HomeMy WebLinkAbout05-22-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of THOMAS E. MOOD
also known as
Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
COUNTY, PENNSYLVANIA
File Number d~~ ~ V \ ~~~
Social Security Number 206-32-0294
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
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(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 executiorio~the utstrurhent(s) offered
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person: N
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B. Grant of Letters of Administration
(If applicable, enter: c.t.n.; d. b. n. c. t. a.; pendente 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.)
Name Relationshi Residence
ZOE ANN BUHOSKY SISTER 3431 Wilson Ave., Orefiled, PA 18069
WILBERTA E. MOOD SISTER 105 S. 15TH ST., CAMP HILL, PA 17011
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal residence at
770 POPLAR CHURCH ROAD EAST PENNSBORO TOWNSHIP CUMBERLAND COUNTY PENNSYLVANIA
(List street address, town/city, township, county, state, zip code)
Decedent, then 68 years of age, died on MAY 18, 2009
at HOLY SPIRIT HOSPITAL
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:
$ 1,000.00
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
ZOE ANN BUHOSKY, 3431 Wilson Avenue, Orefield, PA 18069
FormRW-02 rev. /0./3.06 Page 1 of
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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 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 ~a day of
or the Register
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Signature of Personal Representative = ~
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Signature of Personal Representative ~
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File Number: ~~ ~~ o~ ~"
Estate of THOMAS E. MOOD
Deceased
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Social Securi Number: 206-32-0294 Date of Death:MAY I8 2009
AND NOW, ~ 2~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, T IS DECRE that Letters ADMINISTRATION
are hereby granted to ZOE ANN BUHOSKY
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of
FEES
...../.,.~ ... $ ~Q
Letters
Short Certificate(s) ..aZ... ~ $
Renunciation(s) ... 1...... $ .~
~ ...$ 5
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~-6:68"'
as the last Fill (and Codicil(s)) o~ D
of Wills
Attorney Signature: Vw` ~-~
Attorney Name: MARIE COYNE
Supreme Court I.D. No.: 53788
Address: 3901 MARKET STREET
CAMP HILL, PA 17011
Telephone: 717-737-0464
Form RW-02 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, 56.00
P 15185619
Certification Number
This is to certify that the informatio^ here given is
correctly copied from an original Certificate of Death
duly tiled with me as Local Regisn-ar. The original
certificate will be forwarded to the State Vital
Records Office tin- permanent filin~~.
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Loco] Registrar r•., Date ]slued
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REV n/zoo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
PRINT IN CERTIFICATE OF DEATH ~ ~ ~~ ~~ ~\
ANENT ~ /Cnc Incfn mftnne and examples on reverse) CTGTF FII F NI IaARFR [w
2. Sex 3. Social Security Number 4. Date of Death (Month, day, year)
1. Name of Decedent (First, middle, last, suXix) `L06 - 32 .~ 0294 May 18, 2009
Thomas E. Mood
ear Under 1 day 6. Dale of Binh (Month, day, year) 7. Binhplace (City and state or forego country) ea. Place of Death (Check onty one)
Under t
y
Other
5. Age (Last Binhtlay)
Hospital:
HoMhs Days wovrs fMnNSS
January 28,1941 Woodbury, N. J. ~j InpaAent ^ ER / Outpatient ^ DOA ^ Nursing Home ^ Residence ^Other 5pecity
68
Yrs
Twp. of Death 6d. FaciAry Name Qf not inslnution, gNe street and number) 9. Was Decadent of Hiepank Origin? No ^Ves 10. Roca: American Indian, Black, WNte, etc.
City
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(If yes, specity Cuban,
Bb. County of beam
CIEllberland East Pennsboro HOl S irit Hos trot Mexican, Pueno Rican, etc.) WLLLte
Decedent's Usual Occ Aar Kintl of wok done du ~ most of wool Nfe. Do not state retlretl 12. Was Decedent ever in the 13. Decedent's Education (Specify Dory hghest grede completed) 14. Marital Status: Marred, Never Married, 16. Surviving Spouse (If wife, give maiden name)
Widowed, Divorced (Spen/y)
11
.
U.S. Armed Fomes? Elementary /Secondary (P12) College (1-4 or 6+)
Kind of Work Kind of Busktess I Industry
Si l
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laboror eon Central Oil ^Yes C~1p 12
16. Decedents Mailing Address (Street, city /town. state, zip code) Decedent's Did Decedent Fy~~+~
Stale Live in a t 7c. U~ Yes, Decedent Lived in ~ ~ 9T1C~ Twp.
Actual Residence 17a
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770 Poplar Church Road +, Township?
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17D. county
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Camp Hill, Pa 17011
16. Father's Nama (First, middle, Ies1, suXix) 19. Homer's Name (FIceL middle. maiden surwme)
Eleanor Manion
R.Fdgar Mood
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s Mailing Address (
20a. Inlormanl's Neme (Type / Prml) 2Ub. Informant
Pa 18069
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3431 Wilson Avenue
Zoe Buhosky
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~remation ^ Donation 21 b. Date of Dispositon (Hoorn, day, year) 21c. Place of Disposition (Nama of certretery, crematory or other place) ltd. Location (City I town, stale. z
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ifi
on
21a. Method of Dispos
^ Burial ^ Removal from 5181e ~! Was Cremation or Donation Authorized ^ ~ Ma 22 2009 Hollis er CYemato Mt Holl Sri s Pa
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es
^ Other - Spectily' i b/ Medical Exemirter I Coroner
~ 22a. ~ re of Fu Service L' 'rig as such) 22b. License Number 22c. Name aM Address of FaciAry
011654-L ers-Hamer Funeral Herne Inc 1903 Market St Hill Pa.17011
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23b. License Number 23c. Date Signed (Month, day, year)
date aM place stated. (Signature and IiAe)
deem occured ar the Ame
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Co ate It s 23ac only when cedihPng 23a. To the best o
physician is not available at Ome of tlealh to
cenily CBUSe of deers
Dale Prorauncetl Oead (Month, day, year) 26. Was Case Relerred to Medical Examiner I Coroner for a Reason Omer than Cremation or Donator?
25
.
2d. Time of Death
Items 24.26 must ce completed by person ) N ^Ves ^ No
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who pronounces death. ~
tions and examples) r Approximate Intarvah Pan IC Enter other ~~p~ tiranl condlfons conlrbuf'no to rleath, 28. Did tobacco Use Comribute to Death?
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CAUSE OF DEATH (See
Item 27. Pan I: Enter the main of event -diseases, injuries, or compllcarpns -mar directly caused me death. DO NOT enter terminal events such as cardiac arrest, Onset to Death but rid resulting In the undenying cause given in Pan I. ^ Yes ^ Probably
~ ^ No ^ Unknown
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respialory artesL or ventricular fibrillation wAhout showing me Niobgy Lisl only one cause on eac
29. If Female
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IMMEDIATE CAUSE IFinal disease or ~~ ~~J7
. ~ 1 ~ ' (~- ~ /~/?~{7 ~.tfr Tti- rte/ ~ ~ ~ ^ Nol pregnant within pass year
m deem)
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Due r (or a consequence op: / ~ ^ Pregnem at time of deem
r ^ No1 pregnant, but pregnant wtlhin 42 days
Sequentialqq Nsl condAions, It any. D. [ / /~ ~ ~~ ~LL't7 /~ c/ /'~~ _~ / ! C'r' 3 r' r
leadmg to dte cause fisted on Gne a.
Enter the UNDERLYING CAUSE Due to (or as a consequence oq: r of death
(disease or ifqury mat inhaled the p, r ^ Nor pregnant, Mil pregnam 43 days l0 1 year
evems esulang m deem) LAST. Due to (or as a consequence of}. i before death
r ^ Unknown if pregnant wimm Ina past year
d.
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Were Autopsy Findings
30b
31. Manner o1 Death 32a. Date of In'u Monet, day, year)
I N ( 32b. Describe How Inryry Occurred 32c. Place of Injury' Home, Farts. Slreel, Factory.
Olfice Building, etc. (SpeciyJ
opsy
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30a. Was an
Penortned? .
Available Poor to Completion ^ Natural ^ homicide
of Cause of beam?
^ Accident ^ Pending Investigation
32tl. Time of Injury ~
32e. Injury a1 Work.
321. If Transpcnation Injury (SpecityJ
g. j ry (Smear, ci I lawn, state
32 Location of In u ry I
^ Yes ^ No ^ Yes ^ No ^ Yes ^ No ^ Driver /Operator ^ Passenger ^Pedesrnan
^ Suicide ^ DWW Not be Delertnined M, aver - Speary:
336. Sgnature TiAe of Certifier
33a. Genstar (check onty one)
• CerlNying physklan (Physician cenilyirg reuse o1 deem when another physician nos pronounced tlealh and competed Item 23) ^
- - - - - - - - - - - - - -
ted
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To the best of my knowledge, death occurred due to the cause(s) and manner as s
aken (Physician bom prorauncing deem arxl cen4yirg to cause W deem)
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^ 33c License t4urnber are SignM (Monet. day, Year)
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• Prorauncing en
To die best of my knowedge, death rx:curtad at the ame, date, and place, and due to ale cause(s) and manner as sated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ / l ;.~ / ~ C~ / ~'
• Medkal Exeminer I Coroner
On lM heels of axaminallat and / a invesagatlon, In my oplnlon, deaM acurted et the tlma, date, and place, and due to the caues(s) and manner es stated_ ^ ..
34 Na ntl Adtlreu of Pe Who Completed Cause o1 Deelh (Item 27) Type /Print
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36 Date Filed (MOMXr~ay, year) ~
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36. Req 's Sigrature and District Number { !~1' I ~ { dl ~ { ~ {
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/ / Disposition Permit No. /`/ r'~ 3 °~J C~
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of THOMAS E. MOOD
I, WILBERTA E. MOOD
(Print Nnme)
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Deceased
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
ZOE ANN BUHOSKY
5/22/2009
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
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(Signature)
105 S. 15TH STREET
(Street Address)
CAMP HILL, PA 17011
(City, Stnte, 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 a2- day
of AItIM Zoo
Deputy for Register of Wills
Nota Public ~
ommission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
ty1ty10N?WEIt_t__~N Of PENN$YtVA~II
Form RW-06 rev. [0.13.06
NI~TAFNAI SEAL
Liss Marie Coyne; Notary Public
Harrapden T~petnahip, Cumberland County
My Contmisaio fi~pirn Jun~'1~'l~~Q13