HomeMy WebLinkAbout04-16-09 (2)PETITION FOR PROBATE 1AND GRANT OF LETTERS
REGISTER OF WILLS OF Cam ~ ~- r I Gi.N ~ COUNTY, PENNSYLVANIA
Estate of 1 Y t i r 1r Ul M E. 1"~1~ Y" ~~ ~.T t File Number (~ ~ ~ (~~~ ~~1,~/
also known as
Deceased Social Security Number f U ~ ~~ t~ 6 ! a ~ 9
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.) j
A. Probate and Grant of Lette Tes mentary and aver that Petitioner(s) is /are the ,~ 1 G ~1 Gte ~ ~ ~ h ~'" I ned in the
last Will of the Decedern dated a- a~ and codicil(s) dated _ ~ ~ ~=i
.~ ~ _ _ - -~
(State relevmrt circumstances, e.g., remorciation, death ofexecutor, etc.) °_- ~ ~ ri '' '~~t
~ _ ,~
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution p~~;}~me~) offered ~fi`}
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:. `~-~ ~ ~~=
~ ~ - :. era
^ B. Grant of Letters of Administration o
(]f applicable, enter: c.t.a.; ctb.n.c.t.a.; penderue liter durante absentia; durante 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.)
was
(List street address, towr/ctty, tawnshtp, county, state, zip
his /her last principal residence at L1 ~ r" ~lt ~
:-~ .....
situated as follows:
Wherefore, Petitioner(s) respectfutty request(s) the probate of the last Wdl and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
(COMPLETE INALL CASES:) Attach additional sb~ets f necessary.
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 $
Form RW-02 rev. 10.13.06 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
p~ SS
COUNTY OF ~ ~ U I ~-~
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 a~{n~d(~subscribed
before me the ~' _! day of
or egister
Sigratrve of Personal Re~esentative ~Q
~ rte-'
Signature of Personal Representative -y,:y
,-~ j~
~~ ~ -
_ ~f ~-C~3to1 ~_
Filee NNumber: -~
Estate of Iy11r IC~i(Yl ~~ • 5~1~~~ ~~ .Deceased
c" ' `'~,
~ z.`
.,_. ~:
-~--~---r-,-: -;,
-„..~
0
Social Security Number: I ~J' ~ ~ ^ "I ~ ~~ Date of Death: ~-' ~ ' Q 1
AND NOW, u(~ ~Q ~ ~ ~ . _s~ ~~, in consideration of the foregoing Petition, satisfactory proof
having been presented before4he, I'Z' IS DECREED that
are hereby granted to ~ 1 ~~(1C.L~ V~ ~ . ~~~X K~
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 (a/n~d Codicil(s)) o~f.~DAec~edent.
FEES ~~~ WQ~ ' ~Ql1,Y«.. ~f~ll~h~~_~,l .
Letters ............... $ ~ Register of Wills ~O~n,^
Short Certificate(s) ........ $
Renunciation(s) .......... $
... $ •~
$
...
$
...
... $
... $
... $
... $
TOTAL .............. $ ~P ~, ~'
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Form Rw-o2 rev. 10.13.06 Page 2 of 2
- __ _
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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 1~2~.62?6
Certitlcation Number
This is to certify that the information here given is
correc~:ly 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.
ocal Registra Date Issued
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Hto5~la3 REV urzoos COMMONWEALTH OF PENNSYWANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE ~ PRWT W
PERAiAlIENT CERTIFICATE OF QEATH
aucK YY( (See Instructbns and examples on reverse) „~ F„ ~ s,,,,,,~,
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1. Name a Darden (First, naddr. last. w1ix1 2. Sex 7. Serial SacaYy NaMer /. Date d Death papN, my, Year)
Miriam E. Burkett Female 183 -12 -9819 February 1, 2009
5. Aqe 4Lari UinWayl Unger 1 Under 1 mY 6. Dale d DOYI (NpNh, mY• r) 7. ace C' arld era a caadrY) Sa. Place d Death (ChwN opt
Honeu pan rows xr~vk, MosV°a: Wwn
86 Yra. October 5, 1922 Lockport, PA ^,r,~,~n, ^ER1pApatien ^DDA
t~twrs0p Hann ^ Resbance ^gher ~ Spxay:
Be. Caay d DeaN 9c. Cay, Bono, Twp. a Death Bd. Fadry Name (q not:ts0lu0as, gtw tnaM arA taaMar) S. Waz DepdxY d FYSpxec Origin? ~ No ^ Yn 10. Rap: Anruca, Eidien, Srck, IVlar, etc.
Cumberland South Middleton Manor Care wx,sanl ~ .b.) I~O~Nhite
n Decamne UwY wn l(rb a wak dorr nwat a we. oo na wr nikea t2. waz Decamp avr N Yw to OeoederlYe E4rrA0al
( oM' nywn perm conplaad) /e. M~
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Alurrd, 15. SurvlyYlp Spouw (Y wm, pv mYdn name)
YiW d Wak Hind a Buapss IOrdus'W ~
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U.S. ArmW fags? Er y
Y fin' lo-tt) Coaepe Ili a 5+1
^Yae ~fN° 12 Widowed
tS.D«emn[s wiNg Adaess (sweat caylrown, wte,:p meal Deceawx's p°~mrs South Middleton
~
940 Walnut Bottom Road Aaual Residence na. Swe
PA five n a t,c.~• Yes, Decedent tired n Twp
Tom?
Carlisle PA 17013 1°_O rb,Depd.raureaw~ain
nb cwdy Cumberland
AdaN tinloaa cay/eao
1S. FaNar's Name Ifrst midde. rsl, suau) 1S. Mldywy's Nama IFrri, rtidde, maiden sumerne)
Staple Giles Bertha Laubscher
20a. Norman's Name (Type /Prim) 20D. NbrmeN's Maarg Amress (sreN, dry /Iowa,, srr, nD pda)
Michael W. Burkett 3 Shady Lane Mechanicsburg, PA 17050
eta laennd a Disposi0on ~GnnlaOOn ^ Dawuon zln. Dar a Disposilim IyAOdn, my, ywl ztc. Plata d Dorosabn (Narp a prnwry. cnnlawry' a otlwr Plapl 21d. LopGon IcAy r town, aUw. ap wde)
^ ~~ ^ Remwalransrw ~iasdlcEarNr~lCornari7~U~ Yea^rb February 4, 2009 Conolite Crematory Schaefferstown, Pa. 17088
22a. fawal ( acYq az such) 220, llcerre Number 22c. Narre and Address d FariWy
~ FD-012662-L Myers Funeral Home, Inc. 37 East Maln Street Mechanicsburg, PA 17055
IMwN rway wnen amyvp ro ew lw nn wr»,odge, daeN amrned a Ne Mnw, dw aN place al.a, ISIPyan~te era Nr) 23e. Lkanw Nanlb.r zx. Dale Slpnea IMaah, mY Y••O
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wno praw,ces MN. ~~ .~-)~.) f M. F'~S .A ra f ~ 00 ~ ^Yes ~VfL~.._'
CAUSE OF DEATH (Sas InetruclbM and aaampMe) , Approainrle eaerva: Put N: Enter oYrr ' ' - - - - 28. Db Tmecp Use Camrwaa m DeeNT
Irm 21. Pan I. Eiuer Na Con d eves ~ - deaeses, rMuoes, a cmVacauar -that madly posed Na daaN. W NDi aNar krmew events sudr es cANiac aynn s Onsd b DeaN Ora rwt resu4p n Yr urlmdynp cape prvan n PN L [) Yea ^ ProUaOy
ras{mmalay arrest. a vwrbdar 00naaaon woad slmwing ew e0obgy. Uri oay aw cause an each ape. r
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BE IT REMEMBERED, That I, MIRIAM E. BURKETT, of Mechanicsburg,
Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and
declare Phis as and for my Last Will and Testament, hereby revoking and making null and void
any and all Wills and Testaments or Writings in the nature thereof, by me at any time
heretofore made.
ITEM 1. I order and direct the payment of all my just debts and funeral expenses as
soon as conveniently may be after my decease.
ITEM 2. All the rest, residue and remainder of my estate, real, personal or mixed, of
whatever nature or kind and wheresoever situate, I give, devise and bequeath unto my beloved
son, MICHAEL W. BURKETT. In the event my said son should predecease me or die in a
common accident with me, then I give, devise and bequeath the said rest, residue and
reminder of ?ry estate ur.±o the children of my said son, Michael W. Burkett, namely:
DONNA S. POTTEIGER, DAVID M. BURKETT, and DIANE M. HEILAND, equally, share
and share alike. In the event any of my above-named grandchildren should also predecease me
or die in a common accident with me, then I give, devise and bequeath the share of the one so
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ITEM 3. Lastly, I nominate, constitute and appoint as Sole Executor of this, my Last
Will and Testament, my son, MICHAEL W. BURKETT. In the event my said son should
predecease me or for any reason be unable to act or continue to act as Executor hereof, then I
nominate, constitute and appoint my grandson, DAVID M. BURKETT, to act in his stead as
Executor of this, my Last Will and Testament. My Fiduciaries shall serve without bond.
IN WITNESS WHEREOF, I, MIRIAM E. BURKETT, the Testatrix above named, have
hereunto affixed my hand and seal this ~ Nd day of February, 2005.
/~~~~_ _~ ~_.,~~:' ~:E~ (SEAL)
Signed, sealed, published and declared by MIRIAM E. BURKETT, the Testatrix above
named, as and for her Last Will and Testament, in the presence of us, who have, at her request,
in her presence and in the presence of each other, subscribed our names as witnesses.
~2 ~_
~~~
2
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF C,~,~(~~.t~l_aN~
We, So ~. ~A~P,tc~cc-m and ~-Ug~T J. ~~.~.s ~ ,the witnesses
whose names are signed to the attached or foregoing instrument, being duly sworn according to
law, depose and say that we were present and saw the Testatrix sign and execute the instrument
as her Last Will and Testament; that MIRIAM E. BURKETT signed willingly and that
MIRIAM E. BURKETT executed it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses;
that to the best of our knowledge, the Testatrix was at that time 18 years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to and subscribed before me this ~ day of February, 2005.
COMMUNW~HL iH OF PENNSYLVANIA
Noranal seal Pub is
Mary J. Gouffer, NtNary public
Silver Spring Twp., Cumberland County My commission expires: o ~ d
My Commission Expires Nov. 17, 2007
Mem6ar, r~c~nr,,,,,,~,~a,,,,, ,gysociation Of Notaries
3
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~~pq.~ ~t.1.~n1.fl
. SS.
I, MIRIAM E. BURKETT, 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 and Testament; that I signed it willingly; and that
I signed it as my free and voluntary act for the purposes therein expressed.
Sworn or affirmed to and acknowledged before me, by MIRIAM E. BURKETT, the
Testatrix, this c~c~ ~~day of February, 2005.
COMMONWEAL`I"H OF PENNSYLVANIA Ub11C
Notarial Seal
Mary J.Gouifer,NotaryPublic My commission expires: ~~of~MBf~ ~T vo ~
Silver Spring Twp., Cumber{and Camty
My Commissiai E~ires Nov. 17, 2007
R~lerft?~~r, Ppronsylvan~a Association Of Notaries
4