HomeMy WebLinkAbout05-26-09PETITION FOR PROBATE AND GRANT Off' LETTERS
REGISTER OF ~tiILLS OF
Estate of ~~af~l ~~ / ~ ~Yi{'~~f.J2/1G~~
also known as
Deceased
~_~
al sheets if necessary.
Petitioner(s), who is/are 13 years of age or older, apply(ies) for:
(CO;YIPLETE A' or 'B' BELOIV:)
~A. Probate and Grant of LettgrJs T tamentary~nd aver that Petitioner(s) is /are the
last Will of the Decedent dated ~'I~_ and codicil(s) dated
name~r the
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(State relevant circumstances, e.g., renunciation, death ajexecutor, etc.) ----!~ r ~
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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 the insttm~eat(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: -; c
- ~) - -
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^ B. Grant of Letters of Administration
(ljappiicable, enter: c.t.a.; d. b. n. c.t.a.: pendentelite; durante absentin; durnnte minoritate)
(COrYIPLETEINALL CASES:) Attach
Decedent, then ~ years of age, died on
COL~ITY, PE~~SY"L~-ASIA
File Number a ~ C ~ d~~
Social Security Number /0 ~ _o ~_ l~s`~ ('I
]vania with his /her last principal residence at
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 fol
~~7
,~
i~`7
/~'~ ~/
$ ~/, ADD
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:
I /1 Si;n~,ture /~ _ Twed or printed name and residence I
/J,~7~~~ ~~ , ~ ~
Form RbV-0? rev. ro.l3.06 Page 1 of 2
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: (!f
Administration, c. t. a. or d. b. n. c. t. a., enter dale of Will in Section A above and complete list of heirs.)
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
'~ S S
COWTY OF ~ !`•
'The Petitioner(s) above-Warned swear(s) or affirm(s) that the statements in the foregoing Petition are true 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.
_ vv
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Sworn to or affirmed and subscribed _
Signatur of Personal Re a ntntive -n w:.x+.
before me the ~~ day of - ~ --~.
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Signature of Persons/ Representative ,_ - -
_-~ "-C1
-'i~
the Register Signntxve of Personal Representative _ ~:~ -~ "
'= CeJ
File Number. ~,~ V Cl b~~
Estate of Flrrr~n ~e T~ ~y ~ "'R-~ \~' ""' ,Deceased
Social Security Number: C(1 J ~ 7 U `~ 7 / Date of Death: ~ S ~~/ /Z UU ~/
AND NOW, ~`'u' ~~ / ' t , ~, in consi eration of tl foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREE at Lette s
are hereby granted to l> h I ~ /Gill ~ ~ -t-i'~~
in the above estate
and that the instrument(s) dated ~yG
described in the Petition be admitted to probate and
FEES
Letters ....3,f.,Od~ . . $ 7D
Short Certificate(s) . ~ . ... $ CJ
Renunciation(s) ....... ... $
L~,rf ... $ /S
~~ p ... $
... $
... $
... $
... $
... $
... $
-
TOTAL ........... ... $ 6ZtS
(~
of
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
For~ui R6V-0? rev. 10.13.0( Page 2. Of 2
105.805 REV (01/071
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 15~38~3~1
Certification Number
' This i~ 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
rds Office for manent filing.
~s a ~9
gistrar r-.~ Date Issued
C7 0
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itOS143 REV 112008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS --~
TYPE /PRINT IN
PE&RA1 ~NE~ CERTIFICATE OF DEATH ~ ~
(See instructions and examples on reverse) STATE EILE NUMBER +.3
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t. Name d Decedent (First, midde, Yet, auna) 2. Sea 3. Socal Sec«Ny N«Mer 4. Dale d Deem (MaMh, day, year)
Florence Brinkerhoff Female 183 _ 07 _ 8349 May 19, 2009
5. Age (Lest BidtdaY) IhNw 1 year Under 1 day 6. Date d Bidh (Modh, day, year) 7. &rlhplace (CNy and slate ar casNry) 8a. Place d Deelh (Greek any one)
wnaw Ikea Roue Mva4a ou amp on wp. NospiNl: _ when
94 rrs. 04/16/1915 ranklin Ct.,PA ®1ryreNent ^ER/Outpatient ^DOA ^NursegFiome ^Raidence ^Gher-Spedty:
Bb. County d beam Bc. City. Boor, Twp. d Deem Bd. FacYNy Name (11 not k16611dKK1. give atreM en0 daMar) 9. Wes Decedent d INspedc Origin? ®No ^ Yes 10. Race: Armncen kdan, Black, wnne, ek.
•
Franklin Chambersburg IN yes, spedly Cuban, (Specvy)7
The Chambersburg Hospital Mesirxn,PuenoRicen,mc) White
11. Decedend's Usual Kkd d work done most d Ne. Do iial slab r 12. Was Decedent ever A the 13. Decedent's Educet~ (Spedty any hiphal grade Wlipletetl) 14. Marital Status: Mardeq Never Monied, 18. Survivirg Spouse (II wNe, 9s'e maiden rieme)
Kind d Wok l(ntl d Business / Ndudry U.S. Armed Forces? Elementary /Secondary (0-12) Cdlege (t-4 «Sa) W~~' Divorced (~eob1
Weaver Hoffman Milts ^Yes ®NO 9 Widowed
Is.DeceaenraMaa:rgAam.c: STred,aityrtown,sbb,,yaotle)
23 W. Bard treat Decedenf6 Pennsylvania t~lvem~'M
Aduel Resitlerice i7a. Sbte
17c
^Ye4 Decedan livedm T
Shippensburg, PA 17257 .
wP.
ioanship4
nb.caanty Cumberland t7a.{~7
i"edwnbn Shippensburg
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18. Femer's Name (First, rtedtlb, Iasi, ndla) 19. MdlleYS Name (Pleat, nkdda, riegen sumazne)
Edward Handshaw Florence Cline
20a. Inbrmad's Name (Type / Pmn) 20b. IMomarM6 Meting Adddss (SYael cdY / nwn, stab, zp wde)
Shirley LeDane 216 Kennedy Court, Hanover, PA 17331
21e. Mdhod d DispceNbn ^ Craroaon ^ Donation
! 21b. Date d D'sDOSillon (MOrdh, day, year) 21c. PFace d Dieposiem (Name d ceriwlery, crematory w Omer place) 2 L ion (' / state, zp code)
~lt~ppe~T's°~'ur
17257
® Bunel ^ Remwal~romstab
waCnelallon«DOnatlonAUtllalzed
^ al»r- ~ n+L IExaminer/coroner? ^ya^y~ 5/22/09 Spring Hill Cemetery g,
Cumberland Ct. , PA
22a ' dFureral sacs) 226. Licerwe Number 22c. Name and Address of FedNy FOgelean9er-Bricker Funeral Home, Inc.
- FD-011776-L P.O. Box 336, Shippensburg, PA 17257
CompNte Nana 23aa arty when ceNlyirq 23e. Tome Deal d my knowbdpe, deem accuretl at aw tone, dale end place abled. ( we ant die 23b. lirance NaMer 23c. Date
SI¢b0 (MOdh, day, year)
physidan b not avafiade et are d deem b
ceraryasseddam. ~ R~loOaaGa s~os3g I~
Hama 21-28 moat be b1 pan,on
t
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m 24. tans d
5 h 25. Defy Prmourced dead (MOMh, day, 26. was case Role ed to I E4emmer / Coroner for a Re alter mmi Creration « Daelgn?
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CAUSE OF DEATN (See Inatruetlone end ampka) , Approzknaze'sibrval: Pa II: Enter Omer ' 20. Did Tdtecco Use CaadMe b Death?
Nem 27. Pon L Eder tle dmin d evems - deeae6, inryna, a mripl'ratias-mat dNegty caused die tlalh. W NOT enter brmkNl evenN arch e6 cerdac ertest, s Omd b Deem hd not re6uNrp n the widedykp cease given n Pad I. ^ Yes ^ Probably
raPdl«Y meal, «vedricder Fbdnalbn w8tlod stawkg die e6obgy. ~ only one ease on each kne. '
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IMMEDIATE CAUSE (Final cheese «
corMnidr resugkg n deem)
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.~ a. y~°
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Due m (« a e casequence d): Nd ge¢ud wntin pest year
~Ay Nsl centlniors, n any. b, C a\+YF ~
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Ever gee UNDERLYING CAUSE (r ,, 0~' ` (~ r
~ Nd rd, but pregnad within 42 da
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(disease «mjury met kelieled the c, Ol.~--~ 'C ~ c1 C:
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eveds resdtkg n deem) LAST'
~ d tlaeth
Dce m (or as a censeguence of):
i ^ Nd pregred, but pngrent 43 days to 1 yeaz
d. ~ Ddae tlaeth
^ IANIrIDwn N peprad witlwt the pall year
30e. Was a Adopsy 30b. Were Aubpay Fkdirgs 31. Mazxwr d Deem 32a Dale d mMY (Mmdh, day, year) 3ffi. Describe How Iryury Occurtetl 32c. PFace d Injury: Flume, Farm, Slree4 Fedory,
Perl«med? Available Pda b Cortpblion pt
Ndurel ^ Homicide Office Bdqug, etc. (SµMY)
d Corse d Death? Wl
^ Yes ~No ^ Yea ^ No ^ Accidatl ^ Paring mvestigalion 32tl. Tece d Injury 32e. Iryury at W«k? 321. II Trensportation Irlhsy (Spedly) 32g. Location d Injixy (Sired, dY / bwn, slab)
^ SlXdtle ^ CrANtl Nd be Ddemdred ^ Yes ^ No ^ Driuer / Opedlor ^ Passenger ^PedeMdan
M Gher - Spacily:
33a. CeMbr (daek aMy anal
' CenNying phyakln (Physician cerlityvg cause d deem when endher physidan has prorquncetl de91h and canplded Nam 23) 33b. Sgmlure ant TAk d CedNier ;~^ ^
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TO file best of lm'knowletlge,dam oaumd tlue to the aua(a)aM mercer es ataled_____________._______.____________ vv \
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• Pronounclnp end cenlly4ry phyekbn (Physician both prariarrc4tg death end cedNldtp to cause d deethl
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On tM basis d exeml nd I a MvesligM n my 1 ,dam occurred al the tune, dale, and plere, and due to the ceuae(e) end manner as armed- ^
34. Name and Address d Person WM Cmpkled Cause d Dedh (Hem 27) Type! Prk6
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U Disposition Permit No. O ~ ~ O 33
Last Wi11 and Testament of
Florence H. Brinkerhoff
I, FLORENCE H. BRINKERHOFF, of the Borough of Shippensburg, Cumberland
County, Pennsylvania, being of sound mind and memory declare this to be my Last Will and
Testament and revoke any will or codicil previously made by me.
ITEM I: I direct that all my just debts and funeral expenses, including my gravemarker
and all expenses of my last illness, shall be paid from my residuary estate a~~n as p~ticable..
~~ ~ ,
after my decease as a part of the administration of my estate. ~_'- ~~
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ITEM II: I give, devise and bequeath all of my estate of every nature and wlic~esoever
situate to my daughters, JANET L. TARNER, SHIRLEY A. LEDANE, and CHARLOTTE
E. COMMERER, their heirs and assigns, living on the thirty-first day following my death, in
shares which are to be distributed on a per stirpes basis, share and share alike.
ITEM III: I direct that all taxes that may be assessed in consequence of my
death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary
estate as part of the expenses of the administration of my estate.
ITEM IV: I appoint SHIRLEY A. LEDANE, Executrix of this, my Last Will and
Testament. Should she fail to qualify or cease to act, then I appoint JAMES E. LEDANE,
Executor of this my Last Will and Testament.
ITEM V: I direct that my Executors or their successor shall not be required to give bond
for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and
Testament, written on ~_ sheets of paper, dated this 1~{?~day of May, 2005.
.~
f SAL)
FLORENCE H. BRINKS F
The preceding instrument, consisting of this and 1 other typewritten page(s),
each identified by the signature of the testatrix, FLORENCE H. BRINKERHOFF, was on the
day and date thereof signed, published and declared by FLORENCE H. BRINKERHOFF, the
testatrix herein named, as and for her Last Will, in the presence of us, who, at her request, in her
presence, and in the presence of each other, have subscribed our names as witnesses hereto.
Zg at ~~ ~ c ` f ~~-
1g at `~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
We, FLORENCE H. BRINKERHOFF, the testatrix in, and the undersigned witnesses
to, the will, the attached or foregoing instrument, who have signed the instrument, having been
qualified according to law do depose and say:
(a) that I, the testatrix, do hereby acknowledge that I signed the instrument as
my will, that I signed it willingly and as my free and voluntary act for the
purposes therein expressed; and
(b) that we, the witnesses, were present and saw the testatrix sign and execute
the instrument as her will, that she signed it willingly and 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 a witness and that to the best of our
knowledge the testatrix was at that time 18 or more years of age, of sound mind
and under no constraint or undue influence.
FLORENCE H. BRINKERHOFF
witness
Subscribed to and subscribed or
affirmed and acknowledged before me
by Florence H. Brinkerhoff, the testatrix
and the witnesses whose names are signed above
this ~ day of May, 2005.
Notary Pu is
NOTARIAL SEAL
SIILLYI. wINOER, NOTARY PUBLIC
NMY COMM 3S ON EXPIR S MARCH 6 20U7Y