Decedent dated and codicil(s) dated ~ - __._ --i-~ N _ ,-- , ,- - ,~ (State relevant circumstances, e.g., renunciation, death ofezecutor, etc.) 'a- - _..'~~ N t . , Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution o~~e instrumen (~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 lire; durance absentia; durance 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 Relationshi Residence DARRELL D. GOODHART BROTHER 69 E. MAIN ST., WAL. BTM., PA 17266 (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal residence at 1471 PINE ROAD, CARLISLE, PA 17015 ~ Penn T~wnshi n (List street address, town/city, township, county, state, zip code) Decedent, then 59 years of age, died on FEBRUARY 7, 2009 at M.S. HERSHEY MED. CTR., DAUPHIN CTY, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ ~~v ~~ (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ ~. Value of real estate in Pennsylvania $ z 5 ~~~ situated as follows: 1471 PINE ROAD, CARLISLE, PA 17015; MOUNTAIN LAND IN PENN TOWNSHIP 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: S' n/at-ure T ed or rinted name and residence ~`.~ 1`G ` t ~ ~; `~' :~Zf ~ SUSAN HOUGHTON, 1471 PINE ROAD, CARLISLE, PA 17015 Form RW-02 rev. 10.13.06 Page 1 of t Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF 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. i~ ~ ~ n. / _ Sworn to or affirmed and subscribed ~~~'l~'G~,lt ~`~~~' C~~~l Z ~"'---___ Signature of Personal Representative before me the ~_ day of rv ~j^y~ C7 f--, T~ , ~ Signature of Personal Representative ? C~? w ~ - 1_ ' ~ ~3 ~r._ t z For the Register Signature of Personal Representative N ~ ._} f _~ ".~ ~ ~ [.J -' .F ~~ _.. 1 7} File Number: ~ ` ~ ~ d~3~ W Estate of 3AMES H. GOJDHART ,Deceased Social Security Number: Date of Death: AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters are hereby granted to 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 ... ~4~,.~~... $ ~\~ Short Certificate(s) ...~--~.... $ t~ Renunciation(s) .... t ..... $ ~ ,~C_x~ _...$ ~b ... $ ... $ ... $ ... $ ... $ ... $ ... $ (l ~~' -9-99-- TOTAL .............. $ c~14~ ' in the above estate Register of Wills t Attorney Signature: .~~` i' C _~ Attorney Name: ~ ~~J Gz ~.. .~ ~ ~ ca- ~'~ vw, ~ ~~ Supreme Court I.D. No.: ~s / ~ `-~ Address: / ~ C"v i ~~ f. Rai. (Q ~ 1 ~~ ~ 1~ +~~ %7~~/.3 Telephone: -7/ 7 - :~ 5/ ~1 - ~7?~ Form RW-02 rev. 10.13.06 Page 2 of 2 [lu° ~. -° itiA .il' i~". >u~ee Inn- this certificate. S(~.O0 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this Copy by photostat or photograph. This is to certit~~ that the i)~Yorm.iw-ion here <~i~~ea is correctly copied l€ryrn an In-isinal Certificate of Death duly tiled u'iih me as Local Rei~istrR(r. _i he t~ri~,inal certificate ~~ill 1+e fin~tiz(rded tt~ the State y"ital Kecords Offi(_c 1.+r permanent filing. . ~~~e~.c~-~~e.~x' _~ E ~` 9 2009 Local Rc ~ stra?~ Date Issued _ P_15n9413 ~' Ce~-tifir>tion tinmber H108.143 REV 172006 TYPE / PRINT IN PERMANENT BLACK INK n n °w vd 3 N C,7 t~ _ J _ - !~ '-~ - 1 -r J r'- ~ : r- .~ -v~~~ ~ -- ::~ --n ~` 7 c7 ~-~ 4V , 3=° W . COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH ~ ` ~ ~ n ~~~ (See instructions and examples on reverse) STATE FILE NUMBER } ) 7 Name d Decedent (Flrst nkdde, last, sulfa) 2. Sex 3. Sodal Seariry Number 4. Date d Deem (Monet, day, year) James H. Goodhart Male 210 - 40 -0637 Feb. 7,2009 5. Age (Last amxmy) UMar 1 year UMer 1 day 8. Dale of Binh (Madh, day, year) 7. Birttplace (City and state a fo ' n country) Be. Piece d beam (Check mh one) 59 "~"" °'"' "°"` Maa° 7/29,1949 Walnut ?iottom PA Hoapltal: rnner _ yrs Irpatied ^ ER / Outpatient ^ DOA ^ Nursing Home ^ Residence ^Omer - Specity: Bb. County of Deem Bc. Clry, Boro, Twp. of Death merican Indan, &ack, While, etc. oc a: A Btl. Fadllly Neme (If not nstimtion, gNe sheet and number) 9. Wes Decedent of Hispank Odgin? No ^ Yes 10. R Dauphin Derry Twp. s ~ r~ gr yea. opacity caban, I W n i t e M.S. Hershey Medical Center Mexiran, Puerto Ran, etc.) Decedenrs Uwel Bon Kind d work den d ' mo91 d warttl Ha. Do rpt stele reti 11 12. Wes Decedem ever m me 13. DecedenYS Education (Spedly onry highest grede cpnpleted) 14. Mantel setus: MemeQ Never Marred, 15. Survrving Spouse Qf wife, 9Ne maitlen name) ' . d Wok Irintl d uslrness I Induelry en10i~er union r M U.S. Amretl Faced Elementary / Secon 0-12) College (1-d ar 5t) WitloweQ Divorced (Spea `~"~ Nevered Morrie ~ p ca ,~ ^~ - 18. Decetled's Meiln~ Adkess jsreal dry /town, state, zip code) 1 4 71 P 1 tie Rc~ . o~nra P anti s y 1 van i a ~D.meceeaem Acbnl Resitlence 17a. sate 17c. [~ Yea, Oecetlent Lived in Penn rwp. PA 1 7 01 5 - Carlisle ,,,. ~„nry Cumberland Tawnshpv t7d. ^ No, Decedent Lived wimk, ' , Aduel L onds d City /Barn 18. Femer's Neme (Kral, middle, Oat, wlfix t t 19. Homer's Name (Flrst middle, maiden sumwrnj Elois L ton Da har Homer R. Good . y 20a. IdormanYs Name (Type / Pnnll 2C0. InmmnenCs Mailing Adtlress (Street, cdY I town, state, zip code) Susan Houghton 1471 Pine Rd. Carlisle, PA 17015 21a. Method d Dispositlon remotion ^ Dofntian 210. Date d Dispoallron (Mash, day, Year) 21 c. Place d Disposaion (Name d cemetery, cremelay a other place) 21d. Locatan (City I town, slate, zip rnde) 1 7 0 6 5 ^ Budel ^ RemovalfromSlale ~wa.cramananerDal>atlonamnerl:ed ~ - 2/9/09. Hollinger Crematory Mt, Holly Springs,PA Yes ^ No ^ omen - Spedty: i a/ Medical Examiner I raroneYf ~ 22a. Nre d Fune I (a person acting as such) - ~ ~, 22b. License Number 011589E 22c. Name entl Address of Fadtiry HollingerFH&CrematoryMt.HollySprings,PA17065 Complete Berra 23e<onty when aedNm9 . To tin Eeat d my laww9edge, deem acarted et me 8me, date end place slated. (Signewre and tale) 230. License Number 23c. Dale Sgned (Monet, day, Year) gmkian is nd eveiMble et time d seem ro ceraly cause d tlretiti Ilema 24-26 must lb 0anplerotl by Parson 24. Time d Deem 28. Dale Pronourcetl Deed (Month, day, year) 28. Was Case Refened tc Medkel Examiner I Coroner M e Reason Omer man Cremation or Donation? ,' who pranurx:es seem. 3 ~ )'~- M. p ~. (fyllNl 2 a7O / ^Vae ^ 1'1v CAUSE OF DEATH (Sae InsLruetbne entl exampbs r Approximate Interval Pan IL Enter Omar sghgirant mndtions comdbutino to deem ze. Did Tobacco use contna,re ro Deem? dam 27. Pan C Enlar me da®.gL9YffiIli- rlkeeses, injures, a cangbetions -met directly caused the tleam. W NOT enter teminal events such as cardiac arrest Oreel ro Death but not resulting in die undadying cause gNen in Pen I. ^ Ves ^ Probabry respkalo7 enact or vermkuler fibdletion wiman showing the etbbgy. Let eery ale cause on each We. ~ I ^ No ~Udmown WMEDIATE CAUSE IFlnel disease a ~l~l (~ I ~ 1 axMitim resulting m ml -~ a. / • t (,L S S r l~'C_ f `7 ~ G(I n ( ~ GNp wtiC 1 ~ YCi-I 2g. If Femele~. ^ i Due to (or es a canaeWence oQ: Not pregnant w min past year ^ Pregnant at time d deem Sepuenlfepy lul wndi0orn, B arty, p_ ~a~rq b the cetree ksted on Imo a nse uence on: D I ( ^ Nd Pregnant twt Pregnam wimin 42 days ue o ar es a w p Eder the UNDERLYING CAUSE d deem (disease a ntleY tint initial me c ~ eyana rewlbng m deem) ST. Duero (or es a consequence op: ^ Not d, but t /3 de ro 1 lxegre pregren ys year bebre Beam d. ^ Unknown d pmgnent withinn me past year 30a. Was an Auropsy 30b. Wee Adapry Flndrgs 3t. Manner d Deem 32a. Date d Iryury (Monet, deY. Year) 320. Descdbe How Injury Orsuned 32c. Place d Injury: Hare, Farm, Street Factory. OBke Buildkg, etc (Specify) Penametl7 Avagade Pdor ro Completion d Cause d Deem? ~ Ndael ^ Homkide ^ Aardenl ^ Pertdbg Investigation 32tl. Time d Iryay 32e. Irpzry al Wak? 32f. If Trenspaletron IOWry (Spedty) 32g. Laetion of Irryury (Sheet cdY /town, stale) V No ^ ~ / Y No ^ ~ ^ Sukide ^ CouM Nd be Ddempred ^ Vas ^ No ^ Ddver I Oparemr ^ PAssenger ^Pedeshian M OUnr Speay. 33e. Cenekr (deck only one) 33b. Signature Tde d Certifier • c.rurymg phy.ernr (Phyeidan aemrying ease a seam wlnn anomer phyeklen nee prmwnced seam sad congletea rem z3) deadr aoaerred due to the cauegs)srM memnr as ebrbd_________________________________ ^ To do baeLdmYl~'I~ga , ~ r , • Prernauncmg end cerBlYlnn9 PNYeklen (Phyelden beet Drmaxcinp tlaem eM cartllying ro rtuae d deem) ~ tl M t t 4 33c. Licese Number 33d. Date Signed (Morph, day, year) manner ae a _________________ n ewea(e)s e e To tln heatdmy kmwNdga, deetlr occurred NtM mna,deb, end plea, end dw to rer l E M / C kl dk ~~ // (O ^ /O L eem r aro e e on end / a ImreatLgatkn, M mY ogdon, tlesM aeeumd n the Nnr, OMs, entl geee, erM due ro mta wuWsl aM runner es shterL ^ l n etl On the Msle d szrm - 34. Name eM Address d Perem Win Conpleted Cause d Drsm prom 27) Type I Pdd o L ~ p j ~~a .~~~r~~ I 1 I D I - I ~ DataRlad(Ma,m,asrear) LQWGK~ ~'Q ~ //~ M.S. Hershey Medical Ctr. F ~ ~ ~ Disposition Permit No. D ~) ~1:) L~ RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of JAMES H. GOODHART I, DARRELL D. GOODHART (Print Name) BROTHER C. ~ r~ r-~ c..a -~j `'rte J:l -~' -`~: ~ ~-~ -;~- .. _~,~~ ,_.- ' ~ ~ ~ _ -,~ , _ -- - ~_~_-:~ ~ ~ =a w ° Deceased 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 SUSAN HOUGHTON ~~IGt2t 6~ 1 0 ~a ~ (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills Fornr RW-06 rev. 10.13.06 0 (Signature) 69 EAST MAIN STREET (Street Address) WALNUT BOTTOM, PA 17266 (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 /OIL/ day of ~~ 1%~ ~Do9 ~~ ~'(~ _ Nota Public My Commission Expires: (Signature and Seal of Notary or other official qualitied to administer oaths. Show date of expiration of Notary's Commission.) ..»:._,y+h hi.fwti`~ ~~~€-1~.~'F'EcYtir.t7S~`4UAt°11r~