HomeMy WebLinkAbout05-13-09PETITION; FOR PROBATE AND GRAFT Off' LETTERS
REGISTER OF ~~VILLS OF _~,_„~,her~a.~d COiJ~tTY, PE~~~SYL~'AVIA
Estate of .~}'~ ~ - e ~ ~ ~ U I.JG..~e(Z File Number _ o~ L __ ~ ~ ~'~~~ _
also known as _ ,/~-{~ yL t ~ ~ na,4r-k~ vt ~ 5 ~ our ~ ~Cr/L _~
,Deceased Sociai Security Number ~ 7~ - 3~ ~~ (off{ ,~'
Petitioner(s), who is'/are l3 years of age or older, apply(ies) for:
(CO,DIPLETE i1' or 'B' BELO66'.)
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the
last Will oFthe Decedent dated and codicil(s) dated
/-~ r,~~
l i C
~~ __
-=i ~~ -named in the -
-= t'-~ -
(State relevant circumstances, e.g., renunciation, dendi of executor, etc.) _` -~.-,
y'_ `i
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution o€~ttt~nsUUmen~ offered
~,7 --t . .
for' probate, was not the victim of a killing aad was never adjudicated an incapacitated person:
LC'
Q. Grant of Letters of Administration
(IJnpplicable, enter: c.ta.; d. b. n. c. t. n.; pendente lire; dw•ante absentia; durnnte minoritnte)
Petitioner(s) after a proper search has /have ascertained that Decedent Left no WiI1 and was survived by the foIlowing spouse (if any) and heirs: (lf
Adrrtinistration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section ,4 above and complete list of heirs.)
domiciled at death in ~-U i+~ ~ ~s-~~ ~~ County, Pennsylvania with his /her last principal residence at ~ L t n K 5
(List sU eet address, town/cYy, township, county, state, zip code)~ / ~ ~
Decedent, then ~ years of age, died on `1 ag 4 at ~o~ ~ j ~ ph~-
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 6d , OGtCI , c.cv
(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 Poll
Wherefore, Petitioner(s) respecttiilly request(s) the probate of the last Wilt and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Signature Ty ed or rioted name and residence
f ~nnt5' S S Gt,vc~ ~2
~ O ~e~ d yr , ~ Crc IYSIc ~- [ ?C~t j
Foinr RbV-p? ,e~,. 10.13.06 p$be I Of Z
(CO~YIPLETE INf1LL CASES:) ~4ttac/: additional sheets if necessary,
Oath of Personal Representative
CO~I~IONWEALTH OF PENNSYLVANLA
^~( SS
'The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tare and con-ect 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 affirmel znl su`scri~ed ~ `J' r-~
nature ojPersonnl Representative ~_~ ,,.,_
before me the 1 J day of <-~=
e "-
z-W t Signature ojPersonnl Representative ~ _ . ~ ~s~•~..~~
For the Register Signnnu-e ojPersonnl Representative ~ ~
File Number: o(~ G Q ~~~~~
Estate of ~ nC,~ 2. ~ ~~1~~•'-S.>,-~'t' G--~L~ ~nn~E' -, tJeceased
1t1I~
Social Security Number. ~ -1 ~-- ~~ ~~ ~ ~ ~ Date of Death: L~a~ U
AND NOW, in consideration of t1 e foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters ~dmt r11 ~~~'-,
are hereby granted to ~~ nn~ S ~ `_51-~ o.~-r~~P~
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 (and Codicil(s)) of Decedent.
FEES
Letters .... IQ tt~(~C~ .. $ 4S-~'•O
Short Certificate(s) ..~.~ ... $ '~O •U~-% Attorney Signature:
Renunciation(s) .. °?Z...... $ 10 • c~i~
$ Attorney Name:
~ ~ '~ . .
~~% ... $ Supreme Court LD. No.:
... $
$ Address:
... ~
... $
... $
_.__ • • • $ Telephone:
,.. $
TOTAL .............. $ I ~ C1 • ~ y
Register oJWills
Fenn R6V-I)_' rev. 10.13 JG Page 2 Of 2
I05_ri0~ RGV IOIID"~
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, 56.00
Certification Number
This is tv certify that the int~>rmatiun here given is
correctly copied °:i~1~m an original Certificate of Death
duly filed with ore as Local Registrar. The original
certificate will be forwarded to the State Vitai
Records Office !«r permanent filing
~~~n r A~ ~ o zoos
Local Registrar date Issued
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H1ost43 REV nrzggfi COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITALRECORDS
TVPEIPRINT IN ~~ ~~, ~~~~
PERMANENT CERTIFICATE OF DEATH
BLACK INK (See instructions and examples on reverse) STATE FILE NUMBER `' ~
0
1. Name of Decedent (Frsl, middle, last, sWfix) 2 Sex 3. Social Secud Number 4. 0 e of M 1 de ,
ry
rl ~
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e 172
Annie Martin Showaker
- 36 = 0648
5. Age (Coal Binhtlay) UMer 1 year Under 1 day fi. Date of Binh (Month, gay, year) 7. Birthplace (City and stale a f ) Be. Place of DeaM (Check only one)
,~, Da,y ~„ wmmn Hospdal: Other.
May 19, 1944 Carlisle, PA 17013 Om
64
t ^ER /ON
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fib. County of Death &.Ciry, Born, Twp. W Death Bd. Facility Name QI not insdlutiM, gNe street antl number) 9. Was Decedent of Hspank Odgin? ~] No ^Ves 10. Race: American InRen, Slack, Whde, eh.
Cumberland E. Pennsboro Twp. (g ya:. apa°~v aban. {s°"'r~, White
Holy Spirit Hospital Mexican, Pueno Rican, etc.)
DerafenYs Usual Occu ea, Km0 d wok done du' most d wodd life. Oo no1 state mend
11 12. Was Deceoant ever in tM 13. Decetlent's Education (Speciy only highest grade completed) 14. Menial SIeNS: Mamed, Never Married, 15. Surviving Speuse (II wde, give maitlen name)
.
Km0 of Wak Kind d Butiness / Intlusby U.S. Artnetl Forces? Elementary / SecoMa (0-12) College (1.4 or 5+) WMOwed. DNO~ (sP~M
d
Wid
l
File clerk Insurance Company owe
l
^vea ®Ng i
16. Decedents Meiing Address (Street. city /town, state, np coael DecedanYS Did Decadent r7p
PA uYeina ,7
edentL»actin Hampden Tw
D
yes
6 Links Mobile Home Park, Lot 27 ,
ec
p
AtIUalReaidenre t7a.Slate
c.Li
Township?
PA 17050
Mechanicsburg ,7h. camly Cumberland 17° ^ "
oiNetl rnm~n
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Ckyl egg
Ifi. Father's Name (First, midde, Fast, sulax)
Kenneth Martin 19. Mother's Name (Frsl, middle, marten surtuvne)
Elizabeth Hoover
20a. InFOrnanYS Name (Type / Pnnp 206. IidortnanYS Meiling Adrfre (51ree1, ci to ,state, p cod
PA 17015
~ar°~isle
sbur
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t
I30 P
Kenneth Showaker ,
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e
2te. Method of Dispositlon I ^ Cremation ^ Daatkn 21 b. Dale of Disposition (MOnm, day, year) 21c. Place a Dislxssition (Name of cemetery crematey or other place) 21 tl. Location (Ciry /sown, slate, zip code)
[~ Burial ^ Removal fmm State j Wea Cmnetlon or Dautfon AWhonzad
• Ma 2
2009
y Mt. Zion Cemetery Churchtown, PA.
^ Omer ~ Specify: ~ b/ Metllcel Examine / CeeMl? ^ Yes ^ No ,
22a IureofFuneralServiceUce (m reonacer~gaswch) 72b.ucereeNgmbar 22t.NameaMAddmeaWFaciliry Hoffman-Roth Funeral Home & Crematory, Inc.
. ~ l~ir.Lt-~ (~ 013I44L 219 N. Hanover St., Carlisle, PA 17013
Complete Items 23e< mry when cend)dn9 23e. io the bestW my knoMedge, death occured et en lime, date and dace slatetl. (Signaaae art title) 23b. Cleanse Number 23c, Date Sigletl (Monty, day, year)
physkian is rwl avehebk at time of deem to
cerldy cause of death.
w Items 24-26 must he canpkled W person 24. T e
;aN 25. Da
nxau
d ( tt~,
az ase Rerened tolladlr'el Examiner I Canner for a Reason Omer than CramaNon a Donation?
26. O C
/
wM Womounces deem. ' ~ M
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L , ~
~
~ ~
~!y o~LC o
I,L-~'r
O
CAUSE OF DEATH (Bea instruetlona antl xamplas) ~ Approximate interval: Pan II: Enter amer =imifice t .v+n" t'N t' t deem, 2B. Did Tobago Use Candbute ro Deem?
Item 27. Pan l: Emu IM then of events - dise~es, inryms, a cortplk' tkns -tool dilatlty quaed tM deem. DO NOT ante terminal events such as cardiac anesl, Onset to Dsetn but not resubing in tM uMerlyirg cause given In Pan I. ^Ves ^ Probehy
reslxrelory ertest ar ventrkular fibnllatlon wiemut showing dle eedogy. Usnt ~~tyJare cause on each line. ^ No ^ Unkrwwi
// / _
~
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IMMEDIATE CAUSE (Final disease a '~'" 29, If Femsle:
t
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mriditkn rewldng m death) _~ a (/V lv(~{,/J v.4..N-X /\.((iyN~•(, TJ[
~ ^ N
i
hi
e
Due to (or as a consequence off: r
Sequentially list mMitions, II any, ~
U~ at pregnant w
t
n pest y
ar
^ Pregnam at time of tleam
r
leading to the cause YWed on hoe a.
D ^ Nol ('regnant, but pmgrem within 42 days
ua to (or as a consequence oQ:
Enter @le UNDEflLYfNG CAUSE
d death
jdiseaee a irQury Met initiated the
°
events msulhrg in Beam) LAST.
D ^ Not pregnant, but pregnant 43 tlays to 1 Year
uero (a as a conaegaamta ~:
helae deem
d ^ Unknown q pfagneM wthin the past year
.
30a. Was an Autopsy 30b. Were ANOpsy Fintlings 31. M DeaM 32a. Dart of lryury (Month, tley, year) 32b. DesrnLe How Injury Occured 32c. Place of Injury: Home, Fame, Srteel, Fecrory,
Pedamed? Avylable Pdor ro Cenplation
of Cause W Deam?
Natural ^ Hankxtle Office Buiklimg, etc. (Speciy)
^ Accident ^ Parting NVeSegalgn 320. Tme of Injury 32e. In"ryry at Work? 32f. g Transportation Injury (Speciry) 329. Location of Injury (Street, city l town, slate) i
^Ves t o ^ Yes ^ No ^ Sukide ^ Court Not M Dalenranad ^Ves ^ No ^ DrNu I Operate assenger ^Pedastrien
M Other - Spea/y:
33e. Caraaer (check Dory oral
ronounced dean and compkletl Item 23)
h
idan has
th
anaMr
d
i
a d
h 33h. si and rm
/~~
en
p
ys
p
y
ng cause
ea
w
• Cartllying physklan (Physkian cert
tleam oeeumdtlue to Ma eause(s)antl mmner ae etebtL________________________________ ^
7o IM beN Of my Nnonbdge ,
,
• Pronouncing end cMmylrg physkian (Physician bom prawungng deem and cenlrykg b cause of death)
r° me beat of my knowledge, deem occurtad N me Nrre, data, eM plxs, and due to 1M wae(e) and manner u :mted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
i
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I C 33c. nee Number ~ ~ ~ ~'
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/ ! `~ 33d (e ~ ~n ay, y6af)
/~./ ' UY
ororror
xam
ner
• fMd
el
On tM basis al examinatlon art I a Inveatlgalbn, In my aplnim, daeU oauned at dte Nme, dale, and piece. ~ due ro the ceuae(s) art manner u sMted_ ^ ~ .~a~ M use of Death (11em ZTI Typo / Ptinf
JZIN.e-
35. Registrar's ,rind Dist ,~
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. Date F fMamh, day. you) Q
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3 ~ Al ~ib~~~; ~.~r,
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Disposition Permit No. ~ ~ 1
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RENUNCIATION
REGISTER OF WILLS
I~ ~~ COUNTY, PENNSYLVANIA
Estate of
I,
r
h rl l 2 ~ , ~ ~OW(~.1C~2..~
~d~U~~1UVi,~f ~ S~~~c.,ua.~(ce.~-
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Deceased
in my capacity/relationship as
°'~~ (PrintNameJ
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~~~n ~ s ~' fn ecz SI~~~x~.1~ r
rl~h.~~ ~ (~, ~rr~~
(Date)
_~-- ~'
(Signature)
f"
2 j ~J ~
~J t u G'1 ~1 ~ ~ f ~~.ll`~`l ,
(Street Address)
(~~
F~t.~ ~ ~ ~' l ~l ~ 7~~i~( ~
(City, State, Zip)
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
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this ~_ day
of ~
i ,~'~ n t~
Notary Public
My Commission Expires: ~l_~ i~ l.~ ~~
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
t 1:': 5~) a.
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--
RENUNCIATION 'f `~`~' =~~
t.: = ~:.
REGISTER OF WILLS t-= ``-=~
~ ~~~-~ ~ COUNTY, PENNSYLVANIA ~`~ V; a7
Estate of ~ ~ ~ 1 ~ ~ _ ~~ ~~~~~~-~- ,Deceased
I, ~! ~~ ~~`~-'[-~ ~ ~ ~(~~-~~..~. , in my capacity/relationship as
(Print Name)
~-~/~ U~~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
(Date)
Executed in Register's Off ce
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
~~~~ ~ z~~
(Signature)
i 3 0 ~r'~ T e /S~z'S c_~ r'c; ~~
(Street Address)
C',9 r Lis fie. 1~~ 1 > v / ~'.._
(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 renunciation for the
purposes stated within on this ~ T ~ day
Nota Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
..~...~~
NOTARIAL SEAL
CAME4A J MAN6ES
Notary Publlc
HAMILTON 7WP, FRANKLIN COUNTY
My Commisalon Explna Jun 21, 2010