HomeMy WebLinkAbout04-20-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA
Estate of Judith A. Jones
also known as
File Number ~ I V ~ ~ v ~~
Deceased Social Security Number 200-34-1501
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 named in the
last Will of the Decedent dated and codicil(s) dated
(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 instrument(s) offered
for probate, was not the victim of a kiiling and was never adjudicated an incapacitated person:
B. Grant of Letters of Administration
(If applicable, enter.• at.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante minoritate)
Tt{L hSSc'i5 dr t~~ MATE- N~tZ Qtlnt~~,l r+~ T•t~ Gp.at pr~l~ G~57~Q~ n~C `(yLL PG'(~NS~l1/~r~~~ ~LtSli?L"^~
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (tf an )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.)
Daniel Keith Jones Son 306 North Old Stonehouse Road, Cazlisle, PA 17015
Jarrod James Jones Son 9839 S.W. 117th Ct., Miami, FL 33186
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(COMPLETE INALL CASES:) Attach additional sheets if necessary. _ ~'
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal race at~T„r
1004 South Hanover Street Carlisle Ctunberland County Pennsvlvatua 17013 =- -, ~ ~
(List street address, town/city, township, county, state, zip code) _ _'~~' !'` r
Decedent, then 63 years of age, died on January 9, 2009 at Holy Spirit Hospital, Camp ;fin-'berland=~°ounty; PA
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Decedent at death owned property with estimated values as follows: ~
(If domiciled in PA) A11 personal property $ 28,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 155,000.00
situated as follows: 1004 South Hanover Street, Carlisle, Cumberland County, Pennsylvania
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:
Jarrod J. Jones, 9839 S. W. 117th Ct., Miami, FL 33186-2754
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Form RW-02 rev. 10. /3.06 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF C~unberland
SS
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 the _ ~ ~~ day of
i~
For Register
of Personal
Signature
Signature of Personal Representative --= ~ ~*
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File Number: ~"""
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Estate of Judith A. Jones ,Dec ased red
Social Security Number: 200-34-1501 ~,~.',~p Date of Death: January 9, 2009
AND NOW, ~ ~f , ~, in consideration of the foregoing Petition, satisfactory proof
having been presented before e, I DECREED at Letters of Administration
are hereby granted to 7arrod James Jones /~ ~ ~'~ ~i ~ O
in the above estate
and that the instrument(s) dated n/a
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of
FEES
Letters ............... $
260.00
Short Certificate(s) ........ $ 40.00
Renunciation(s) .......... $ 5.00
JCP/Automation Fee , . , $ 15.00
Inventory $ 15.00
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ 335.00
ister
Reg
of
Wills T `^ t°,~
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Attorney Signature:
Attorney Name: Nathan C.
Supreme Court I.D. No.: 87380
Address: Wolf & Wolf, Attorneys at Law
10 West High Street
Carlisle, PA 17013
Telephone: 717-241-4436
Form Rw oz rev. 10.13.06 Page 2 of 2
~(1; ~2i - 09- o~7g
LOCAL REGISTRAR'S CERTIFICATION OF CEATH
WARNING: It is illegal to duplicate this copy by photostat or photogra~sh.
Fee for this certificate. `~6.0(?
P 15064410 _
Certification Niunber
Th„ i~, k~ c'ertjt~ ::'):i' .hL~ +lifurl~Iatit>n hcnr ~ri~~cn i
correrily co~,ic~4~r+~m :1:) ori~~ilzal t~c(~til~i~~~tc of t~eatl
duly f+1ed x(t- ;=x r. f.(f~a! Red:<trar. The <n-i~ina
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H105-143 REV 11/2006
TYPE I PRINT IN
PERMANENT
BLACK INK
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See inatructlons and examples on reversal rl 1l n 71 `] °--f n
_._.____.._...__.. vye L
1. Name of Decetle~ IFirsl, mirfdk, last, wXnl 2. Sex 3. Social Secuny Numbez 4. Dale of Death {Month, da , art
5. Age (lass einnaayl UIMer 1 year UMer 7 az 6. Date of Ginn (Monti, day, year) ] BlMplace (City ant state or loregn country) Ba, P ace of Death (C only onel
_ NoNns Days rww, semwes Hospital: Omer:
Yrs
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.
Iryu¢ant ^ ER I Oulpatiem ^ DOA ^ Nursing Home ^ Residence Qrhher- SpoclN:
Bb. county w Deals &;. City, Born, Twp. of Death
I
~ Bd. Facility Name (If tw1 iruVWlWn, give street arW r) 9. Was Decedent of Nlspank Oriym? ~ No [7 Yas 10. Fiac¢' American Indian, Black, While, etc.
Ot yes, sPaury Ganes.
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V !~ ~': ~ n `-/ ~ ( 1 V r Mexican, Pue(w fliun, etcj
N. Deceoanl's Usual 0. lwn KirW of work done Burin moll d worMn life- W ~ le reured f2. Waz Oeeed nr ever in me l3. Decedent's Etluoatan (Specrty ily mghest glade wmpleled) t4. Marital Stews. Mardeq Never Married, I S Surviving Syouw (If wib, give ma~dan name)
KiiN of Work Nino of slne5 !Industry
' ~)'eq Divorced (S/xv;r
US. Ar Forcos' Elen1enlary Secondary (0-12) Collage (1-4 or 5a) W'y
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^ Yes No 1/ l,/C~ ((, l~
16. Decedents A4aArny AdLdrf~ss (Slreei City I town, slate xip code)
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• 3~ Decedent's Did Decedent
Actua' Residence I7a
Slate N n h ~ Live in a
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Yes, Decedent Lwed in Tw
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Town
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1]tl. ~ No, Decedent Lrved widen {,
17b. County (~ J ~~
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Actual LMIYhW
f r {{{ I S (~ fJ0 (G City I Boro
1B. Father's Name (FnsL middle, last, sulhxl 19. e' Name (Flrs~nWd¢, Wen surname)
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20a kdornuHdS Namg (TyTI Pnnl)
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~ 20b InlamanYs -'ug AOMe {Syre¢t, GN I town, stile, zip
wde)
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21a klethW of DisWSition ~ ~ Crematan ~ Donaual 21h. Dale of DisPOSi1Wn (Momh, day, year) 21c. Place al Disposition (Name
ol cemetery, clemalo
pr other place) 27d. Location ICity I lawn, !t te, zp code)
Iy~y~~ Bunat Q Removal Iron slate I WN Crematlon or DOnelpn Aulhwbwd
^ Other peaty' I by Medaal Examirrer / Cororerl ^ Yes ~ No
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22a. Sgn' ie of Finaral Servke uerusae ( per such) 22b lWenw Number 22c. Name and Address of Fatii'
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!3 38~-L. r~~, ea ~.~ ~ ~ os,z /~~r,a z~
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ems 23a-c only when celWyUg 23a. To Ue bNl of my knowledge, Beaty attuned al da ame, dale arW place slated (S9nature ant tillel 23h. license Number 3c
Dale
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ned IMantn
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ear)
ph - ' Iwl available at Woe d tleaN a .
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w iN se of Blau.
P4.~ must be ~~~ ~, Verson
Wa gonounc05 death 24. rmle of Death ~ 75. pats Pronounced Dead (Monti, day, year) 26. Was Case Referred to Medal Examiner I Coroner for a Reason Other roan Crematan or Damrion?
. M O O Yes ~No
CAUSE OF DEATH (Sea Inatructlons antl axemplea) r Approximate Interval:
II&n 27. Pan I; Enbr Ue Chain al events -diseases, ryunes, a comP4caaom - Mal dreary caused dte tlealh. DD NOT enter terminal events such az cardiac arrest, r Onset b DeaU Pan 11: Enter other 5'anifirant cwWeims contrtut t da U,
Dul tat resWang U me undenyWg Cause grvan W Pan I. ZB. DW Tobaca Use CamrinMe b Death?
~ Yes ~ Probably
resgralory arrest, w uenhiaWer kdrtlhtion wehaA showtig Ina edalogy. List aNy ana Udse on Bach kN. r , -
~ No [~'Ulduwwn
,
MWEgATE CAUSE IFinal dsease or 1
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cordAial resWtinga aNl
I `~1y~LvY U'~1~1 L
~ •~0~ 2s. n Female
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' Due t0 (or as a consequence oQ: ~ ~t pregnam wrfNn past year
Sequen¢alry lest tIXWilWns, it any, p r
1ea6rq b the cause Nsted m line a.
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Pregwnt aI M1ma d dNM
DW a la a5 a come
Eller Ue UNDERLYING CAUSE quanta op:
1
^ Rot pregnant, but pregnant witlun 42 days
~disaaw or nry' ry that WNhleO dre
ants resudiy in Beau) LAST. °' °f ~~
Due to for as a consequence ofl~.
^ Nd pregNM, but Pregnanl43 days b 1 year
d. i before Beau
Unknown g pregnam witNn the past YNr
30a. Was an Aulcpsy 30b. Were Auapsy Findrps 31. M of Death 32a. Dale of Injury IMonU, day, year) 32b. Describe How Inlury pccurretl 32c. Plata of lryury'. Home
Farm
STr¢el
Faawy
Penwinetl?
AvailaNe Prar Io GomplelWn
Nawml ^ Homicide ,
,
,
.
Odwe BuiWUg, etc. (Speciryl
of Cause of Deem ~
Yes ~ No ~~ Ves ~ No ^ Acddem ~ PerWirg Investiyadon 32d. Time of Injury 32e. aljury al WorA? 3:N. II Tmr6ponalion Iryury (Specity) 329. Loulim of Injury (SYreet, city /town, slate)
^
" SuwWe ^ CoWd Nd CB Determined ^ Yas ^ No ^ Driver/ DperalW ^ Passenger QPedeslNn
M Omer - Specdy- 1
33a. CeniPel (theok cmy anal 3'N. $iglWwre and 7Sa pl C -
• Cerlityag physkbn (Physician cerlifymg cause d death when andhar pnysoan has Dronouncetl Beau and cwrpleletl Item 23) . - /V•_MV ~"
To the bast of my knowedge, tlealh occurred due to Nor ouea(a)md mannerNSYeYed________________________~______„_ ~ - _
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• Prorquncing and caHilying Dhyeklan (Physician both promuxirg tleaN ant CeNllmrg a cause d deaml
To the best of my knowledge
Beall ouunad aY fM time
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^ 33c. License Nu 33tl. Oale Signed IMon(h, day yaerl
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• Medical Enminer / Coroner ~n ~ I l ~/ ~ ~
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On the bash o! a HWwn ant / a im'eafipslan, In mY opinion, death xcmred 01
Me
ame, dab, and pbce
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d Cause d Deem (Ite m 27J Typa I Priul
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RENUNCIATION
REGISTER OF WILLS ,, ~
Cumberland COUNTY, PENNSYLVANIA ~ ,T
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Judith A. Jones ~> ~
Estate of , ~ ceased
I, Daniel Keith Jones , in my capacity/relationship as
(Print Name)
son of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Jarrod James Jones
~^ ~ `~
(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
(Signature)
306 North Old Stonehouse Road
(Street Address)
Carlisle, PA 17015
(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 renunciati~ for the
pure . es stated within on this ~0 day
Notary Public ~
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
NOTARWL SEAL
BONNIE L COYLE, NOTARY PUBLIC
80R0 OF CARLISLE, CUMBERLAND CO. PA
MY COMMISSION EXPIRES OCTOBER 17, 2010