HomeMy WebLinkAbout05-15-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Mary Patricia Mackin
also known as Mary P. Mackin, aka M. Patricia Mackin
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
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named in the
(State relevant circumstances, e.g., renunciation, death of executor, etc.) ~ -.
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of-tFje?in~rumen""fs's) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ ~ -
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B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d. b. n. c. t. a.; pendente lice; durance absentia; durance minorttate)
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.)
Name Relationshi Residence
Charles P. Mackin, Jr. child 2734 Logan Street, Camp Hill, PA 17011
Patricia J. Wilcox child 718 Regester Avenue, Baltimore, MD 21212
Timothy P. Mackin child 60 Kenton Road, Chagrin Falls, OH 44022
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
COUNTY, PENNSYLVANIA
File Number ~ l ~ `l ~~~~
Social Security Number 023-18-3898
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
836 Mandy Lane, Camp Hill, Hampden Twp, Cumberland County, Pennsylvania 17011
(List street address, town/city, township, county, state, zip code)
Decedent, then 87 years of age, died on 02/02/2009 at Holy Spirit Hospital, East Pennsboro Township,
Cumberland County. Pennsylvania
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: 836 Mandy Lane, Camp Hill, Hampden Twp, Cumberland County, Pennsylvania 17011
$ 200,000.00
250,000.00
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
the undersigned:
or printed name and residence
%~,^ f/ dj/J` ,/ ( ~ I Charles P. Mackin, Jr. , 2734 Logan Street, Camp Hill, PA 17011
Form RW-02 rev. 10.13.06
Page l of
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF ~~~ ~~~~~~~
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
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or the Register
Signature of Personal Representative
Signature of Persona! Representative
Signature of Personal Representative
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Estate of Mary Patricia Mackin ,aka, Mary P. Mackin, aka M. Patricia Mackin ,Deceased
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Social Seppcurity Number: 023-18-3898 Date of Death:Februarv 2, 2009
AND NOW, I ~~ , _1z,~, in consideration of the foregoing Petition, satisfactory proof
having been presented before , IT IS DEC D that Letters of Administration
are hereby granted to Charles P. Mackin, 7r.
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of
FEES
Letters .. ~.~~ QL~. $ ~~
Short Certificate(s) ..w ... $ ~~
Renunciation(s) ... a:.... $ L~
... $ l
... $ ,5
... $
... $
... $
... $
... $
... $
... $
`° x-99--
TOTAL .............. $ 7.S° '
as the last Will (agld Codicil(s)) of Decedent.
of
Attorney Signature: t 'A- ~-~"---- 1
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Attorney Name: H. Anthony Adams
Supreme Court LD. No.: 25502
Address: 49 West Orange Street
Suite 3
Shippensburg, PA 17257
Telephone: 717-532-3270
Form RW-02 rev. !0.!3.06 Page 2 of 2
I105-SOS RGV iUll6';
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, ~ib.00
P 15186913
Certification Number
This is to certify that the information here given is
correctly 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.
FEB~ 0 41)09
Local Registrar ~ Date Issued
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REV 1lrzoo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
PRINT IN CERTIFICATE OF DEATH + ~ C
3M1~NT ~ 1 ~'l~l ~.`~
x ySna instructions and examples on reverse) CTaTF FII F NI IMRFR
1. Name of Decedent (FrsL middle, last, suffix) 2. Sex 3. Social Semrty Number 4. Date of Death (Monet, day, year)
esmale 023 _ 18 ~ 3898 02-02-2009
Mary P. Mackin
Age (Last &rthday) Untler 1 year Under 1 day 6. Date of Binh (Month, tlay, year) 7. Binhplace (GNy antl stale or forego country) 6a. Place of Death (Check only one)
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Manlhs Deys Hours Minutes Hospital:
87 Y s March 7 , 1921 BOS ton, MA ®Inpaliem ^ ER / Outpatient ^ DOA ^ Nursing Home ^ Residence ^Other Specify
Bb. County of Death &. City, Bom, Twp. of Death Btl. Facility Name (II rwl institullon, give street and number) 9. Was Decedent of Hispanic Origin? (~ No ^Yes 10. Race: American Indian, Black, White. etc.
(If yes, specify Cuban, a (SpacrM
~.1IIIberL9Ild E. Pennsboro Hol S lrlt HO flat Mexican, Paerlc Rican, etc.) White
11. Decedent's Usual Occu lion Kind of work done dud most of world tile. Do ml state retired 12. Was Decedent ever in the 13. Decedent's Etlucation (Specify only highest grade mmpletetl) t 4. Marital Slalus: Monied, Never Mamed, 15. Surviving Spouse (If wile, give maiden name)
Widowed, DNOmed (Specify)
Kind of Work Kind d Business I Industry U.S. Armed Foroes? Elementary /Secondary (0.12) College (1-4 or 5+)
4 Wid
d
Homemaker Own Home owe
^Yes ~No
16. Decddmt's Mailing Address (Street, city I town, state, tip code)
836 Maud Ln Decedent's Did Decedent
Aduel Residence 17a. Stele PA Live in a 17c.~Yes, Decedent LNetl in en Twp
Township?
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Camp Hill, PA 17011 ,76. County Ctmberl-attd nd ^ "nc°ia°ah`imi ~' oii~ed wthin city r eom
16. Fadur's Name (First, middle, last, suffix) 19. Mother's Name (First, mitltlle, maitlen surname)
Jane Ducey
Henry F. Sparkes
20a. Informant's Name (Type I Pnnt) 20b. Informant's Mailing Address (Strad, city I Town, state, zip code)
. PA 17011
Camp Hill
an St
2734 Lo
Charles Mackin ,
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21 a. Medal of Disposition ^ Cremation ^ Donation spositbn (Mmth, day, year)
i
21 b. D
ale
of
D 21c. Place of Dispositon (Name d mmetery, crematory or other place) 21 d. Lmation (City I Town, slate. ziD tale)
Burial ^ Removal from Slate j Wes Cremadon or Donation Aufhonzed ~
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FeUl Urlry 6, 2009 Rolling Green Memorial Park Camp Hill, PA
No
Yes
^ O - ~ ; by MerAcel Exemlrrer I CoroneR
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umL 22c. Name and Addmss d FadGry M..ers_Harner FlIIleral HO1112
e21 Service Licensee person rig es such) 22;.; ~n~ t'1
28. Signature of F
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1903 Market St. Hill PA 17011
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Complete Items 23ac only when certifying 23a. To the best d my knowedge, death occurred at tlu 6me, date aM place detetl. (Signature and use) 23b. License Number 23c. Date Signetl (Monet, day. year)
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physician Is ml available al time of tleath to t - r ~ `, -.._) tt jr ' ~L '~ 3 -~ ~% ~(_ )Y ~ ~(.~ f l ~ ~' J , ~ U-'i~ C
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24. Tune of Death 25. Dale Pronouncetl Dead (Month, day, yeaz) 26. Wes Case Referred to Medical Examiner I Coroner for a Reason Other than Cremalio or Donation?
erson
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26
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Items 24-
who pronounces death Imo. .'~~~ C)~, ~ M. G! ~?Y~ ~l(-,•(l.~ ~. ~~ •,~~i ~.~ ~1 ^Yes No
CAUSE OF DEATH (See inatructlona end examples) r Approximate interval:
or complicetiore - that dredty reused tlu death. DO NOT enter terminal events such es cardiac arrest, I Onset to Death
injures
tliseases
f
t Pan II: Enlar other =ia 'li n t mntlilp = n ra ~taa to death,
but not resulting in the undertying cause given In Pan L 26. Did Tobecm Use Conlnbule to Death
^Yes ^ Probably
,
,
even
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Item 27. Pan I: Enter the then o
respiratory arest, or venlrimlar fihrplatbn wimod showing the etidogy. List Doty one cause on each line. ~
V • ^ No ^~known
IMMEDIATE CAUSE Fkul dksea~ ~S ~ • - - - L, _ ~I ~ u . w0 r
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29. If Female.
nant within
ear
^ Nol
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me' ~)
r~tim resu
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D to ( as a consequerx:e ~: ~ ~] ~ b p
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^ Pregnant at lime of death
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Sequa fifty list cmtlitbre, it any, b.
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leading m the cause listed m line a. Due to (or as a consequence op: I
LYING CAUSE ~ ^ Not pregnant, bN pregnant wihin 42 days
of death
Enter the UNDER
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(dlseese or injury
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evenR resulting a deem) LAST. t ^ Nol pregnant, but pregnant 43 days to 1 year
Due to (or as a consequence oq: r
r before tlealh
^ Unknown d pregnant wilhln the past year
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30a. Was an Autopsy 30b. Were Adopsy Findings 31. Manner of Death 32a. Date of Injury (Mmth, tlay, year) 32b. Descrbe How InWrY Occurred 32c. Place of Injury: Home, Farm, Street, Factory.
Ofrae Building, etc. (Specify)
PerlametlP Available Poor to Complelan ~ Natural ^ Homicide
of Cause of Death?
^ Accitlenl ^ Pending Investigation
32d. Time of Irqury
32e. Injury at Work?
321. If Transporletim Injury (Speo'ly)
32g. Location of Injury (SlreeL city /town, state)
^ Vas ~No ^Yes ^ No ^Yes ^ No ^ Dn'~ /Operator ^ Passenger ^Petlestnen
^ Suicide ^ codtl Not be Determined M. Other - Spedfy
33b. Signatu a of Cemfier
33a. Cenifler (cluck Doty one)
• Cenitying physician (Physician cedfiying cause of death when ammer physidan has pronounced death and completed Item 23) ~'' w
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To the best d my knowledge, deem oceuned due to the cause(s) and manner as sgted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• pronouncing aM cerlNying phyalclan (Physician both pronouncag Beam and cenihyirg m cause of deem)
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33c. License Number
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33tl Date Signetl (Monty, day, year)
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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To the beat of my knowledge, deem occurred at the Ume, date, and place, end due to me cause(s) and manrur as atn ~ D U
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• Medcal Examiner 1 Coroner
On tae baste of examinalbn and / ar InveaUgetlon, in my opinion, deem occurred at the ame, date, erM place, end due Lo the cause(s) and manner as stated_ 34. erne and rase of Persm Coco/o/~~teK_d Cause of Death (Item 7) T pe I Prid
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35. Regis) s end D' I~ I / ~ r~l ~ I ~ I 36. Det Filed (M m, day, year)
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RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
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Estate of Mary Patricia Mackin aka Mary P. Mackin , aka M. Patricia Mackin
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Deceased
I, Timothy P. Mackin , in my capacity/relationship as
(Print Name)
an intestate heir
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Charles P. Mackin, Jr.
~ ~
(Date) (Signature)
Executed' in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
(Sheet Address)
Cs~rt' ~s ~ ~~~ ~ ~~ ~/~/c~ 2 ~
(City, Stat , Ztp)
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
purpo es stated within on this ~ day
of __ o~UG~
~'l a 1'tit..ti~YJ i ~
Nota Public 11-I~ ~-'`~
My Commission Expires: ~~,(, ~,L~ti ~~ri ~
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(Signature and Seal of Notary or other ofticial qualitied to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.06
at o~ ~~5~
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND
COUNTY, PENNSYLVANIA
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Estate of Mary Patricia Mackin aka Mary P. Mackin aka M. atr; ci a Mar,k;„ ,Deceased
I, Patricia J. Wilcox
(Print Name)
an intestate heir
in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Charles P. Mackin, Jr.
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(Date)
_J ~,-'
(Signature) ( r
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(Street Address)
(City, State, zip) '
Executed in Register's Office
Sworn to or affirmed and subscribed
before e this ~~-~ day
of ~ / , ~!~
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Deputy for Register of Wills
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that~fitel~r she executed the renunciation for the
purposes stated within on this o7~_ day
of _,
otary Public
My Commission Expires: /p~~r~/apl~
(Signature and Seal of Notary or other official qualitied to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.06