HomeMy WebLinkAbout04-01-09
Register of Wills of Dauphin County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of I~If11~1 ~r IC~~
also known as
1'euuoner75), who is/aie t u yearn of age or rider, epplybeal lor:
(COMPLETE "A" OR "B" BELOW:)
Deceased
Social Security No. ~~- I b~~JrOV
A. Probate d~C~r~rt~~ Letters and aver that Petitioners) is/ere the execut r named in the Last Will of the
Decedent, dated / 6 / and codicillsl dated
Seale relevnn urcumstances, e.g., rr.nunciarion, Aeath 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 documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
Ir,.i a.. A.Rnc..t .n pcu Acurc Lt e; A,nanre abr'enua; iln umre nnunm an.i
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:
Name Relationship Residen (.~ ~o
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Decedent was domiciled at de th i1n- (J~~f /Q~Q County, Pennsylvania, with hislher last family or prrncipal
residence at ,~50f $P~~~ i~)n t-~IJI~ /)') ~ncniGS~v~~ , R /rlfl Q
hst sriecttt. niur~6vi ruin nx,nicpall)yl T ~ II l
Decedent, then ~ years of age, died f ~ Z-~ litir at ~Isl) n1e 0~1 ~f/.~(ffG)
u o~:nnoor
Decedent at death owned property with estimated values as follows:
(If domiciled in PAI All personal property .......................... S LDIODD
(lf not domiciled in PAI Personal property in Pennsylvania ...................... S
(If not domiciled in PA) Personal property in County .......................... S
Value of real estate in Pennsylvania ................................... ..... S
Total .... S '
Real Estate situated as follows: y~ 1/)~QfG$f j/~ 3S~I ~~/~/~ ~~~~Q~~oSp
Wherefore, Petitionerls) respectfully requestlsl the probate of the last Will and Codicills) presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Signature Typed or printed name and residence
~ ~ ~ s~o 3SoI B e ~,. l'
RW-7
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Dauphin
The Petitioner(s) above-named swearlsl and 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 representativels) of the Decedent,
Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
before me this r y day of
DECREE OF REGISTER
Estate of ~~IL1 Lr KV~S Deceased No. ~/ ~=~ - (A>O'7
also known as
Social Security No: 2®~ ~-~Jra ~ Date of Death: ~ L 0
AND NOW, ~~ ,~~_, in consideration of the Petition
on the reverse side hereon, s tisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary ^ of Administration
y, ~ n n ~ /~ /,~ ~~ ~.„, ~ ~,,:,~~,~.,,~~~ ~~,,, ,,,,,,,,,,, ,~,,,,,~,,:,. ,~„~a„~,: ,
are hereby Qranted to
in the above estate and that the instrument(s1, if any, dated ~~1~~g3
described in the Petition be admitted to probate and filed of record as the last Will of Decedent
FEES
Letters........i0.~a.4~~~...... s al~(>
Short Certificate(s)....-~...... S ~a
Renunciation .................. S
Affidavit ( ) ................. S
Extra Pages ( )............ S
~r..l<Ja.t.t ................ s 15
JCP Fee....:'. A"`~`.'....... S
Inventory & Tax Forms... S
Other ............................ S
~~~~~1~~C-1(.1C~ LJI~/GYL~
Register of Wills
Attorney:
I.D. No: .3 .3
Address: ~/
TOTAL ................ S ~~ Telephone:
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T, L.~W l S
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DATE FILED:
~3W-7a
IOSN(15 RP.V (01/('l
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 14810288
Certification Number
f REV II2W6
/PRINT IN
IMANENT
ACK INN
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STATE FII E NI IMRER
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 be forwarded to the State Vital
Records Office for permanent filing.
d`' NO 2 8 008
~- ~ ~
Local Registrar Date Issued
t:uMINUNOVEAL7 H OF PENNSYLVANIA • DEPARTMENT OF HEALTH • Vn'AL RECOkDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
1. Name d Decedent (FTrsI, middle, coal, sdfix) Mary E . R U S S 2. ~ 3. Sodel Seconry Number 4. Dale of Death (Month, tlay, year)
Female 201 _ 16 _1580 November 27, 2008
5. Age (Last adnoayl Under 1 year Urder 1 tlay 6. Date d Bits (Monts, ,Year) 7. (q ant etas a
roreipl courtry)
3e. Place a Death (Check ady 1
89 """h` °"e """' 'a""" 10/4/19 Harrisburg, PA "°'°"al aner
Yrs. ^ Iryetlent ^ ER I Ou~alent ^ DOA Nureing Home ^ Residence ^Omer - SperJry:
ee. Cony d Deem &. City, Born, Twp. d Death Btl. Faalgy Name (II Irol ilatlalbn, gNe oral end aan6er) 9. Wes Delxstlent of Ideperdc Ongkr7 ~] No ^ Yes 10. Race: American Indian, BIerA, White, etc.
Dauphin Harrisburg Jewish Home of Harrisburg ("v°'''p°~'D°ban' (S0e"`~ White
Mezk:an, Puerto Rkan, elc.l
11. DeudeM'c Usual d wxxk acne most d Ym. Do not amts re 12. was Decedent ever n the 13. DecederlYe Edlratlon (Spelt' ally hklmel Breda completed) 16. Makd Status: Monied, Never Mertmd, 15. Surviving Spouse (II wife, glue maitlen name)
vS Upe r V l S O r Kind d Busiress I Industry U.S. Armetl Forced Demenfary! Secondary (0.12) Cdlege (1-4 a Sr) Widaved, Divorced (Speclly)
Penn Dot ^vea ®Ne U K Never Married
1fi. Dacedenl's Mdlkg addeca (sleet, dry /town. amle, zip code)
3 5 0 1 Beech Run Lane DecetlenYa Pennsylvania ~ mDBCBdB"t
Aludi9eaitlenco 17a. Smle
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Decedent Lived h
Mechanicsburg, PA 17050 .
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Towrahip7
,,,:r~,,,,y Cumberland 17d.[~No,DacedenlLlvedwMin Mechanicsburg
Actual Lknps of Gty! Boro
1e. Fames Name ~ sL nxade, coal, sums) Frank Russ 19. Mamer'e Name (Flrd, Itkddm, maWen aumame) .
Amelia Magaro
20a. IMormant's Name (Type 1 PnM) Jennifer L . B 1 a s c o 200. mlormanYe MaMing Addraa (greet, col' / lowq, amen, zip cam)
3501 Beech Run Lane Mechanicsburg, PA 17050
21e. Mamod d Dispollion ~ ^ Cremation ^ Dmalion
g] aun~ ^ Ramwalfrom5mm ~ 216. Date of DmDOSlaorl (Month, day, Year) 21c. Place d llsporbOco (Name d cemetery, crematory or omer pace) 21d. Lastbn (Gry f sown, smle, dp coda)
WasCrematbnorDautlmAUtltodzed
^ Omer - Specify: by fAedkal Enminer / Coroner? ^ Yee ^ No 12/2/08 Resurrection Cemetery Harrisburg PA
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~ 22a. Sigrelure d ~ ~ ecln a sl~nl ....._..._ 22b. Licalee NumOer 22c. Nerve ant Addraea d Fecfiily $ u i va n F une r a Home
~ rjC~,v~, FD014993 51 N. Enola Dr. Enol a, PA 17025
Carlpae I 23ec aYy when redKying
phyelial ~ rot available al Ikne d deem to
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m 238. To tlm best d my Mnowletlge Beam aeaxred at tla corm, dam and puree smled (Sigmlure and We)
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r' 23b. License Number 23c. Date Signed (Month, daY. Ye9r1
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~ Nema 21-26 coal a ocnplemd by person
who
pronaxlcwe roam 24 Time dfdeath _ 25. Dam Prmconced Deed (Month day year)
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~1 28. Wee Case RefenadJo'Medicel Examiner / Carorrer for a Reason Omer men remetbn or Donetwn7
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CAUSE OF DEATH (See InstrueUona and e:empbe) -" r Appraxhrem kuarvel:
Ilan 27. pan I: Fnmr 8a d)ypg~Om -diseases, aryales, a corllpeCalpna - Iha drelry caused tlm tleam. DO NOT eMa remand events soh as cen-ac arreal
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h Pen II: Enter otlla 23. Dld Tobacco Use Cmhimne la Deem?
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rmppekxy anat. a veMriarer fibrtlmlion wMIM showing tlm etlekgy. List wt' one rase co each lie. r 6u1 nd reedWg in the untleltying cause gNen m Pan I. ^ Yes ^ Prdxrhry
WIIEdATE CADS„ (Patel daeasa a ` i
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lloonn raadtlrg deem) _~ a. h'1 L ~".1 'r'.~ ~
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G"/" V! ~ t7 ~J~ v,t ~ t"`v"~ ," 1 h f 29. II Femam:
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Oue b (e as a mrreequence oQ: ^ Not pregrenl within past year
Smeegdrrnadntlalh~eaY condtlala, 9 arty, D. r
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^ Pragnenl al time of deem
(a ea a con
ue to sequence dJ:
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^ Nd pregnant, but pragnanl within 42 days
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r d deem
ue
(a es a consequence of):
r ^ Nd pregnant, bd pregnant 43 days l01 year
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d. r Odore deem
^ llMnam 9 pregnant within me peal year
3(m. Wes en Adapsy
Perlamea't 30b. Wae Autopsy FFldngs
Available Prig to Carplalun 31. Meme Daam 32e. Dam of Injury (Maul. day, Year) 326. Deeame How Mwry Oaumed 32c. Pence of Iryur~ Nana, Farm, Street. Fectay
d Corse d Death?
slurs ^ Hanfcide Office Buildin (Spec N)
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^ Yes l~ ry° ^vea ^ No ^ ACddBnl ^ Pendip Investk3elbn 32d. Time d Iryury 32e. Injury el Work? 321. If Trenspamgm Input' (Specify) 32g. Loc88m d Iryury (Street, dly I town, smtel
^ suicide ^ Count Nd be Delemined ^ Vee ^ No ^ Driver /Operate ^ Passenger ^petlesuler
M gher - Spelty:
~~ ~~ (~ o^ry awl - 33b. Sigralure end Ti9e of CeNfier
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' CerlNying phydclan (Physiden cedlYvi9 teas d Beam when andha pflysilan has pronamced death ant comported Item 23) /~ ~ '~
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To ma bestdmy knowletlga, deem occurred due to tM raree(s)and manner as ammd_________________________________
• Prarlouncmg and o
rfggklg phyallan (Ph
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antl cerlirykg to case of deem)
To the heal d my knowledge, deem occurred at the tlme, dMe, and pmca, and due to Ina causs(a) and manner ac emled_ _ _
^ 33c. Lkalse Number
, 33d Dele S' Y 1
gnetl (Monm, da .Year
_ _ _ _ _ _ _ _
• 1ledicN Eaamkwrl Carorra _______ ~ ~ r,t a ~? ~
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On the bWs d examinalan and / a Inwaligslbn, in my opinim, dnlh a:cumed el the time, date, arts pence, and due to Me ceuae(a) and manna es ststel. ^
31. NN
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e and Atldrecc of Poem Who Cartplaled Cauca of Deem Ilte m 27) Type 1 Pdnl
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Disposieon Pennh No. O .l o V 1 g
L:ST '.GILL M.ND TESTr'~MENT
OF
T~i,~ RY E . R tJS S
I, NI~RY E. BUSS, of the Boroug}~ of Mechanicsburg, County
of Cu:r;berla:.d, Com;,;on~.~ealth of= Pent;sylvania, bei~ia of sound
[i--rind., [l eC;"',Ory ?.''-Z~ uz:d.erstandliig, d0 IC; a)Ce, NUbll ;`] aT,i'~ai declare
tr~~is as :~y Last 'will and Testament, hereby revokinr.; and
:r,aking void all wills and test=rr;ents in •;-~ritiag, ire the
nature trlerecf, by me at sr_y time Hereto [rude.
;`;vD FIRST, I direct that r,~y funeral be conducted i11 a
~r.anr~er corres~ondirig ~tiith ;;y estate aril situation in life ar.d
to 1t all r~,y just debts avid funeral ex~..~enses and costs of
~.;~lacing a gravemarker and the sum: necessary to vrrange for
the ~ erretual care of my grave be fully ~"i.d -~:,:~~~, s::ti.sfied
~~s soo;, ,_:;~ co:~.veniently ,r;ay be after my decease.
:;s to such estate as it has ~.:>leased God to entrust rye
~•.~it},., I .~_s~-ose of the same as follo~.ti~s, v_'Lz.
ITEM I - I hereby give, be_ueath ar.d devise ri.1~ entire
estate both real acid L~ersonal or mixed c1~he.resoever si.tu~:te
to ~r~y niece, MRS. JO~'~N C. BLFt5C0, 3`~Ol Beech Rurr Larice,
Tviec7~,r:icsburg, Pennsylvania, 170`:x.
ITEM II - Ir the event that I a,r, r:ot survived bjr
T~irs. Joa:. C. Blasco, I them give, be ueat'r. a.u' devise ,ny
e:,_tire estate to [~,y great-nieces, J.vNIFLR BL:=~SCO -•ici JG ~LLv?v
BLt~SCO, -,:~a ttiev ~~re to snare e:ually bet~~.eer~ tne~:,selves ~[•Y
entire e~t,ate.
I1~EN;. III- I hereby r~.or~inate ar.d aL~ o~.:lt r~~y r~i_ece, Ni:RS.
JO.~~~ C. BL~SCO, asIxecutrix of this rr,y Last vJill a:~d _N
Testa[r,er~t. ~~ A r-~~
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IN ~~JITTvLSS ~~JH~REOF . I, T4:.i,;Y RUSS, the 'T'estatrix, have
this day, my ~vJill set <<~y har.c. a.r~~=. peal this 1 G ~:i~~y of
~ _
~'`--~.,~ ~~~~`-_'t-~ orle t7,ousanr r~:~ ne hurlcire;' ~:r~~:~ e i ght~---three
.~
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TviriRY ;~ . RUSS
SIGI..~D, S~<~L~iJ, FUBLISH.~D and J~.CL:.R~l uy tL~e ..~bvve-
;1a[;e~. T~i;.RY .~. RUSS, as atl: for 4,er Lest vu`ill aT1{~ Test: ~i:ent
irl tl,:e Nreyer~.ce of us, ~,~~ho ~~_ave hereunto subscri':~e~': our
..._...e~ ut T~echanic::burc~, Penn aylv~!~~ia, re,_uest s ._..tr~e5..
t?~.ereto, ~_~. the ~%resence of t;~e s_.ic! 'i'e tatrix ~~~._' of each
otr:er.
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OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
C-UmB~~ IUD COUNTY, PENNSYLVANIA
~ t - 09 - C~3D~
Estate of l'~11~.'I ~, KU.S.s ,Deceased
SAN C ~ 8 ~S~(! and SEIJA1l ~~' ,BlASCO
(each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well-
acquainted with mA~Y ~+ RV.~ and am/are familiar
with the handwriting and signature of the decedent, and that the signature of _ ~1A12y ~, leysJ
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~,~i~ ~ Lr leyS-r
is in his/her own proper handwriting.
(Sigr~rlre)
35d/ I~eec~ IQun ~A'RP
(Street Address)
~ec~, , ~A I'70 ~`D
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this ~~ day
of ~~~{~ a~0n0 ~l
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Deputy for,~egister of Wills
(/
(Si~(ature) _" J~
350/ ,3Beui ~lic tlG/1
(Street Address)
/neC~~. ~!I /~asD
(City, State, 7Jfp)
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Form RW-04 rev. 10.13.06