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HomeMy WebLinkAbout03-30-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF L'lt..r-~,~~dL1~J~ COUNTY, .PENNSYLVANIA Estate of ~~7~tti%~ L Piq-~a,r}~ File Number ~~` ~" (J~~ V~-/ also known as ~7 ' / ,Deceased Social Security Number ~ / ^-~ 7 - ~~~~ 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 e-~ named in the last Will of the Decedent dated and codicil(s) dated ~ +~ -- n-5- _..., -~ ~ ~ -, U (State relevant circumstances, e.g., renunciation, death of executor, etc.) ~:7 :, ~ f.~ _,:~ Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after executto(t:gP`t~te%t3rsnument(s) ofliered - ...~ ~ J i~ j =g - :.. ., for probate, was not the victim of a killing and was never adjudicated an incapacitated person: -r-t ~.. °:~~ LJ B. Grant of Letters of Administration 7~ .~' -, (Ifapplicabie, enter.• c. t. a.; d.b.n.c.t.n.: pendentelite; durante absentia; durante minoritnte) 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 Adrrtinistratiort, c. t. a. ord.b.et.c.t.a., enter date of Will in Section A above and complete list of heirs.) Decedent was domiciled at death in C County, Pennsylvania withhis-/ her last principal residence at oZ ~/~ /~Tj~/E (List street address, town/city, township, county, state, zip code) !, y ~- ~.. n Decedent, then ~ years of age, died on ~ at (~}~-~L.-( S~~ /(,~ ~/t'J~ A m~Di~ ~ ~xt~ T~i'~- Decedent at death owned property with estimated values as follows: ~ ~ (If domiciled in PA) All personal property $ ~ Q QQ (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: Form RW-0? rep,. lo.rs.o6 Page 1 of 2 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. 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: Oath of Personal Representative COIv1NIONWEALTH OF PENNSYLVANIA / SS COUNTY OF LL~'1t~~2-Z.r~.~ The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con•ect 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 the ~_ day of V' ~./ Fo she Register ojPersonal Representative Signnrure ojPersorinl Representative Signnrure ojPersaml Representntive Register ojWills - ; Ti .. .._l , ...~ ~_ J ~._F, ~ ZJ ~' _t: r--; ~`~ ~._' . - ;' (" 1 C: `' rs.` ,..i File Number: ~ ~ Q % "' d ~ ~~ Estate of ~dt).r)l IEL/. ~~-SD~ s ,Deceased Social Security Number:~~0 ~~`- ~7 - 73'~D Date of Death: 3 .~ G / °I AND NOW, ~~ , in consideration of the foregoing Petition, satisfactory proof having been presented befoyyre me, IT IS DECREED that Letters t are hereby granted to ~ lQ C ~ ~ ~G~-/~SC~`Yl S 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 ............... $~ Short Certificate(s) ........ $ ~• Renunciation(s) .......... $ 5 ... $~.~ .. $ ~~ ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: W F .~ ~. F~rrrr Rw-oa rw. 10.13.or Page 2 of 2 InS.sU~ Rev ,t,lln-, „~j ~- ~ -~~r~~,~~ LOCAL REGISTRAR'S CERTIFICATION OF DE;~~TI-I WARNING: It is illegal to duplicate this copy by photostat or photogr~~~r'h. Fee for this certificate, $6.00 - P 15188199 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as local Registrar. The original certificate will he forwarded to the State Vital Records Office for permanent filing. ~ °`~ ~- Local Fegistrar ~ Date Issued TEV ttrzoDS COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN .""E"T CERTIFICATE OF DEATH ,K INK (See instructions and examples on reverse) 7~a C? `~ r~ = - ~ ~ - - _ __ ~ c~ ~ ,- - ._a ,_ _ " o _,,_., :_; ' ~ ~` _, 'r~ _.. . t '^ ~. v ~ (~) .~` ,, t. Nana d DBWdenl (FrsL nadde, last, suffix) 2. Sex 3. Social Secumy Number 4. Dera of Deem (MOnm, daY. Year) Bonnie L. Parsons Female 207 -34 '-'7340 3/26/09 5. Age (last BirVgay) Under 1 year Under 1 6. Dated &M (Manor, de , err) 7. Girt ( end slate a for ~ sup ) Be. Place of Deem (Check ony as - 6 3 Yrs. Mmaw I)oys rleus ww. Jan 8, 1946 Mechanicsburg,P Nosppal: pV,npakeM ^ER/OWpakenl ^)OA other: ^NUrskg Home ^Residence ^Olher-Specify: Bb. County of Deem &. Cq. Boro, Twp. d Deem Bd. feWq Nartw (C not imtlMbn, give street end ramber) 9. Wes Decedent of Fgppa111C Origin? ®No ^ Ves 10. Race: American Indian, Black, Wh4e, etc. Cumberland Carlisle Carlisle Re Tonal Med Ctr. ("''~'~P°°'''0"ba'' i~"M g Mexkan, Puerb Rican, etc.) White 11. Decedents Usual bon KinO d wok done most d ~ Mfe. Do not stele retired 12. Was Deudem ever in the 13. Decedent's Education (Sperdty a,ry hlgheat grade conpleled) 14. Marital Status: Monied, Never Marred, 15. SurvMng Spouse (If wile, give maiden name) KkM d Wark Kintl of Busisas I mduNry U.S. Arrtsd Forces? Elements ! Seconder 412 Col Wxbwed, Divorced ry ry ( ) legs (td or Sr) (~M Homemaker ^Y~ ~ U k Married Jack C. Parsons 16. Decedenya McPng Address (Street, city / bvm, state, zip cede) 2 Oak Ave DePedenra Did Deceden' East P e n n s bo r o Aztud ResNer¢e na. Slete_ Pennsylvania LNe ins „~.®Yea. Decaderrulved'n T Enola Pa 17025 wp. Townehy7 lam. ~ro Cumberland ,7d.^NC, Decedem LNed wphin , Actual Umas of City! Boo 18. Fatlsfs Name IFlm, niklae, lest, auto) 19. Mdher's Name (Rrs4 middle. meroan enamel John Wolfe Rose Griffith 20a IMOmara's Name (Type I Print) Jack C. Parsons 20b. IMortnenra Maskg Adlreee (Street, d+Y /Town, elate. zip code) 2 Oak Ave., Enola, Pa. 17025 21a. Memod d Oisporipon i ~] Gematicn ^ Donation ^ &rial ^ Removal hom Sate i W 210. Dale d D1sDOattiorl (Month, dq, year) 27c. Place d I)lepospron (Narts d cemetery, cremarory a otlwr place i 21d. Locafim (City /town, slate, zip coda) as Crarnelbn a Dorolbrt AutlrorFtad ^OCrr-spetdry: jby wedlw Ex,mlrtarlCoronerY ®vea^NO 3/27/09 vans Cremation Service Leola Pa Yla. sipr Postal servloe li:ersee (a person acting as such) ~ 22b. License Number 22c. Name antl Adtlreas d Faciiry S u 11 i va n Fune r a 1 Home - FD 011897-. 51 N. Enola Dr. Enola Pa 17025 Complde 23ac ony when cenpYroA as et tore d deem w 23a. To me ben d my knowledge, seem occurred at tls tow, date and place stated. (Sigrsbre ant Iple) 23b. License Number 23c. Date S' aped (Maim, my, year) a AMuS A ILL TAtT 1 N 1 I`/~D ~+'ID4.34.$4-~ March 26 2001 parts z4-28 oral ha mn9leted q peram who pepuces deem. 24. Time d Dee ~ 03:3 M 25. Dale Prmamed Deed (MaMh, day, yea) i 00~j h ~ 6 ` M 26. Was Cave Refined b Metlical Examiner / Cororer for a Reazon Omer then Cremelbn a Donatron? . A . arc p Yee ®IJO CAUSE OF DEATH (see IrMructlona arrd examples) , Appmxbsq inervd: Cernl 27. Pan I: Enter the t -diseases. iryunes, a cargkcetfom -met dkectly caused ile deem. DO NOT erller temiisl events such as cer6ec erreal, n Onset ro Deem r i t t i Y N iH Pan II: Enaer odsr ~ bon not rmlbtlng In Ne crMerying case given le Pan I. 2a. Did tobacco use contribute b Deem? ~ Yes ^ Probady esp ra ory anen . a ventr p ar x atipn witlad stxmkng tlas etlobgy Ud oNy one raise an each Nne. r r ^ No ^ Unknown r CIYEpATE CAUSE FiW 6seese a ~ J corMpion rewekng m ) _~ a. p r1Q.{.11Y1~ fi'1 ~ a i O ~S~f/1 COWnAYY Ou ~2r~ 7G 29. II Female: Duero (or as a mrseq ~1e of): ; segnernltapy 6sl rwrrdnicrs, d aq, b ~1L- ~ et 1 lung Gahce r ~ ~a A+rtal ' br ll ~ ~ o~ ^ rid Pne9npnt wdhin Past year ^ Pregnant at lime d deem . . . b re Pause yeled an Wr0 a. l ~t Eller UNDERLYNG CAUSE Due to (or ea a coneequerce ol): /+~ r (seam a ~n met ireroded me I 4 ~ ~ ~ ( ^ Not Dregnant but Pregnant wphin 42 days U(~ c. 1 QQ~ ~ ZT-A - C-ll eveMS reslYtingmrkelh)IAST. I Due t ~"' } l u yc,vrigt S~+~e ~1 q~ d aeatn o fa as a consegrierx:e oQ: r ^ Nd pregnant, bd pregnant 43 days to 1 year d. ; before deem ^ Unknown p pre9nanl wpnin the peal year 30e. was an Autapey Penannetl? sob. were Aubpsy Ferdngs Available Prior ro Complefion 31. Manner d Death ~. Dare d I nprty (Month, day, year) 32b. Describe Flow Irnjury OPCtirretl 32c. Place of I ' Fkxne ~ Steel. Facrory, te ' of cause d Deem? ~ NeMal ^ Fkxnicida S ry' Office Bus d g, et Yes No ^ ~ Yes No ^ ® ^ ACddenl ^ PeMnq Inveslipation std. Tore d Ir~ury 32e. mNry al Wonk? 321, b Trasportedon I~yury /SDeci1Y1 32g. Lacelion d I 'u Sreat M ry ( cp1' /sown, Gate) ^ Suicide ^ Could Nd be Detemtined ^ Yes ^ No ^ DMer! Operate ^ Passenger ^Pedesbien M Omer - Specify: 33a. Cerofsr (pack ady erne) 33b. Signekne ant 7me d Certifier ' CMNybg PNYproipp IPNY ~M^9 cause d deem when andher physician has pronounced death ant completed Item 23) 7o pie beats my lotewledge, aesm occurred due to Cie ceuae(e)and manner es emted--------------------------------- ~ ' P d W p - AMt~.sA NtAT- IV , MD raraun ng ar Mn9 pnyskban (Pgsician Ooltl prmoaxwg deem arM cemhying to cause d deem) c•r To Ile Wn dory knowledge. loam occurred Ktle tlme,date, and plece, and due to the cause(el and nenrner es BtetetL ^ 33c. License NurMer 33d. Dale Sgne d (MOON. day, year) - - - - - - -__-------- • NedbN Examiner! Coroner `,~~1 ~~~~ ,mil 7 L ~~f'C'] i~ ~~ On the leeie d ezeminatlon ant! or imectlgetion, m my opinion, deem occurred at the Ilene, date, and place, and due to the eauee(s) and manner ea sleled_ ^ 34. Name and AdNess of Person WM Cortlpleled Cause of Deam (Ite m 27) Type !Prim 35. Regat nd ~ ~ u ~ < ; ~ '~ 36. Date~filed (MOnth, day, year) ' Carlisle Regional Medical Ctr - I I I I I I _-l .:4-;- , ,~;; - Carlisle, Pa Disposition Permp No. l/ l + *+C ~ ~-S C7 t.a ~' ~`_ © ~, _ ~ ~ - ,' -T c? ._ ~ `- ~ - J _ t-y f T ' + W RENUNCIATION l ~ -- - ~ _~~ t ° , "' - _ i } .1 L..i ;_} ~ .~,,._ ~ ' GISTER OF WILLS ~ ~ `•~'' } r ~ COUNTY, PENNSYLVANIA can Estate of __~~~`(~ 1 ~ ~ ~~~s (~ I, LU Deceased _- in my s~'elationship as Pri t Name) ~- '~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~r~ _;~ C t ~~~ ~~ .31a~1c ~ (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this of day Deputy for Register of Wills Form RW-06 rev. 10.13.06 ~~ t~ iugnat e) l (Street Address) r~~~ i ~~l (City, St ie, 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 pu oses stated within on this c~~ day of ~.LS~L t~ ~~~. Nola blic My Commission E:Kpires: (Signature and Seal of Notary or other official qualified to administer o~l ~a~e~~n~~ygission.) Notarial Seal Melissa J. Greerntwod, Notary Pt.~lic East Pemsbttro Ttnip., Gmberland Courtly My Corrtrnissian E~ires May 18, 2011 Member. Penn.>ylvania Association of Notaries rya ~~_~ ~ T C"a ! ~ ~~- c_ _~ ~ RENUNCIATION ~ `° ` - ' =-' ~ . ~ ....._ i_. i _ : }`. ,. ., ~ .. . - - _..'~_~~. .) L~ ....~.., -... ~ C '' REGISTER OF WILLS ~~- ~ i ~ ~ COUNTY, PENNSYLVANIA ~ ~ ~~' ~ -; ., nn /~ _ cn Estate of ~ ~~~-~'~ ~ ' ~~ ~ ~I ~ ~ ,Deceased I, ~ ~~~ ~` ~~~!! ~~ ~ ~ _, in m~/relationship as L~ ©_ (Print Name) -~~/J of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to y ~ CSC ~ t ~ ~-~t~ c~ u~ (Signature) a i ~a ~~ r ~~~ 3 8 (Street Address) y~.~~~I ~~- ~ ~y~/ (City, State. Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 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 _ ~`7 day of 1 r~~G~J ti~ Nota P blic My Commission E:>{pires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA Notarial Seal Megssa J. (,reenwood, Notary Public East Pemsboro Twp., Cumberland County My CorruxtGSSion Eacpires May 16, 2011 Member. Penn~sytvania AssACiatian of Notaries ~ ~- ~ ~ ~~ .,o `~:i ~ -; s C'~ ~ ' ~' ' ` ' RENUNCIATION _ ~;, ~ ilJ~s:~ REGISTER OF WILLS ~ ~' ~~ ~} { ~ ~ ~ u -'~ ~+Z ~ ~ -N r COUNTY, PENNSYLVANIA to - - . .~ crt - r~~ - ~ -~~a~~ Estate of ~ ~ ~ ~ ^~ Z C `- ` ~ ~'~~ S ~ N ~ ,Deceased ~. ~ I, ~~'M ~~ `~ `~ ~ ~ ~ ~ t ~---- in m / y qty relationshi a p s (Print Name) S U ~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~ z~~~~ (Date) ~ Executed in Register's Office Sworn to or affirmed and subscribed before me this of day Deputy for Register of Wills Form RW-06 rev. 10.13.06 ~ ;~,1 ~.: = ~ r,~ (SignauGre) .---- ~~~~ t - ~C~-~ ~f~ (Street Address) N i3 ~ ~~ 7~~ 3U. (City, State, ZipJ 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 `Y1Ct~-cal ~C3CG~l .~ ~ Not ublic ' My Commission Expires: (Signature and Seal of Notar!r or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH t'.}r PENNSYLVANIA Notanai Sea! Melissa J. Greerzvw~od, Notary Publ~ East Pemsboro Twp., Cumberland County My C;gnmission E~tires May 18, 2011 Member, Pennsylvania Association of Notaries