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HomeMy WebLinkAbout05-05-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland Estate of Laurie A. Walters also known as Deceased 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 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 bom or adopted after execution of the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ©/ B. Grant of Letters of Administration (Ifapplicabte, enter: c. t. a.; db.n.c.t.a.; pendentelite; duranteabsentia; durantd,r~~noritate) t =~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse-~~' any) anc~irs: (J~' Administration, c. t. a. or d.b.n.e.t.a., enter date of Will in Section A above and complete list of heirs.) '.~ C7 --C -, r-- -- ~.~ Name Relationshi Residen~e~'~ ~1 ~ _ Gerald A. Walters Husband 316 Center Street, Enola, PA .17,0- `- ~ - ;,-- (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland 316 Center Street, Enola, PA 17025 (List sheet address, town/eity, township, county, state, :ip code) Decedent, then 42 County, Pennsylvania with his /her last principal residence at years of age, died on December 4, 2008 ...., - N GJ 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 fo 0.00 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 me aers~gneu: Si nature T ed or rinted name and residence - Gerald A. Walters of 316 Center Street, Enola, PA 17025 ...i COUNTY, PENNSYLVANIA File Number e~ ~ ~ 1 ~ ~ ~~~ Social Security Number 377-72-1800 named in the at Frazer Street at Norfolk Southern Rail Line. Form kW-02 rev. 10. L3.06 Page I Of 2 ,~ ~/ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland 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 administer the estate according to law. Sworn to or affirmed and subscribed representative(s) of the Decedent, Pe~itZoner(s) will well and truly l.~l c t ~.a.~«~u~~ ~ ~~~~~u, Representative before me the ~_ day of ev .-~ ~--~ z~~ - ~-~ Si at fPersonal Representative - J~ ; ,. - r~ ;,.~ '_~ r- r the Register Signature of Personal Representative ~, ~ ,' ' Cf i i - '"c) -~ - ~ W -- N File Number: c.~ Estate of Laurie A. Walters Attorney Signature: Social Security Number: 377-72-1800 Date of Death: December 4, 2008 AND NOW, ~~ UlL , in consideration of the foregoing Petition, satisfactory proof having been presented before , IT IS DECRE that Letters of Administration are hereby granted to Gerald A. Walters in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of FE S Letters ........... ... $ Z~ -Oct Short Certificate(s) .. ~.... $ ~. ~~ Renunciati n(s) .......... $ JC~ ... $ I©~~ n~ ... $ ~. Del ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ ~~ Deceased of Decedent. Supreme Court I.D. No.: 85715 Address: 8 N. Baltimore Street Dillsburg, PA 17019 Telephone: 717-432-2089 Forn: RW-02 rev. 10.13.06 Page 2 of 2 Attorney Name: Duane P. Stone 105.805 REV (Ul/071 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 This is to certify tir<lt the information here glean is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be for~~~ardL:d to the State Vital Records Office f+~r permanent fit-]n x. d..~ ~EC 0 6 2008 LGnrL ~ __ °~-_~ Local Registrar Date Issued 1'J ;~ r :-_~ ~ ~ t:~ ~ - .. ~TY7 .... :ts i ~ v \ - L~~+ fT'i ~ ` _ L~'i , / :».7 W N W 3EV 1tY2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN CORONER'S CERTIFICATE OF DEATH (ANENT :K INK (See instructions and examples on reverse) STATE FILE NUMBER 1. Name of Decedent (First, mirkpe, last, suffix) 2. Sex 3. Social Security Number 4. Dale ath (Month, tlay, y r , Laurie Ann Walters female 377 - 72 ~ 1800 ~ 'C ~-~ ~'(~'~-u 5. Aga (Last Birthday) UMer 1 year Untler 1 day 6. Date of Binh (Month, day, year) 7. Birmplace (City arM state a for eign crounlry) fie. Place of Death (Check only one) Months Deys Haxs Mmules Hospital: Other , ~ "t"I 42 yrs August 5, 1966 Detroit, MI ^ Inpahent ^ ER / Oulpatienl ^ DOA ^ Nursing Home ^ Residence Omer -Specify. 6b. County of Deam i ty, O oro, Twp, of Death Bc. C fW.LEaciliry Name (ll mstlnAi°n, give street aM ~um + ) ~~ G-{' ~l x( '~ ' 9. Was Decedent of Nispenic Origin? ®No ^ Ves If C b 10. Race. American Indian, Black, White, etc. Y -k / i / ~y - ~-' ~ r C.2 c . /V I G IG ~ u yes, ~N an, ( M i P n Ri t jgpaciyl o] ~ ~ ;~ , _i 1 LJC 1 `r ~ r~ ,(l L , ,rp ex can, ua o can, e c.) whit e 11. Oeradem's Usual tbn Kind of work d one d ud most of work' life. Do nor state retired 12. Was Decedent ever in die 13. OecedenYS Education (Speclh only highest grade comp leletl) 14. Mantel Status: MaMed, Never Martietl. 15. Surviving Spo use (lf wife, give maiden name) Kind of Work G+QfiB t`Siges~i{iMUSiry U.S. Armed Forces? Elementary /Secondary (0-12) College (1-4 or 5.) Widowed, Divoroed (Speciy» Business Analyst Heal#lt Cflre ^Y55 QNn 12 2 Married Gerald A. Walters 16. Decedent's Mailing Address (Street, city /town, state, rip cotle) 316 Center Street Decedent's Did Decedent AdMal Residence nor. state Pennsylvania Live ins 17c.®Yes Decedent Laved in E. PennSbOTO T nola PA 17025 , wp Township? 17b. Coon Cumberland 17d.^NO, Decadent Llvetl wuhin ro , Actualumksof cily/Boro 18. Famer's Name (First middle, last, suXix) 19. Mother's Name (Firs(, mitltlle, maker surname) Charles Majewski Victoria Stabinski 20a. Informant's Name (Type / Pnnq 20b. Informant's Maiing Address (Street, city /town, state, zry code) Ger--old A. Walters 316 Center Street, Enola, PA 17025 21a. Method of Dkposabn [Cremation ^ Donetkn 21 h. Date a Dkposttkn (Month, day, year) 21c. Place of Disposition (Name of cemetery, wematory a other place) 21tl. Locatbn (City I town, state, zip code) ^ Burial ^ RemovalfromSkte j WesCrematbnwDOnatlonAutltodzed December 5, 2008 Evans Crematory Schaefferstown PA 17088 byMedlcalExaminerlCoroner? ®vea^Np ^ Other -Specify: , 22a. Signature tic (or person acting as such) 22b. license Number 22c. Name and Address of Fadliry ~ FS 012 849 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 Complete Items 23at nihing skian i5 not avails ai 1 of death to 23a. T the e k ge, deem occurred a t me'tlfalf and p ~ fed. (Signature and title) 1 f J r 23b. License Number 23c. D Signed (Month, tlay, year) . ~ fd " ebl m d~ti c (;,= -' Deputy Coroner -, .~ j . ycauseo ea . , ~ tterm 24.26 must ce completed oY person 24 me of Death ~ ' 25. Date Pro n Deatl (Norm, day, year) ~ 26. Was Cese Referted to Medical Examiner /Coroner for a Reason Other than Cremation or Donation? wM pronounces Oemh. ~, L ~ ~ M. a I C 2fU~,. ( [~s ^ No CAUSE OF DEATH (See Inatructlona end examples) i Approximate Interval: Pad II: Enter other siwifxanl corlAkons contnbutine to deem, 28. Ditl Tobacco Use Coninbule to Dealn? Item 27. Pan I: Enter the chain v t -diseases, injures, or rnmplkalions -mat directly caused the deem. 00 NOT enter tsrtninal averts such as cardiac arest, Onset to Death but not resutling in the untlsdying cause given in Pan I. ^ Yes ^ Probably respiratory arrest, or venlncular fibniklbn wimout showing me etiokgy. List only one rouse on each line. ^ No ^ Unknown A J i ~ IMMEDIATE CAUSE Rnal disease or ' ` candkm resudirg in ~ath) ,_' a. ~(/ V.I ~LM1F. ~ (,I r•~ ~?'Lk ~~Q(j~(~- t 29. II Female. ^ 0 to (or as conseque a oQ/e ~ ~ ~ ~ Not pregnant within past year Sequentkpy list coMilions, d any, D. ~ (n f(v (~( y". l~~ ' ~~ ~ ~ 1 ~P+ ~ 7' ~ ~~ i ' ^ Pregnant at time of tleam leadap tome cause I sted on Nne a. Due to or es a con Enter Ste UNDERLYING CAUSE ( eepuence oq: ~ ^ Not pregnant. but pregnant within 42 days (disease a injury mat kiaatetl the c events restating m deem) LAST of tleam . Due to (or as a consequence oil: ^ N°I pregnant but pregnant 43 days to 1 year d. before death ^ Umcnown if pregnant wdnin Ire Oast year 30a. Was an Amapsy PedamKk? 3gb. Were Autopsy Findings Available Prior to Canplelkn 31. Manner of Death 32a. Q9to of Injury (Norm, day, year) ' 32b. Describe How Injury Occurted t // r j tt ,yl tY ~~ 32c. Place of Injury. Nome, Farm, Street Factory, Office BuAdmG~sc. (Soapil~' M Cause of Death? a tur al ^ Hartkgde ^ N ~) (~e ~: ~, jb ,!'~: v+ ~ : t. L ~- I V \ 7'.t'f--t" ^ Yes ~ ^ Yes ^ No r ~ ~ L7 ^°°~nt ^ PeiMing Imesfigation 32d, T e ofnlnj/u1ry ~ 32e. Inlury at WO~k?„ 32f. 11 nsportation Injury (SpepM 3~acation of Inj (Street ry / toown, sUde r y _,. I , ~Y ~.it~+.:.;"°~ /~ t -'mot }r, ~ ~ ~7e r~ ^Sukide ^COUId NOt be Delermiried ;/1 ~ ~ ^Yes ENO Driver/Operator ^Passenger ^Pedestnan ` ! ' ~ ~ k - ~ ~ l l _ ~ M. aner-syxrcih . < _, -~c l .. 33a. Certifier (check aAy one) • Certltying phyekkn ;Pnysidan cenityinq cause of tleam wren anomer physiaen nos pronounced death antl cortipkled Item 23) 33b. Signature a tie of ~rtdier 1 -~ J1 ' I ff r r , F ~" ~ ~~' /// ~ To the beat of mY knowbdge, deatn acurrod due to the cauae(e) arh manner es atated_ _ _ _ _ _ _ _ _ _ _ _' _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ' L Ui..? .c.~/ • Pranouneing MM certifying phyal°len (Physician both pronoundng Beam and centlying to cause of tleam) ^ 33c. License Nnp~e LICbUt C O roller 3tl. ate $i~ed (Norm, der , ear . Y Y I_ r _ _ _ - _ - To the heal of my knowledge, death oaurred at the tlme, date, and plea, and duo to the oase(s) and manner as atated_ _ _ _ _ _ _ _ _ _ _ _ y II . , tJ ` ,, fT; f ' • Medcal Exsminer /Coroner ` J l ~. On the bask of exeminatlon erM I w InvesligNion, in my opinion, death occurred m the Nme, tlete, antl pkce, and due to the cause(s) and manner as ehtad_ ^ Name an~A}~ti~~~yq(>~pml~liled ~~ of ~~ y'~(+~`1 e I- 35. Re strar's5 stare mbar 36. DateR (Mont aa,year 118 Pleasant cres Road, ork• PA 17402 Disposition Permit No. j1,) (~ ~~ ~ (A