HomeMy WebLinkAbout06-01-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of ALICE M. HARRIS
also known as
Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
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File Number
Social Security Number 178-16-4575
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the Executor
last Will of the Decedent dated November 19, 1984 and codicil(s) dated N/A
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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 execution ol'ih~riirtstrument~ offered;
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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 liter durante absentia; durantc~»zinorttate/ " ,1
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following sPgusit (if any j ~'d he.ii~: (If
Administration, c.t.a. or d. b. n.c.t.a., enter date of Will in SectionA above and complete list of heirs.) 1' ---
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Name Relationshi Residence
J. Leo Harris Spouse Deceased in 1987
Jane L. Patrick Daughter 2312 Yale Avenue, Camp Hill, PA 17011
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
2143 Yale Avenue Cam Hill PA 17011
(List street address, town city, township, county, state, yip code)
Decedent, then 88 years of age, died on May 20, 2009 at Carolyn Croxton Slane Residence, Susquehanna Township,
Dau hin Coun Penns lvania
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 5,000.00
(Ifnot domiciled in PA) Personal property in Pennsylvania $
(Jf not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 113,660.00
situated as fo
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; { - 12312 Yale Avenue, Camp Hill, PA 17011
CUMBERLAND COUNTY, PENNSYLVANIA
named in the
FormRW-o2 rev.lo.l3.n6 Page 1 oft
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
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.
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Sworn to or affirmed and subscribed `' ~~ _ `~
Signat ~ of Personal Representative ~ _7 `= ~
before me the _~_/dray of
W ~ Signature of Personal Representative ~ ~~-
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(_ _ __._
or the Register Signature of Personal Representative _ ~ ~
File Number: ~ 1 V ~ ~~~~
Estate of ALICE M. HARRIS ,Deceased
Social Security Number: 178-16-4575 Date of Death: May 20, 2009
S r ~' ' ' , ~, in consideration of the foregoing Petition, satisfactory proof
AND NOW,
having been presented before m , IT IS DECREED that Letters Testamentary
are hereby granted to JANE L. PATRICK
in the above estate
and that the instrument(s) dated November 19, 1984
described in the Petition be admitted to probate and filed o
FEES
...l.l. (oC~. $
Letters ~•~• • ~ b
Short Certificate(s)
Renunciation s) .......... $
... $
... $
1' ... $ `~
$
...
... $
$
...
... $
... $
... $
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TOTAL .............. $ ?
Attorney Name: Michael Cherewka
Supreme Court I.D. No.: 35073
Address: 624 North Front Street
Telephone:
Wormleysburg, PA 17043
717-232-4701
Page 2 of 2
Form RW-02 rev. 10.13.06
Attorney ~~gnature:
f'fIS~ i k. P. r. ~.r I
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. 56.00
This is to certify that the i;~formatit>n here ~i~en i~
correctly copied arum an ori~tina] Certificate of Death
duly fined with Ina a~ Loral Re~~istrar. The ori~rinul
certificate will be f~>rwarded to the State Vital
Records Office Tar permanent film ~.
P 151~96~5__
Certification '~'umher
~~
SHOULD RE AS FQLLOWS:
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'~~_~'~~`' -~Y
Local Registrar Date Issued
fEV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
'RIM IN
A"E"T CERTIFICATE OF DEATH
.K INK
(See instructions and examples on reverse) ~...~ ~ 1 ~`1 a ~~
1. Name of Decedent (Bret middle, last, sueix) 2. Sex 3. Soctial Security Number 4. Date of Death (MontR tlay, year)
Alice M. Harris Female / "'r8 - /~ = ~/.5 ~ Ma 20 2009
5. Age (Last Birthday) Under 1 year UrMer 1 day 6. Date of Birth (Month, day, year) 7. BirthpWce (City and stale or loreign country) Ba. Place of Death (Check Doty one)
88 Yrs Months DAYS Haurs MMMea
March 1
6
1921 7,. ~ n
HarrlstXlr
PA Hospital: Other
. , g ~ ^ Inpatient ^ ER /Outpatient ^ DOA Nursing Home ^ Residence ^Other Specity
8b. County of Death &. City, Boro, Twp. of Oeath 6d. FacrPoy Name (II not in5lAWbn, give street aM number
1 9. Was Decetlem of Hispank Odgin? ~] No ^ Vea 10. Race: American Indian, Black, White, att.
Susquehanna Ttap. Dauphin (If yes, specity Cuban, (Speci/y)
Carolyn Croxton Slane Residenace Mexlcan,PuertoRican
ek
)
,
.
White
11. Decetlenys Usual Occu atbn Kind W work done du ~ most of rro ~ life. Do nut slate refired) 12. Was Decedent ever in the 13. Decedent's Educatbn (Spedfy only highest grade completed) 14. Marital Status: Manied, Never Married, 15. Surviving Spouse (II wife. give maiden name)
Kmtl of Work Kind of Business / Indatry
Ii«netnaker Own Hom U.S. Armed Forces? Elem~n'ry /Secondary (012) College (1-4 or 5+) Wbew~• Divorced (Spedly)
e Yaa ^No 1L idowed
16. Decedent's Maikrg Atldress (Street, city /Town, state, zip code) Decedents Did Decedent
2143 Yale Ave Actual Residence 17a. State PA Live in a 17c. ^ yes, Decedent LNed in
Twp
.
Hill PA 17011 .
Township?
17b. County GLimberl arx! , 7d. ~ Na. oeaetlenl uvea wihin
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Aquel Limits of
anID Hl
Ciry / Bom
78. Famer's Name (First, mitltlle, last, nude) 19. Mother's Name (First, middle, maiden wmame)
Frank W. Baker Fhma Miller
20a. Inlormam's Name (T 1 PdnQ •
Jane L
'~atrick n. ~t
lob, Inf 2~t~ 2 ilinYa~e( Ave . t
am
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C,
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ill , PA 17011
21 a. Memod of Disposdion ^ Cremafbn ^ Dmelion 21b. Date of Uspositim (Month, tlay, year) 21c. Place of Disposition (Name of cemetery, crematory a omen place) 21d. Location (Ciry I town
stale
zp code)
Banal ^ Removal Iron Slate ;Was Cremation ar Donation Authorized
^ Other- Spedty i by Medial Examiner/ r? ^Yaa ^ No y 23, 2009
Rolli Green Memorial Park ,
,
Hill PA
22a. gna of F 226. License Number 22c. Name and Address of Facility Myers-Hamer Funeral Home
014819
Complete Items 23ac only wlren ertilying
ptrya fan is not available at time of Beam to fed
23a. Tome best of my krww ge, death attuned at Iha tens, da aM place sated. (Sgnetula antl tltle)
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'^ 23b. License Number 23c. Date Signed (Month, day, year)
cerOhy ease of death
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Items 2426 must be cmpletetl Dy person 24. Time of Death 26. Date P Dead (Month, day, year) 26. Was Case Referred to Medical Examiner /Coroner for a Reason than Crematon or Donation?
wtp pronounces deem. ~ SO A • M. D p p ^ Yes ^ No
CAUSE OF DEATH (See Instructlans antl exam ) r Approxenate interval:
Item 27. Pan I: Enter the chain of events -diseases, injuries, a complicatbns -that directly caused the death. DO NOT r terminal events such as cardiac arrest. r Onset tg Deam Pad IL Enter omen significant condifom confri6ufirw t be m,
bW not resulting in the unbertying rouse given in Pan I. 26. Ditl Tobacco Use Contnbme to DeaN?
^Ves ^ Pro6abty
respiratory anent, a venMadar fibnlladon wilhoW showing the efidogy. List Doty ale cause on each Ime. t
IMMEDIATE CAUSE (Final disease or ,.
r
~}NO ^ Unknown
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candilbn resulting nde~m) // /~ tl ~ ~,~ '~ 29. If Female
Du
e1~o (or as a consequence og: 1
) _ ~ g Not pregnant within pe51 year
/
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Sequemielty Wst cardilkxx;, N any, b. 1, (7 (Vt~.C ~ 1 1 J^Y fl ~~ ~ ~"" i
leading a the ease ksted on lens a. ~ ~p 4~
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^ Pr nant a1 time of death
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Enter the UNDEflLYING CAUSE Due to (or as consequence off: ~ ^ Not pregnant but pregnant within 42 days
(tlsease or injury That aiUatee me
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Q
W death
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evens resudag in deem) LAST. G ( (
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Due to (or as a consequence oft: ,
^ Not pregnant but pregnant 43 days to 1 year
d t
'~ l~1rl tl'f~' ~C~ betas death
^ Unknown if pegnam within the past year
30a. Was an AWOpsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Dale of hryury (MOnm, day, year) 326. Describe How Injury Otuned 32c. Place of Injury. Home, Farm, Street Factory
Performed?
Available Pda tg Completion
^ Natural ^ Hanicide ,
Office Suildmg, etc. (Specityl
of Cause of Death?
^ Yes ^ No ^ Yes ^ No ^ Aardent ^ Pending Investgatpn 32d. Tma of Injury 32e. Injury at Work? 321. II Trenspatason Injury (SpeaiyJ 32g. Location of Injury (Street city /town, slate)
^ Suicide ^ Could Not be Delermirred ^Ves ^ No ^ Dnverl0perator ^ Passenger ^Pedestnan
M ^Otber ~ Specity:
33a. Certifier (check only one) 33b. Siq and Tme 1 Certsar
• Certlfying physician (Physician certitying cause of death when anmher physician has pronounced deem and completed Item 23)
-
To Nre hest of my knowledge, death occurred due to the ease(s) and manner as staterl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• Pronouncing and certltying physician (Physician bom pronouncing death and cartiying to reuse of death)
T
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^ 33c. Licen a Number 33d. Date Signed (Month, day, year)
now
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my
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ea
occure
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me,
e
a
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ace, an
ue to t
e ease(s) and manner as sated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Medical FxamhKr I Coroner ~ '~
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On the basis of examination and / or Investlgatlon, In my opinion, death occurred at the time, date, and place, and due to the ease(s) and manrwr as sated- ^ _
34. Name and Atldress of Person Who Completed Cause of Death (uem 27) Type / Prin
t
35. Registrar's Lure and Dist be~ ~1 /
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36. Date FNed onth, d y, yeart
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,S 3~5~ Market Street
U oiaooeifionPermi,NO 0332526 ~'a^~,~~ N:Il, t':~ 1Tt~~ !
WILL
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ALICE M. HARRIS .~ `''
I, ALICE M. HARRIS, of Camp Hill, Cumberland County, and State of
Pennsylvania, declare this to be my last will and revoke any will
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, and any
and all taxes and assessments imposed by any governmental body as a
result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary estate as soon as
practicable after my decease as a part of the expense of the
administration of my estate.
ITE M II. I give, devise, and bequeath to my husband, J. LEO
HARRIS, all my possessions and estate of every nature and wherever
situate, provided he survives my death by sixty (60) days.
ITEM III. Should my said husband predecease me or be deceased on
the sixty-first day after my death, I give, devise, and bequeath all
of my possessions and estate of every nature and wherever situate to
such of my issue, per stirpes, as survive my death by sixty (60) days.
ITEM IV. I appoint my husband, J. LEO HARRIS, executor of this
my last will. Should my said husband predecease me or otherwise fail
to qualify or cease to serve as executor of this my last will, I
appoint my daughter, JANE L. PATRICK, executrix of this my last will.
ITE M V. I direct that my personal representatives shall not be
1
required to give bond for the faithful performance of their duties in
any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this ~~~~~~ day of ~'1~~-t~=~f~~~~-~^1 , 1984.
~, ,'" `
ALICE M. HARRIS
2
The preceding instrument, consisting of this and TWO other
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typewritten pages, each identified by the signature of the testatrix
was on the date thereof signed, published, and declared by ALICE M.
HARRIS, the testatrix therein 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.
G! ~~ ~--
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3
COMMONWEALTH OF PENNSYLVANIA )
( SS..
COUNTY OF CUMBERLAND )
The undersigned, being the testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, does hereby acknowledge that I signed and executed the
foregoing instrument as my last will, that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes therein
expressed.
[mot -C-t~=--P~ ~~ ~~ t f~' ~ ~. < < tiL
ALICE M. HARRIS
Sworn or affirmed to and acknowledged
before me by the testatrix named above
t h i s j (~ -~;~1 day ~ ~ ~,~Q.~'~,~ , 19 8 4 .
t.~ Public
a.
Notary Publi °s ?^~i~ ' ~~~
COMMONWEALTH OF PENNSYLVANIA )
( SS..
COUNTY OF CUMBERLAND )
WE, GEORGE A. VAUGHN, III, and MICHAEL L. BANGS, the witnesses
whose names are signed to the attached or foregoing instrument, being
duly qualified according to law, do depose and say that we were
present and saw the testatrix sign and execute the instrument as her
last will; that she signed it willingly and that she 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 witnesses; 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.
Sworn or affirmed to and
acknowledged before me this
~~ ~i'1 day of ~.~~+~.rr~~~~ , ~ 984 .
~.ld ;~-I~ h D~
Notary Publi
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