HomeMy WebLinkAbout04-15-09PETITION FOR PROs BATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~,~~~ COUNTY, PENNSYLVANIA
Estate of ~ t-~t'i. ~ ~L1 3~("~ ~C,
also known as
Deceased
File Number ~ ~ by 1 O~J
Social Security Number ~~`.. ~ f~ _ ~ ~~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(CO.N1"PLETE 'A' or 'B' BELOW:)
~-,~ ~
LJ A~. Probate and Crant of Letters Testamentary and aver that Petitioner(s) is /are the ~ '~'i-~+~~ ~ ~ named in the
last 1Ui11 of the Decedent dated _~~~~- ~ C7 '"1 and codicil(s) dated N / ~
(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 insnument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^ B. Grant of Letters of Administration
(lfnppficnble, ettter: c.t.n.; d. b. n. c. t. n.; pettdente lire; durante absentia; durnnte ntinoritnt%
n 3v
Petitioners} after a proper search has /have ascertained that Decedent left no Will and was survived by the followingrSgn~e (if any) ~ heirs: ((f..
Ad»tinistratioit, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ =.r7 -' ,
'-;~_~. -fin t
C Name Relationshi Rcstderic,~, ~ '
t
_ ~7
y
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. --
Decedent was domiciled at death in ~ +-~! t1~-- Cormty, Penns ]vania with his /her last p ~ ipal residence at~~
~S~ ~ oc ~~ 1~.~-~v~ c. Ac-~~14 ~ ~'1 c~~4~u1~ ~sw~ t. .L1 / ,7G /
(List street n dress, town/city, torvnskip, county, state, zip code) q
Decedent, then ~~_ years of age, died on f . at ~ ~ ~ S t+ ~
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:
~ `~~~(70U~ 00
Form RVV-0? rev. l0. (3.06 Page I Of 2
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
COMMONWEALTH OF PENNSYLVANIA
SS
COUi1TY OF ~Vt~*`C~~CE t'~ or.(t~ .
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 kr.~owledge and belief of Petitioner(s) and that, as personal
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the 1 ~ day of
~- ~
1~or the Register
ve(s) of the Decedent, Petitioner(s) will well and truly
of Persons! Representntive
Signature of
N
~ Ca
it ~"r' ;
Signature of Personal Representative ~ Q `+~ -
- ~ x7- r
? ~ C7 ~ t - --
r ~.' ,;
-~ -r
__ - _ . ,- ~.~r
~ _ ~~
File Number: ~ ~ ~ W'
~~
Estate of ~ ~~ 2. ~<xP ~C~ < r ~ ~~L , De~a-s~d LJ
(~ 3~
Social Security Number: o(G a °~~ ~~~~~ Date of Death: 1-\.pr t ~ ~ a Z~
AND NOW, _ ~ ~~ C>~~ '~-~l~yr-~_, ~~~1 , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IY'T S DECREED that Letters ~P.~ `C~~ ~j„Yt,
are hereby granted to ~C' ~~CI~S ~ ~ ~ ~ C.~ CxrlC~ ~b, (~2_-_ _ Shy ~ ~
`-t _ _ - - -
and that the instrument(s) dated JG i1y,~
described in the Petition be admitted to probate and filed of
FEES
Letters ...... . ~'~,+Obl.~ $ lp
Short Certificate(s) ...~~.... $ ~ ~-
Ren~.ulciation(s) .......... $
-~~~~ ... $ z~
_ Jc_4' ... $ ~~b
~~ ... $ S
... $
... $
... $
... $
... $
... $
"TOTAL .............. $ IOc~
as the last Will
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
in the above estate
Codicil(s)) ~f Decedent.
Register of Wills
_.,;
~,:
,._.,,
r-~~,~,,, RYV-va rev_ lae3.or Page 2 of 2
10~.80~ KEG r{II/O'1
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certifiicate, $h.00
Certification Number
This is to certif_ti• (hat the information here given is
correctly copied from an original Certificate of Death
duly filed with rase as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office tier permanent filing.
a
L ~l~~gR , t_'~~ 20(}9
_; ~ I
Local Registrar ? ~ rn~ ~ ~y~ued
-~~ _ I,
- ~ r~ _ i:.:.:
~' ~ ~ ~~_ ~ ~ ~ i
A ~
H705-143 REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
PFRMANI~ I" CERTIFICATE OF DEATH //~~ ~
BLACK INK (See instructions and examples on reverse) <..r~ c.. ~ .,~ ,..ono ~ ~ ~`~'1 ~~~~
,~
I~
U
O
E
1. Name of Decedent (f t mitlAe, tall, suffix) 2. Sex 3. Serial Sewdy Number 4. Data of Death (Month, day, year)
Effie Mae Warrick - -
S. Aq (Last Binnday) Under t year Under 1 day 6. Dale o1 BiM (ntonm, day, year) 7. Binliplace (City and stale a fo camtry) 8a. Place d Dam (Check Doty pie)
Montl1 0•YS H°"'• MI^N•s Hospiml: Other:
~ Ya. March 23 , 1925 Mt . Pleasant , PA ^ Inpahem ^ ER I ompatiat ^ DOA ^ Nursing Home ®Rasiaerice ^Offar -Specify:
8b. Canty a Death Bc Ciy, Bom, T'e~P. a Deam 6d. FadlhY Name (II na it iaulion, glue street aM nar8a) 9. Was Decedent of Hispanic Origin? [g No ^ Vas 10. Race: American IrMian, Black. While. etc.
Cumberland S. Middleton (Iryea,apeoiycuben. (5,~;,i1
Lot 55 S rin Garden Estate
P
s
9 Mexican, Puedo Rican, etc.) 4~'1].te
11. Decedent's ll&al tlon Kira a rvak done d ngat a fla. W rim stale retired 12. Was Decedem ever in the 13. Decedent's Education (Speciy ony hlghem grade completed) 14. Martial Statue: Manisa, Never Marrle4 15. Surviving Spouse (Il vwte, give maiden arcs)
Hind a WaN Kind at Busineu / Indusby U.S. Artretl Foraea? Elememary /Secondary (0.12) Calege (1-4 a Sr) Widawetl, Divorced (Specrly)
HOme e ^ yea No
t6. Decetlerrt's MepngAddress (street ciy/town, stale. zip rode) Decebenl's Did Decedent
Lot 55 Spring Garden Estates Actual Residence 17a. Slater PD Live in a nc. ~] Ya, Daedant lived in $. Middleton iwp.
Townshi
?
Carlisle
PA 17013 p
,,, ~,,, Cumberland nil. ^ Na, D«edom weer wlmm
, Acmat Lirataa Oiry,Oa,o
18. Famer's Name (First, midtlle, last, sumo) 19. Mothers Name IFret middle, mvtlen summa)
Geor a A. Kin
20a. In/orment§ Name (type /Prim) 20b. Inhxmanfs Meriting Adtlress (Shea, city /town, slats, zp code)
Dennis Warrick 5009 Firethorn Ln Mechanicsbu PA 1
21e. Matwtl a Disposnron ; ^ Cremalbn ^ Daation 21b. Dam a Disposabn (Month, say, year) 21c. PWce o/ Diapusiaon (Name of CemaeDt aramataY a deer
placer)
21d Lacalim (Ghy /lows, stale, aqp coda)
Burial ^ Remwel from Slate
;wasamn.tlar«Daatronautll«Ixed ril 14
2009
AP Cumberland Valley Memorial Carlisle
PA 17013
^ spedry: : br Msdlal Examiner r c«wnerz ^ veer ^ Na , ,
22e. Signature a Fu a such) ZZb. Lkense Number 22c. Name aM Address a Papery Hof fman-Roth Funeral Home & Cremato
I
- 138425 ry,
nc.
Cornplele ttems 23a<oray when anilyhg 23e. Ta Vw best y .deem oauned at me ' , bete erg pMce sorted. core and titre) n Nu r . De
Y, Year)
physitian N not avasabb m time a deem ro
oemN cause d deem. /
[
-
~
Kems 24-26 must be canplated by person
who
raxxincea dam 24. Tine of Death
' S ~ rommced pad (Math, day, year) 26. Was Case Referred to Medical Ex
e
m7nerl Coroner fora Otlur than Cremat
DOnatbn?
D
. ~.
M. U ^Va ^No
CAUSE OF DEATH (See Inelructlona e tl ezamplea) r gppmximate interval: Pan II: Faster belor ' '
2B. Did t ua cantrilxda ro Deem?
)taco 27 Pan I: Error Va twain a events -please, inJunes, a camplkadals - Vat dreclty caused Vw . W NOT amr terminal events sucm as cardiac anesL I Onset to Dam ad rKK resulting in me uMenying cause given In Pan L Ves ^ PmbaWy
respiratory arrest, a ventricular fibralation whtiua strordng me eadogy. Um any one taus an each tine. r
CAU$E
Final daease a
i
~
n n ~
'm
rondh Itirgm am) ~ '..17
CV 3 \J ~ c
-> a. _ /~ ` 1+
/i~ "'~ ~FM4S\t 'Rlf~tf~g5-
29. If Female:
Due to for es, wnsequence op: , _
/ TT M f'tot pregant wimin past yar
~
Seguem~Y Nsl condtions, h arty, b. (,y,,, ,(`. \A[ S' 1~/ i i(;\,J ~
m to the muse famdcolea a. ~y.~Ckayy ~~,yy ~ ^ Pregnant at time of loam
Enmr me UNDERLYING CAUSE Due to Ip as a uence off: I
^ Not pregrant Out pregani wkhin /2 days
(Olsease ar' ury met idtiale0 Va
a `
C~
u
~ of dam
event readd~ n beath) LAST.
' ~" vt¢.d
•LtnvE
:1~.~ ,
Due b (or ea a consequence oQ: >' r---
^ Not pregaM, ba pregnen143 days to 1 year
d .~.suv\ ~ berore eam
^ Unknown d preganl wahin Vre past yar
30e. Was an Amapsy
Pena
d? 300. Wem Aata(ay FinAngt
A
ah
Pri
d
ro C
l
ti 31. Manner d Dam 32a. Dale a Injury IMamm, day, yeaz) 32b. Dacri6e Hex Injury Occune0 32c. Place d hryury: Home, Farm, Sheet FaMary,
me v
a
e
or
orip
e
on
NerorW ^ Hankdda Office Balding, etc. (Spealy)
of Cause a Dam?
^ Yes ~No ^ Vas [ 10 ^ ant ^ Pendng Investigation mod. Tina a Injury 32e. Inryry of Work? 32f. V Tmnsportatbn Il~ury (Span'!yl 32g. Lpation a Irpury ISreet dty l tpm, slate)
^ Suaide ^ Could Na be Dmemnned ^Ves ^ No ^ Driver /Operate ^ Passenger ^Pedeshian
M OIh« - SpeaTy:
a3e. rxnN;x {check any era) a3n. sgnature anti rile a cemher
• CeHNying physician IPnysicia certilydng cause a deem wren aolhor physiian has pmiwuncetl dam and campetetl ham 23)
'ra me best a my knowktlq, death Declined due to pre csuae(c) and mraxz x ensue_ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _. _ _ _ _ _ _ _ _ _ _
• IPronameing and eertllYin9 phyamien (Physwtian both pronouncing dam and cerrilying m reuse a deem)
'Yo tie beat of m
tleath occumd al the din
knoMed
dam
lint
mt
d tl
th
t
d
^ 33c. license Numhsr 33d. Dare S' nail (Momh, say, year)
y
,
p
e,
s, an
ue
o
e cause(s) a
mannm as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
q,
• NedicalExambl
/Car Y1~ppyc
3r L y ~ ~
er
onw
On Vk balls a examinadan arm I
or Investl
etbn
in m
o
iMo
dam accume0 at tbe Ilme
d
t
nt
e
l
d p
m th
^ i 2~ r
g
y
,
p
R
,
p
ace,
a
e, a
n
us
e pose(s) end mann« a sums). 3a. Name ant Adtlresa d Person Who Completed Cause a Deem (he m 27) Type I Prim
g
35. Registmr's S' ~
~ : Datg Fikd (Manor. daK Yar1 5l.
d
t~fy
~J ~iYr
~
~- ~'.w• '~'~ 2
~.•e~
. 1 E1R'
,~ 1
A
~y
~
1''
~
Disposition Permit No. \ ~ ~ I ~ V
WILL OF
EFFIE BARRICK
I, Effie Barrick, of Cumberland County, Carlisle,
;nnsylvania, declare this to be my fast Will and hereby revoke a8 prior
Its and codicils.
1, l direct that all my just debts and funeral expenses,
;marker and administrative expenses shall be paid from my
uary estate as soon as practicable after my death.
2. I direct that all inheritance, estate, transfer,
ccession and death taxes of any kind whatsoever which may be
yable by reason of my death shall be paid out of my residuary estate.
3. I direct that my estate be distributed as follows:
A. t direct my entire estate be sold and the proceeds
be divided equally between my children Shirley M.
Sheriff, Gary D. Barrick, Dennis A. Barrick, George
A. Barrick, and Michael I_. Barrick. Should any of
my children predecease me, their share shall
lapse and go to the surviving children.
4. I appoint Shirley M. Sheriff and Dennis A. Barrick as
joint Executors. Should either Shirley M. Sheriff or Dennis A.
Barrick be unable or unwilling to serve as the Executor, the other
shall be the sole Executor.
5. The Executors of this Will shall have the power to
distribute my estate in kind or in cash, or partly in either.
6. I direct that no Executor acting under this Will shall be
required to enter bond in any jurisdiction.
LAW OFFICES OF
STEPHEN J.. HOGG
19 S. HANOVER STREET
SUITE 11)1
CARLISLE, PA 17013
IN WITNESS
my hand this ~~ day of
F, I, Effie Barrick, have hereunto set
i, 2002.
:•~ , }' ,.
1 s _~
EFFIE RICK ~?~
=~
~, ~
~l,s ~'
~l, _.
.l
•~
-- --_~
_~
~~
-,~ --1
t
t
~3 _. }
~,~.
~ ~ ... _..
_~ f-~4 - "
..16a _.
ri
m
The preceding instrument consisting of this and one other page was on the
ay and date hereof signed, published and declared by Effie Barrick, as and for her
Ilst Wili in the presence of us, who at her request, in her presence and in the
resence of each other have subscribed our names as witnesses hereto.
.~ ,y
-=-r-
Witness
LAW OFFICES OF
STEPHEN J.. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, P~4 17013
ACKNOWLEDGEMENT
monwealth of Pennsylvania
of Cumberland
ss
I, Effie Barrick, the testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the instrument as my last Will; that I signed it willingly
and as my free and voluntary act for the purposes therein expressed.
%, ~
EFFI RRICK ~ L-
Sworn to or affirme nd acknowledged before me by Effie Barrick, the testatrix,
is ~ day of ,~,~ ~''~ -~~ _, 2002.
V.-r
NOTARIAL SEAL o ary ublic/A r y
STEPHEN J. HOGG, NOYARY P!lBLIG
CARLISLE eoRO, cu>~ss~aGo~cQ~.. i~T
WIY COMMISSION EXPIRES S
nwealth of Pennsylvania
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, F'A 17013
unty of Cumberland
ss
We, /~/~~,~~-l~"U:..'~~' ands ~~>~.c~~~,~,~r~.~i' ~. ,,3~~r'p~ f ,the witnesses whose
names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw the testatrix
sign and execute the instrument as her last Will; that the testatrix signed willingly
and executed it as her free and voluntary act for the purposes therein expressed;
that each subscribing witness in the hearing and sight of the testatrix signed the Will
as a witness; and that to the best of our knowledge the testatrix was at the time 18
or more years of age, of sound mind and under no constraint or undue influence.
~j
Sworn to affirmed and subscribed to before me b~witnesses, this c' ~ day
of ~* , 2002. ~,
~~'~ < ~"
Notary Public/Attorn
®~
NOTARUII. SEAL
STEPHEN J. HOGS'.., NOTA.EtY P~I~LIC
CARLISLE BORO, CUANBERLa~dl? CCl... PA
NIY COMMISSION EXPIRES SEP~B'B&a6tiEfY 3, ?_SY~a